Global climate change: Effects of future temperatures on emergency department visits for mental disorders in Beijing, China.

Rising temperatures can increase the risk of mental disorders. As climate change intensifies, the future disease burden due to mental disorders may be underestimated. Using data on the number of daily emergency department visits for mental disorders at 30 hospitals in Beijing, China during 2016-2018, the relationship between daily mean temperature and such visits was assessed using a quasi-Poisson model integrated with a distributed lag nonlinear model. Emergency department visits for mental disorders attributed to temperature changes were projected using 26 general circulation models under four climate change scenarios. Stratification analyses were then conducted by disease subtype, sex, and age. The results indicate that the temperature-related health burden from mental disorders was projected to increase consistently throughout the 21st century, mainly driven by high temperatures. The future temperature-related health burden was higher for patients with mental disorders due to the use of psychoactive substances and schizophrenia as well as for women and those aged <65 years. These findings enhance our knowledge of how climate change could affect mental well-being and can be used to advance and refine targeted approaches to mitigating and adapting to climate change with a view on addressing mental disorders.

The impact of apparent temperature on the emergency visits for traumatic fractures in Hangzhou, China.

BACKGROUND: Traumatic fractures occur frequently worldwide. However, research remains limited on the association between short-term exposure to temperature and traumatic fractures. This study aims to explore the impact of apparent temperature (AT) on emergency visits (EVs) due to traumatic fractures. METHODS: Based on EVs data for traumatic fractures and the contemporary meteorological data, a generalized Poisson regression model along with a distributed lag nonlinear model (DLNM) were undertaken to determine the impact of AT on traumatic fracture EVs. Subgroup analysis by gender and age and sensitivity analysis were also performed. RESULTS: A total of 25,094 EVs for traumatic fractures were included in the study. We observed a wide "J"-shaped relationship between AT and risk of traumatic fractures, with AT above 9.5 °C positively associated with EVs due to traumatic fractures. The heat effects became significant at cumulative lag 0-11 days, and the relative risk (RR) for moderate heat (95th percentile, 35.7 °C) and extreme heat (99.5th percentile, 38.8 °C) effect was 1.311 (95% CI: 1.132-1.518) and 1.418 (95% CI: 1.191-1.688) at cumulative lag 0-14 days, respectively. The cold effects were consistently non-significant on single or cumulative lag days across 0-14 days. The heat effects were higher among male and those aged 18-65 years old. The sensitivity analysis results remained robust. CONCLUSION: Higher AT is associated with cumulative and delayed higher traumatic fracture EVs. The male and those aged 18-65 years are more susceptible to higher AT.

Long-term follow-up of Janus-kinase inhibitor and novel active disease biomarker in juvenile dermatomyositis.

OBJECTIVE: To evaluate the use of Janus kinase inhibitor (JAKi) in treating JDM and develop cytokine biomarkers of active disease. METHODS: This study involved a retrospective cohort study that evaluated JAKi in 101 JDM patients as well as a cross-sectional study of cytokines in 128 JDM patients and 30 controls between November 2017 and December 2021 in the Affiliated Children's Hospital of Capital Institute of Pediatrics (China). RESULTS: During the median follow-up period of 19 months, 65.5% of the patients had improved rashes, and CAT-BM scores decreased. Overall, 39.6% of JDM patients eliminated glucocorticoids. Muscle strength was improved in all patients who had abnormal muscle strength before JAKi use. Patients and parents provided positive subjective reviews of JAKi, and no serious adverse events were reported. Potential side effects of JAKi included abnormal leukopoenia (14/95) and cough (16/83), which affected over 10% of the JDM patients. In the cytokine analysis, 12/34 cytokines were significantly elevated in active JDM patients. Compared with active JDM patients with multiple phenotypes, active JDM patients with only rashes demonstrated lower cytokine levels. Anti-NXP2-positive active patients had lower cytokine levels compared with those without positive anti-NXP2 antibodies. Among all increased cytokines, IL-1RA changed most dramatically, reaching over 793 times the mean of normal values. We developed a panel composed of six cytokines to differentiate active or stable status in our cohort (area under the curve = 0.8486, P < 0.05). CONCLUSION: The preliminary evidence suggested that JAKi is a relatively safe and effective alternative for JDM patients. Cytokine profiles could well reflect the inflammatory status of JDM patients.

Building a Methodological Foundation for Impactful Urban Planetary Health Science.

Anthropogenic environmental change will heavily impact cities, yet associated health risks will depend significantly on decisions made by urban leaders across a wide range of non-health sectors, including transport, energy, housing, basic urban services, and others. A subset of planetary health researchers focus on understanding the urban health impacts of global environmental change, and how these vary globally and within cities. Such researchers increasingly adopt collaborative transdisciplinary approaches to engage policy-makers, private citizens, and other actors in identifying and evaluating potential policy solutions that will reduce environmental impacts in ways that simultaneously promote health, equity, and/or local economies-in other words, maximising 'co-benefits'. This report presents observations from a participatory workshop focused on challenges and opportunities for urban planetary health research. The workshop, held at the 16th International Conference on Urban Health (ICUH) in Xiamen, China, in November 2019, brought together 49 participants and covered topics related to collaboration, data, and research impact. It featured research projects funded by the Wellcome Trust's Our Planet Our Health (OPOH) programme. This report aims to concisely summarise and disseminate participants' collective contributions to current methodological practice in urban planetary health research.

Climate factors driven typhus group rickettsiosis incidence dynamics in Xishuangbanna Dai autonomous prefecture of Yunnan province in China, 2005-2017.

BACKGROUND: Typhus group rickettsiosis (TGR), which is a neglected vector-borne infectious disease, including epidemic typhus and endemic typhus. We explored the lag effects and nonlinear association between meteorological factors and TGR incidence in Xishuangbanna Dai autonomous prefecture from 2005 to 2017, China. METHODS: A Poisson regression with a distributed lag nonlinear model (DLNM) was utilized to analyze TGR cases data and the contemporaneous meteorological data. RESULTS: A J-shaped nonlinear association between weekly mean temperature and TGR incidence was found. The cumulative exposure to weekly mean temperature indicated that the RR increased with the increment of temperature. Taking the median value as the reference, lower temperatures could decrease the risk of TGR incidence, while higher temperatures could increase the risk of TGR incidence and last for 21 weeks. We also found a reversed U-shaped nonlinear association between weekly mean precipitation and TGR incidence. Precipitation between 5 mm and 13 mm could increase the risk of TGR incidence. Taking the median value as the reference, no precipitation and lower precipitation could decrease the risk of TGR incidence, while higher precipitation could increase the risk of TGR incidence and last for 18 weeks. CONCLUSIONS: The prevention and control measures of TGR should be implemented according to climatic conditions by the local government and health departments in order to improve the efficiency.

[Preliminary estimating the burden of foodborne acute gastrointestinal illness in Beijing City].

OBJECTIVE: To estimate the burden of foodborne acute gastrointestinal illness(AGI) in community residents, and to provide the basis for prevention and control of foodborne diseases. METHODS: Muli-stage stratified random cluster sampling was used to select samples in community population. A retrospective cross-sectional face-to-face household interviews were conducted over a 12-month period. Respondents were asked questions about vomiting and diarrhea within the 28 days prior to the interviews, healthcare seeking behavior and the related cost due to AGI. RESULTS: There were 0. 15(95%CI 0. 13-0. 16)AGI episodes per person-year, foodboren infection resulted in 911975 AGI cases. About 290 190 cases sought healthcare, resulting in 9120 hospitallizations. The overall economic burden of foodborne AGI was 147 million Yuan per year, accounting for 0. 07᾿of the GDP. The direct cost of medical care was 107 million Yuan(medical costs and non-medical cost were 9. 4 million and 1. 2 million), and the direct cost was 4 million Yuan. CONCLUSION: The burden of foodborne AGI in Beijing should not be ignored. It is necessary to improve the foodborne disease surveillance system to more accurately assess the impact of foodborne disease on society and health.

[Research Advances on Distribution Characteristics of and Factors Associated with Fecal Contamination by Definitive Hosts of Echinococcus spp.].

Echinococcosis is a severe zoonotic parasitic disease caused by larvae of Echinococcus spp.. Fecal contamination by definitive hosts of Echinococcus is the major cause of echinococcosis transmission. It is therefore of great significance to estimate the level of fecal contamination by the definitive hosts and develop prevention and control strategies. This article gives an overview on distribution characteristics of, and factors associated with fecal contamination by definitive hosts of Echinococcus.

[Cost Analysis of Dog Deworming in Echinococcosis Control Program in Daofu，Sichuan Province].

Objective: To estimate the cost of dog deworming in Daofu, Sichuan Province and analyze the factors influencing the cost, in order to provide a scientific basis for the investment for echinococcosis control. Methods: Thirty villages were randomly selected in Daofu, Sichuan Province in November 2015, according to the proportion of agricultural and pastoral areas. Data concerning the cost during each step of dog deworming were collected. The unit cost was estimated, the cost composition in each step, element, and institution were described, and the main cost-influencing factors were analyzed using the linear regression method. Results: The mean cost of dog deworming in the 30 surveyed villages was 3.76 yuan/dog-times, comprising drug cost of 0.38 yuan/dog-times, bait cost of 0.37 yuan/dog-times, drug delivery cost of 0.09 yuan/dog-times, mobilization cost of 0.19 yuan/dog-times, household deworming cost of 2.05 yuan/dog-times, faeces disposal cost of 0.35 yuan/dog-times, training cost of 0.29 yuan/dog-times, and supervision cost of 0.04 yuan/dog-times. Among the deworming steps, household deworming cost occupied the most （2.05 yuan/dog-times）; among the cost elements, labour cost had the highest proportion （2.55 yuan/dog-times）; among the different-leveled institutions, village-level cost was the most important part（2.82 yuan/dog-times）. Linear regression analysis revealed that the type of production and the distance among households were the major influencing factors. The labour price was the most sensitive factor for cost-estimation in the dog deworming activities. Conclusion: The labor cost of dog deworming is very high. Governments should increase investment according to local situations.

[Dog Fecal Contamination by Echinococcus in Cuomei County of Tibet in 2015].

Objective: To understand dog fecal contamination by Echinococcus in Lhoka Prefecture of Tibet and provide basis for development of prevention and control strategies. Methods: Survey spots were sampled around the Zhegu Village of Zhegu Town in Cuomei County of Tibet using the mechanical sampling method in May, 2015. The positions of spots, amount of dog feces, types of camps, pastures, terrains, vegetations and land cover, as well as information concerning the existence of household garbage, were recorded. The linear distance from survey spot to the center of the village was calculated. Dog feces were sampled in survey spot and examined the copro-antigen for Echinococcus contamination by ELISA. The distribution characteristics of fecal contamination were analyzed by chi-square test, Fisher's exact test, Kruskal-Wallis test and Nemenyi test. Results: Seventy-nine survey spots were selected for sampling. A total of 226 feces samples were obtained in 37 of the spots. ELISA results showed that the copro-antigen positive rate was 23.9%（54/226）, the averaged density of feces and the averaged density of positive feces were 0.317 9/100 m2 and 0.075 9/100 m2, with a maximum of 2.555 6/100 m2 and 0.555 6/100 m2 respectively. The density of feces and the density of positive feces were both higher in summer camps（0.601 9/100 m2 and 0.157 4/100 m2 respectively） than in non-camps（0.170 2/100 m2 and 0.033 1/100 m2）（χ2=18.248 4，P<0.01；χ2=15.274 3，P<0.01）. In addition, the density of feces and the density of positive feces were both higher in survey spots with household garbage（0.679 0/100 m2, 0.177 0/100 m2） than in those without household garbage （0.130 3/100 m2 and 0.023 5/100 m2）（χ2=34.634 7，P<0.01；χ2=26.109 1，P<0.01）; as well as higher in survey spots ≥10 km from the center of the village（0.403 7/100 m2, 0.107 4/100 m2） than in those <10 km（0.265 3/100 m2, 0.056 7/100 m2）（χ2=4.432 7，P<0.05；χ2=4.045 5，P<0.05）. Conclusion: The Cuomei County of Tibet is facing a serious situation of dog fecal contamination by Echinococcus. Summer camps, areas with household garbage, and districts with a ≥10 km linear distance from the village center may provide reference for determining the regions for hydatidosis prevention and control.

Pathogenic Surveillance of Foodborne Illness-Related Diarrhea - Beijing Municipality, China, 2013-2023.

What is already known about this topic?: Foodborne diseases present a significant public health concern, particularly in China, where they represent a significant food safety challenge. Currently, there is a need for a thorough and systematic analysis of the extended epidemiological patterns of foodborne diseases in Beijing Municipality. What is added by this report?: Monitoring results show that Norovirus and diarrheagenic Escherichia coli (DEC) are the most commonly identified foodborne diarrheal pathogens. Individuals aged 19-30 are at a higher risk of foodborne diarrhea in Beijing, with Salmonella infection being associated with fever symptoms. What are the implications for public health practice?: This study analyzes 11 years of consecutive monitoring data to enhance understanding of the epidemiological and clinical features of foodborne diarrhea in Beijing. It aims to identify high-risk populations, assist in clinical pathogen identification and treatment, and support the development of tailored preventive strategies.

Risk factors associated with food consumption and food-handling habits for sporadic listeriosis: a case-control study in China from 2013 to 2022.

The prevalence of listeriosis in China has been increasing in recent years. Listeriosis primarily spreads through contaminated food. However, the resilient causative organism, Listeria monocytogenes, and its extended incubation period pose challenges in identifying risk factors associated with food consumption and food-handling habits. This study aimed to identify the risk factors associated with food consumption and food-handling habits for listeriosis in China. A matched case-control study (1:1 ratio) was conducted, which enrolled all eligible cases of listeriosis between 1 January 2013 and 31 December 2022 in China. Basic information and possible risk factors associated with food consumption and food-handling habits were collected. Overall, 359 patients were enrolled, including 208 perinatal and 151 non-perinatal cases. Univariate and multivariable logistic analyzes were performed for the perinatal group. For the perinatal and non-perinatal groups, ice cream and Chinese cold dishes were the high-risk foods for listeriosis (odds ratio (OR) 2.09 95% confidence interval (CI): 1.23-3.55; OR 3.17 95% CI: 1.29-7.81), respectively; consumption of leftovers and pet ownership were the high-risk food-handling habits (OR 1.92 95% CI: 1.03-3.59; OR 3.00 95% CI: 1.11-8.11), respectively. In both groups, separation of raw and cooked foods was a protective factor (OR 0.27 95% CI: 0.14-0.51; OR 0.35 95% CI: 0.14-0.89), while refrigerator cleaning reduced the infection risk by 64.94-70.41% only in the perinatal group. The identification of high-risk foods and food-handling habits for listeriosis is important for improving food safety guidelines for vulnerable populations.

Association of Daytime-Only, Nighttime-Only, and Compound Heat Waves With Preterm Birth by Urban-Rural Area and Regional Socioeconomic Status in China.

Importance: Associations between heat waves and preterm birth (PTB) have been reported. However, associations of daytime-only, nighttime-only, and compound heat waves with PTB have yet to be explored at a national level. Furthermore, possible heterogeneity across urban-rural communities with different socioeconomic statuses needs to be explored. Objective: To examine the association between daytime-only, nighttime-only, and compound heat waves and PTB in China and to find variations between urban and rural regions. Design, Setting, and Participants: This case-crossover study used nationwide representative birth data between January 1, 2012, and December 31, 2019, from China's National Maternal Near Miss Surveillance System. This multisite study covered 30 provinces in China and ensured the representation of urban and rural populations across 3 socioeconomic regions. Singleton live births delivered in the warm seasons from April to October during the study period were included. Exclusion criteria consisted of gestational age younger than 20 or older than 45 weeks, maternal ages younger than 13 or older than 50 years, conception dates earlier than 20 weeks before January 1, 2012, and later than 45 weeks before December 31, 2019, and an inconsistent combination of birthweight and gestational age according to growth standard curves of Chinese newborns. Data were analyzed from September 10, 2021, to April 25, 2023. Exposures: Eighteen definitions of heat waves by 3 distinct types, including daytime only (only daily maximum temperature exceeds thresholds), nighttime only (only daily minimum temperature exceeds thresholds), and compound (both daily maximum and minimum temperature exceeds thresholds) heat waves, and 6 indexes, including 75th percentile of daily temperature thresholds for 2 or more (75th-D2), 3 or more (75th-D3), or 4 or more (75th-D4) consecutive days and 90th percentile of daily temperature thresholds for 2 or more (90th-D2), 3 or more (90th-D3), and 4 or more (90th-D4) consecutive days. Main Outcomes and Measures: Preterm births with less than 37 completed weeks of gestation. Results: Among the 5 446 088 singleton births in the final analytic sample (maternal mean [SD] age, 28.8 [4.8] years), 310 384 were PTBs (maternal mean [SD] age, 29.5 [5.5] years). Compared with unexposed women, exposure of pregnant women to compound heat waves in the last week before delivery was associated with higher risk for PTB, with the adjusted odds ratios (AORs) ranging from 1.02 (95% CI, 1.00-1.03) to 1.04 (95% CI, 1.01-1.07) in 6 indexes. For daytime-only heat wave exposures, AORs ranged from 1.03 (95% CI, 1.01-1.05) to 1.04 (95% CI, 1.01-1.08) in the 75th-D4, 90th-D2, 90th-D3, and 90th-D4 indexes. Such associations varied by rural (AOR range, 1.05 [95% CI, 1.01-1.09] to 1.09 [95% CI, 1.04-1.14]) and urban (AOR range, 1.00 [95% CI, 0.98-1.02] to 1.01 [95% CI, 0.99-1.04]) regions during exposure to daytime-only heat waves in the 75th-D3 and 90th-D3 indexes. Conclusions and Relevance: In this case-crossover study, exposure to compound and daytime-only heat waves in the last week before delivery were associated with PTB, particularly for pregnant women in rural regions exposed to daytime-only heat waves. These findings suggest that tailored urban-rural preventive measures may improve maternal health in the context of climate change.

Short-term effect of apparent temperature on daily hospitalizations for osteoporotic fractures in Beijing, China: A retrospective observational study.

BACKGROUND: Studies on the associations between temperature and osteoporotic fractures (OF) hospitalizations are limited. This study aimed to assess the short-term effect of apparent temperature (AT) on the risk of OF hospitalizations. METHODS: This retrospective observational study was conducted in Beijing Jishuitan Hospital from 2004 to 2021. Daily OF hospitalizations, meteorological variables and fine particulate matter were collected. A Poisson generalized linear regression model combined with a distributed lag non-linear model was applied to analyze the lag-exposure-response relationship between AT and the number of OF hospitalizations. Subgroup analysis by gender, age and fracture type was also conducted. RESULTS: Total daily hospitalization visits for OF during the studied period were 35,595. The exposure-response curve of AT and OF presented a non-linear relationship, with optimum apparent temperature (OAT) at 28.40 °C. Taking OAT as the reference, the cold effect (-10.58 °C, 2.5th percentage) on single lag day had statistical significance from the current day of exposure (RR = 1.18, 95 % CI: 1.08-1.28) to lag 4 day (RR = 1.04, 95 % CI: 1.01-1.08), while the cumulative cold effect increased the risk of OF hospitalization visits from lag 0 to 14 days, with the maximum RR over lag 0-14 days (RR = 1.84, 95 % CI: 1.21-2.79). There were no significant risks of OF hospitalizations for warm effects (32.53 °C, 97.5th percentage) on single or cumulative lag days. The cold effect might be more evident among females, patients aged 80 years or older, and patients with hip fractures. CONCLUSION: Exposure to cold temperatures is associated with an increased risk of OF hospitalizations. Females, patients aged 80 years or older and patients with hip fractures might be more vulnerable to the cold effect of AT.

Genomic Insights into the Increased Occurrence of Campylobacteriosis Caused by Antimicrobial-Resistant Campylobacter coli.

Campylobacter is the leading bacterial cause of diarrheal illnesses worldwide. Campylobacter jejuni and C. coli are the most common species accounting for campylobacteriosis. Although the proportion of campylobacteriosis caused by C. coli is increasing rapidly in China, the underlying mechanisms of this emergence remain unclear. In this study, we analyzed the whole-genome sequences and associated environments of 1,195 C. coli isolates with human, poultry, or porcine origins from 1980 to 2021. C. coli isolates of human origin were closely related to those from poultry, suggesting that poultry was the main source of C. coli infection in humans. Analysis of antimicrobial resistance determinants indicated that the prevalence of multidrug-resistant C. coli has increased dramatically since the 2010s, coinciding with the shift in abundance from C. jejuni to C. coli in Chinese poultry. Compared with C. jejuni, drug-resistant C. coli strains were better adapted and showed increased proliferation in the poultry production environment, where multiple antimicrobial agents were frequently used. This study provides an empirical basis for the molecular mechanisms that have enabled C. coli to become the dominant Campylobacter species in poultry; we also emphasize the importance of poultry products as sources of campylobacteriosis caused by C. coli in human patients. IMPORTANCE The proportion of campylobacteriosis caused by C. coli is increasing rapidly in China. Coincidentally, the dominant species of Campylobacter occurring in poultry products has shifted from C. jejuni to C. coli. Here, we analyzed the whole-genome sequences of 1,195 C. coli isolates from different origins. The phylogenetic relationship among C. coli isolates suggests that poultry was the main source of C. coli infection in humans. Further analysis indicated that antimicrobial resistance in C. coli strains has increased dramatically since the 2010s, which could facilitate their adaptation in the poultry production environment, where multiple antimicrobial agents are frequently used. Thus, our findings suggest that the judicious use of antimicrobial agents could mitigate the emergence of multidrug-resistant C. coli strains and enhance clinical outcomes by restoring drug sensitivity in Campylobacter.

Genomic Characterization of Clinical Listeria monocytogenes Isolates in Beijing, China.

Listeria monocytogenes is a foodborne human pathogen that affects public health worldwide. Whole-genome sequencing (WGS) can classify L. monocytogenes isolates and identify virulence islands and resistance genes potentially influencing infectivity. Herein, WGS was used to assess 151 L. monocytogenes isolates from 120 cases of clinical infection in Beijing, China, between 2014 and 2018. Most isolates were either serogroup 1/2a,3a or serogroup 1/2b,3b,7, with 25 multilocus sequence typing (MLST) types (STs) represented, of which ST8, ST87, and ST5 were the most common. Core-genome MLST (cgMLST) grouped the 151 isolates into 116 cgMLST types. The discriminatory power of cgMLST was greater than other subtypes, revealing that isolates from the same patient were highly related (only differing at one allele). Eighty-six isolates formed 30 complexes with ≤ 7 cgMLST alleles between neighboring isolates, suggesting possible outbreaks. Compared with isolates in the United States, ST8, ST121, ST619, ST87, and ST155 isolates were grouped into unified clades. All 151 isolates were positive for common virulence-associated loci, and 26 lineage I isolates harbored the pathogenicity island 3 (LIPI-3) locus, while 42 lineage I isolates harbored the complete LIPI-4 locus. Eleven ST619 isolates had both LIPI-3 and LIPI-4. Among the 151 isolates, 13 were resistant to at least one antibiotic, and no multidrug-resistant isolates were identified. Resistance phenotypes correlated with genotypes, apart from two meropenem resistance isolates. The findings provided insight into the nature of L. monocytogenes strains currently causing clinical disease in Beijing, and WGS analysis indicated possible outbreaks.

A Systematic Review of the Development and Validation of the Heat Vulnerability Index: Major Factors, Methods, and Spatial Units.

PURPOSE OF REVIEW: This review aims to identify the key factors, methods, and spatial units used in the development and validation of the heat vulnerability index (HVI) and discuss the underlying limitations of the data and methods by evaluating the performance of the HVI. RECENT FINDINGS: Thirteen studies characterizing the factors of the HVI development and relating the index with validation data were identified. Five types of factors (i.e., hazard exposure, demographic characteristics, socioeconomic conditions, built environment, and underlying health) of the HVI development were identified, and the top five were social cohesion, race, and/or ethnicity, landscape, age, and economic status. The principal component analysis/factor analysis (PCA/FA) was often used in index development, and four types of spatial units (i.e., census tracts, administrative area, postal code, grid) were used for establishing the relationship between factors and the HVI. Moreover, although most studies showed that a higher HVI was often associated with the increase in health risk, the strength of the relationship was weak. SUMMARY: This review provides a retrospect of the major factors, methods, and spatial units used in development and validation of the HVI and helps to define the framework for future studies. In the future, more information on the hazard exposure, underlying health, governance, and protection awareness should be considered in the HVI development, and the duration and location of validation data should be strengthened to verify the reliability of HVI. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40641-021-00173-3.

Evidence-informed urban health and sustainability governance in two Chinese cities.

Sustainable development is best supported by intersectoral policies informed by a range of evidence and knowledge types (e.g. scientific and lay). Given China's rapid urbanisation, scale and global importance in climate mitigation, this study investigates how evidence is perceived and used to inform urban health and sustainability policies at central and local levels. Well-informed senior professionals in government/scientific agencies (12 in Beijing and 11 in Ningbo) were interviewed. A thematic analysis is presented using deductive and inductive coding. Government agency participants described formal remits and processes determining the scope and use of evidence by different tiers of government. Academic evidence was influential when commissioned by government departments. Public opinion and economic priorities were two factors that also influenced the use or weight of evidence in policymaking. This study shows that scientific evidence produced or commissioned by government was routinely used to inform urban health and sustainability policy. Extensive and routine data collection is regularly used to inform cyclical policy processes, which improves adaptive capacity. This study contributes to knowledge on the 'cultures of evidence use'. Environmental governance can be further improved through increased data-sharing and use of diverse knowledge types.

Ambient air pollution and low temperature associated with case fatality of COVID-19: A nationwide retrospective cohort study in China.

The evidence for the effects of environmental factors on COVID-19 case fatality remains controversial, and it is crucial to understand the role of preventable environmental factors in driving COVID-19 fatality. We thus conducted a nationwide cohort study to estimate the effects of environmental factors (temperature, particulate matter [PM2.5, PM10], sulfur dioxide [SO2], nitrogen dioxide [NO2], and ozone [O3]) on COVID-19 case fatality. A total of 71,808 confirmed COVID-19 cases were identified and followed up for their vital status through April 25, 2020. Exposures to ambient air pollution and temperature were estimated by linking the city- and county-level monitoring data to the residential community of each participant. For each participant, two windows were defined: the period from symptom onset to diagnosis (exposure window I) and the period from diagnosis date to date of death/recovery or end of the study period (exposure window II). Cox proportional hazards models were used to estimate the associations between these environmental factors and COVID-19 case fatality. COVID-19 case fatality increased in association with environmental factors for the two exposure windows. For example, each 10 µg/m3 increase in PM2.5, PM10, O3, and NO2 in window I was associated with a hazard ratio of 1.11 (95% CI 1.09, 1.13), 1.10 (95% CI 1.08, 1.13), 1.09 (95 CI 1.03, 1.14), and 1.27 (95% CI 1.19, 1.35) for COVID-19 fatality, respectively. A significant effect was also observed for low temperature, with a hazard ratio of 1.03 (95% CI 1.01, 1.04) for COVID-19 case fatality per 1°C decrease. Subgroup analysis indicated that these effects were stronger in the elderly, as well as in those with mild symptoms and living in Wuhan or Hubei. Overall, the sensitivity analyses also yielded consistent estimates. Short-term exposure to ambient air pollution and low temperature during the illness would play a nonnegligible part in causing case fatality due to COVID-19. Reduced exposures to high concentrations of PM2.5, PM10, O3, SO2, and NO2 and low temperature would help improve the prognosis and reduce public health burden.

Developing a programme theory for a transdisciplinary research collaboration: Complex Urban Systems for Sustainability and Health.

Background: Environmental improvement is a priority for urban sustainability and health and achieving it requires transformative change in cities. An approach to achieving such change is to bring together researchers, decision-makers, and public groups in the creation of research and use of scientific evidence. Methods: This article describes the development of a programme theory for Complex Urban Systems for Sustainability and Health (CUSSH), a four-year Wellcome-funded research collaboration which aims to improve capacity to guide transformational health and environmental changes in cities. Results: Drawing on ideas about complex systems, programme evaluation, and transdisciplinary learning, we describe how the programme is understood to "work" in terms of its anticipated processes and resulting changes. The programme theory describes a chain of outputs that ultimately leads to improvement in city sustainability and health (described in an 'action model'), and the kinds of changes that we expect CUSSH should lead to in people, processes, policies, practices, and research (described in a 'change model'). Conclusions: Our paper adds to a growing body of research on the process of developing a comprehensive understanding of a transdisciplinary, multiagency, multi-context programme. The programme theory was developed collaboratively over two years. It involved a participatory process to ensure that a broad range of perspectives were included, to contribute to shared understanding across a multidisciplinary team. Examining our approach allowed an appreciation of the benefits and challenges of developing a programme theory for a complex, transdisciplinary research collaboration. Benefits included the development of teamworking and shared understanding and the use of programme theory in guiding evaluation. Challenges included changing membership within a large group, reaching agreement on what the theory would be 'about', and the inherent unpredictability of complex initiatives.