The high sodium condiments and pre-packaged food should be the focus of dietary sodium control in the adult Shanghai population

Background

Long-term, excessively high sodium consumption can lead to increased blood pressure, which is a major risk factor for cardiovascular disease. Therefore, we aimed to analyze the dietary sodium intake and food sources to understand the epidemiological characteristics associated with potentially influencing variables in adults from Shanghai.

Methods

Residents aged 15 years and above were randomly selected using multi-stage stratified random sampling in Shanghai. Over 3 days, family condiments were weighed for each 24-h day, and recall surveys were conducted for the same timeframe regarding sodium intake during the spring, summer, autumn, and winter seasons.

Results

The median sodium intake for residents aged 15 years and above was 4.3 g/d in Shanghai, where 55.1% was obtained from cooking salt, 13.2% from sodium condiments, and 22.2% from pre-packaged food. There were no significant differences in total sodium intake or main sources of sodium intake between different seasons. The sodium intake of rural residents > suburban residents > urban residents (P < 0.05). The logistic regression demonstrated that compared to the rural, the people living in urban and suburban consumed less sodium. Compared to the 18–44, the people aged 45–59 and ≥ 60 consumed more sodium (P < 0.05).

Conclusions

Sodium intake is high in Shanghai. The absolute amount of cooking salt is low in Shanghai, and the possibility of further reduction is very little under the existing dietary habit. Limiting high sodium condiments and pre-packaged food is the new key to controlling salt intake in the future.

High Resolution On-Road Air Pollution Using a Large Taxi-Based Mobile Sensor Network

Traffic-related air pollution (TRAP) was monitored using a mobile sensor network on 125 urban taxis in Shanghai (November 2019/December 2020), which provide real-time patterns of air pollution at high spatial resolution. Each device determined concentrations of carbon monoxide (CO), nitrogen dioxide (NO₂), and PM_2.5, which characterised spatial and temporal patterns of on-road pollutants. A total of 80% road coverage (motorways, trunk, primary, and secondary roads) required 80-100 taxis, but only 25 on trunk roads. Higher CO concentrations were observed in the urban centre, NO₂ higher in motorway concentrations, and PM_2.5 lower in the west away from the city centre. During the COVID-19 lockdown, concentrations of CO, NO₂, and PM_2.5 in Shanghai decreased by 32, 31 and 41%, compared with the previous period. Local contribution related to traffic emissions changed slightly before and after COVID-19 restrictions, while changing background contributions relate to seasonal variation. Mobile networks are a real-time tool for air quality monitoring, with high spatial resolution (~200 m) and robust against the loss of individual devices.

Influences of Land Policy on Urban Ecological Corridors Governance: A Case Study from Shanghai

The analysis of land use change (LUC) characteristics and the impact of policies related to urban ecological space is required to improve spatial planning and to support decision making regarding green infrastructure (GI) investment. This study employed Geo-informatic Tupu analysis and Fluctuation Potential Tupu analysis methods to analyze the characteristics of LUC in an urban ecological corridor (EC). To help understand the influence of land use policy on GI governance and support the optimization of spatial planning, we proposed a situation-structure-implementation-outcome (SSIO) policy cascade analysis framework. SSIO takes "place" as its starting point, then couples the local policy with the governance structure to promote the sustainability of urban commons governance. The results show that the land use type within an EC in the city is mainly cultivated land. However, between 2009 and 2019, cultivated land, construction land, and facility agricultural land all showed a decreasing trend, while forest land and garden land types underwent increasing trends. The LUC Tupu unit highlights the transition from cultivated land to forest land. Forest land has the greatest increase in area and accounts for 52.34% of the area of increasing land use. Cultivated land shows the greatest decrease in area and accounts for 70.30% of the area of decreasing trends. Based on the local policy situation of the metropolis, a land policy governance mechanism can be constructed by the establishment of a governance structure with local government as the core, using land consolidation as the platform, taking ecological spatial planning and inefficient construction land reduction as typical policy tools, and experimentally integrating the concept of Nature-based Solutions (NbS). In general, these findings may be applicable to other rapidly urbanizing cities around the world that are developing complex land use policies for ecological space governance.

[Spatial characteristics and source apportionment of urban environmental black carbon concentrations based on mobile monitoring]

Black carbon (BC) is an important component of airborne fine particulate matter, with significant impacts on global climate change and human health. Taking Minhang District of Shanghai as the study area, a microaethalometer (MA200) and GPS were installed on the electric taxi to form a mobile observation platform to identify the spatial distribution and hot spots of atmospheric BC in urban environment. We analyzed the sources and influencing factors of BC. The results showed that the overall characteristics of the spatial distribution pattern of near surface atmospheric BC in Minhang District of Shanghai were high in the north and low in the south. The average BC concentration was (4.11±4.87) μg·m^-3. The average concentrations of BC in working days and non-working days were (4.22±1.49) and (3.52±2.26) μg·m^-3. The variability of BC concentration in the high value area was large, indicating that the increases of BC concentration in mobile observation were related to traffic accidents in the road section. In addition to human activities, large-scale dense vegetation might inhibit BC diffusion. The Absorption ngström Exponent (AAE) was (0.82±0.54), which was closer to that of fossil fuel combustion. The contributions of fossil fuel emissions, biomass combustion, and mixed sources to BC sources were 67.5%, 4.9% and 27.6%, respectively.

A unified empirical modeling approach for particulate matter and NO2 in a coastal city in China

Modeling air pollutants on a fine spatiotemporal scale is necessary for health studies that focus on critical short-term exposure windows. A unified empirical modeling approach is useful for health studies; however, it is unclear whether this approach can be used in a coastal city for air pollutants driven by local emissions and regional meteorological factors. An advanced empirical modeling approach was used to develop exposure models from October 2012 to December 2019, for particulate matter with aerodynamic diameters less than or equal to 2.5 and 10 μm (PM_2.5 and PM₁₀) and nitrogen dioxide (NO₂) in the coastal city of Shanghai, China. Air pollutant concentrations were obtained from daily measurements at 55 administrative monitoring sites that were integrated into three-day average concentrations. Data on a large array of geographic variables were collected, and their dimensions were reduced using the partial least squares regression method. A geostatistical model using the land-use regression approach in a universal kriging framework was developed to estimate short-term exposure concentrations. The prediction ability of the models were determined by leave-one (site)-out cross-validation (LOOCV) and external validation (EV). Compared to the LOOCV results, the EV results for PM_2.5 and PM₁₀ were consistently reliable, but the EV for NO₂ had a larger root mean squared error. The temporal random effects involved in the model structure were interpreted using sensitivity analyses. This affected the short-term PM_2.5 and PM₁₀ model predictions. This unified empirical modeling approach was successfully used for particulate matter in Shanghai, where air pollution is affected by complex regional and meteorological conditions. These exposure models are going to be applied for making exposure predictions at residential locations for short-term exposure predictions in the "Growth trajectories and air pollution" (GAAP) study in Shanghai that focuses on maternal and early life exposure to air pollutants.

Incidence, Mortality Features and Lifetime Risk Estimation of Digestive Tract Cancers in an Urban District of Shanghai, China

Digestive tract cancers are the common cause of cancer deaths in both China and worldwide. This study aimed to describe the burden, recent trends and lifetime risks in the incidence and mortality of digestive tract cancers in an urban district of Shanghai, China. Our study extracted data on stomach, colon, rectum and liver cancers diagnosed in Changning District between 2010 and 2019 from the Shanghai Cancer Registry. We calculated age-standardized incidence and mortality rates, the risks of developing and dying from cancer, and the estimated annual percent changes. Between 2010 and 2019, 8619 new cases and 5775 deaths were registered with digestive tract cancers in the district. The age-standardized incidence rates (ASIRs) of liver cancer decreased steadily, whereas the ASIRs of stomach, colon and rectum cancers remained stable from 2010 to 2019. The age-standardized mortality rates (ASMRs) of stomach and liver cancers showed significant declining changes from 2010 to 2019 in both sexes, but that of colon and rectum cancers remained stable during the entire period. The risks of developing and dying from digestive tract cancers were substantially higher in men than women. The burden of digestive tract cancer and its disparities between sex and age group remain major public health challenges in urban Shanghai. To reduce the burden of digestive tract cancers, the government and researchers should develop and promote a healthy diet, organize a screening, and reduce the prevalence of smoking, alcohol drinking, and hepatitis B virus and hepatitis C virus infections.

Epidemiological Characteristics of Patients Operated for Achilles Tendon Rupture in Shanghai

Objective

To reflect the potential epidemiological characteristics of Achilles tendon (AT) rupture in Shanghai, China, which has been rarely reported before.

Methods

This work is a descriptive epidemiology study. A total of 302 cases of AT rupture admitted to our department between 01/2013 and 02/2020 are analyzed according to telephone follow‐up and medical records. Male to female ratio is 10.3 and the average age is 37.5 years. The record of each case includes age, gender, Body mass index (BMI), quinolone use, corticoid exposure and related medical history/comorbidities. If the case is sports‐related (SR), details including kind of sports, intensity of exercise, exercise time before rupture, specific action that causes rupture and situation of warm‐up are collected. Two independent sample t‐tests and Pearson chi‐square tests are used for statistical analysis.

Results

A total of 252 ruptures are SR. Male to female ratio is 15.6 in SR cases. Most SR ruptures occur in patients aged 25–39 years. Ball games are major sports responsible for rupture: basketball in 95 (37.7%), badminton in 68 (27.0%) and soccer in 62 (24.6%). Acceleration and running start is the specific action that cause most (37.7%) ruptures. AT cases are observed in 91 patients with warm‐up and 161 without preparation before exercise. As a result, more ruptures happened within 10 min' sports in 161 unprepared (22.4%) than in 91 prepared (5.5%) cases. In SR cases, 107 and 145 cases are observed on weekends and weekdays. Of the 302 total cases, 64 are associated with Achilles tendinopathy. Frequently reported factors such as quinolone use and corticoid exposure are found only in two and 11 of all cases, respectively.

Conclusion

Middle‐aged males are common victims of AT rupture in Shanghai. Sports including basketball, badminton, soccer and actions involving in sudden and severe contraction of AT cause most ruptures. Warm‐up before exercise reduces rupture in short time. Factors such as quinolone, corticoid and Achilles tendonitis still need attention.

Evaluation of influenza vaccination coverage in Shanghai city during the 2016/17 to 2020/21 influenza seasons

Influenza is a common infectious disease resulting in substantial morbidity and mortality globally. The most effective strategy for preventing influenza is annual vaccination; however, the coverage rate of the influenza vaccine in Shanghai has not been well explored or reported. Therefore, this study aimed to determine coverage with the influenza vaccine and access trends in Shanghai city; data from Shanghai immunization information system was analyzed to estimate vaccination coverage during 2016–2017 through 2020–2021 influenza seasons. Vaccination coverage by age groups, immigration status, and districts was accessed. The influenza vaccination coverage (at least one dose) for 2016/2017 to 2020/2021 influenza seasons was 10.8‰ (95‰ CI: 10.7–10.8), 12.3‰ (95‰ CI: 12.3–12.4), 10.1‰ (95‰ CI: 10.0–10.1), 20.1‰ (95‰ CI: 20.0–20.2) and 50.8‰ (95‰ CI: 50.7–50.8) respectively. Although we found significantly higher vaccination coverage in females, children from 6 months to 17 years, and residents, it is still low in all subgroups of the population in Shanghai. Therefore, taking effective steps to promote influenza vaccination in Shanghai is recommended.

Intercomparison of Local Warming Trends of Shanghai and Hong Kong Based on 120-Year Temperature Observational Data

Using surface air temperature observations from 1901 to 2020, this study compared the warming trends of Shanghai and Hong Kong over a period of 120 years. The statistical results reveal the following: (1) The average temperatures of the two cities underwent fluctuating increases during the past 120 years, with linear warming rates of 0.23 °C/decade in Shanghai and 0.13 °C/decade in Hong Kong. (2) The fluctuation ranges of maximum temperature in the two cities were considerably higher than those of mean temperature. Moreover, in both cities, the annual mean maximum temperature decreased during a phase of more than a decade. The fluctuation ranges of minimum temperature were smaller, whereas the linear increases were higher than those for the mean temperature. (3) The diurnal temperature ranges (DTRs) of the two cities decreased; a certain phase of the decreases in DTR in the two cities was caused by decreases in the maximum temperature. (4) At a certain stage of urban development, owing to the shading effect of new high-rise buildings, the solar shortwave radiation reaching the Earth’s surface decreased, and anthropogenic heat generated by the energy consumption of buildings and urban human activities at that time was not sufficient to make up for the reduced shortwave radiation. This result may have led to the declines in the maximum temperature experienced by both cities. (5) Currently, the number of hot days and extremely hot days in the two cities has increased significantly compared with that a century ago, indicating that climate warming has an adverse impact on human settlements.

Development of high-resolution spatio-temporal models for ambient air pollution in a metropolitan area of China from 2013 to 2019

Modeling high-resolution air pollution concentrations is essential to accurately assess exposure for population studies. The aim of this study is to establish an advanced exposure model to predict spatiotemporal changes in fine particulate matter (PM_2.5), nitrogen dioxides (NO₂), and ozone (O₃) concentrations in Shanghai, China. The model is constructed on a geo-statistical modeling framework that incorporates a dimension reduction regression approach and a spatial smoothing function to deal with fine-scale exposure variations. We used a dataset with comprehensive observational and predictor variables that included monitoring data from both national and local agencies from 2013 to 2019, a high-resolution geographical dataset of predictor variables, and a full-coverage weekly satellite data of the aerosol optical depth at a 1 × 1 km² resolution. Our model performed well in terms of the spatial and temporal prediction ability assessed by cross-validation (CV) for PM_2.5 (spatial R² = 0.89, temporal R² = 0.91), NO₂ (R² = 0.49, 0.78), and O₃ (R² = 0.67, 0.81) at the national monitors over seven years according to the leave-one-out CV. For the predictions at the local agency monitoring stations, the overall CV R² was between 0.77 and 0.89 across the air pollutants. We visualized the long-term and seasonal averaged predictions of the PM_2.5, NO_2, and O₃ exposure on maps with a spatial resolution of 100 × 100 m². Our study provides a useful tool to accurately estimate air pollution exposure with high spatial and temporal resolution at the urban scale. These model predictions will be useful to assess both short-term and long-term air pollution exposure for health studies.

Association of childhood rhinitis with phthalate acid esters in household dust in Shanghai residences

OBJECTIVE

Phthalate acid esters (PAEs) have been identified to be associated with children's health. Present study was conducted to assess associations between PAEs in household dust and childhood rhinitis.

METHODS

Based on phase II of CCHH study (China, Children, Home, Health) conducted in Shanghai, China, 266 indoor dust samples were collected from participants' families. Concentrations of PAEs in dust samples were measured by chemical treatment and gas chromatograph-mass spectrometer. Information about individuals and residences was surveyed by questionnaires. Logistic regression models were applied to obtain the associations between PAEs and childhood rhinitis.

RESULTS

Higher concentrations of benzyl butyl phthalate (BBP) were found in those families with children who had diagnosed rhinitis. Significantly higher concentrations of bis(2-ethylhexyl) phthalate (DEHP) and PAEs with high molecular weight (HMW-PAEs) were found in the positive group of lifetime rhinitis. Using the multiple and ordinal logistic regression models adjusted by covariates, dibutyl phthalate (DBP), DEHP, and HMW-PAEs were found to be significantly associated with diagnosed rhinitis. Boys who exposure to higher concentrations of DBP, DEHP, HMW-PAEs, and total PAEs have significant associations with diagnosed rhinitis compared with girls who exposure to lower concentration of PAEs.

CONCLUSIONS

Present observational study indicated that exposure to high concentrations of DBP, DEHP, and HMW-PAEs in house settled dust was a risk factor for rhinitis for children, especially for boys.

Identification of mcr-1-positive multidrug-resistant Escherichia coli isolates from clinical samples in Shanghai, China

OBJECTIVES

Since the gene encoding mobilized colistin resistance (mcr-1) was first reported in China in 2015, it has been reported in various Enterobacteriaceae worldwide. Escherichia coli, one of the main pathogens causing diarrhea, is the most prevalent, clinically identified species carrying mcr-1. This study aimed to investigate the epidemiologic and genomic characteristics of mcr-1 in E. coli from patients in Shanghai.

METHODS

Fecal samples were collected from hospitals in Shanghai between 2012 and 2015. Polymerase chain reaction was performed to detect mcr-1, and molecular characteristics of the mcr-1-positive E. coli was determined by antimicrobial susceptibility testing and whole-genome sequencing.

RESULTS

We detected 40 (3.9%) mcr-1-positive E. coli strains from fecal samples in clinical settings between 2012 and 2015 in Shanghai. mcr-1 was detected in 4 types of E. coli, including aEPEC, EPEC, ETEC, and EAEC. Most strains harboring mcr-1 were isolated from children aged <7 years. Whole-genome sequencing revealed that nearly half of the strains that carried quinolone resistance- or β-lactam resistance-related genes were multidrug-resistant. IncX4 was the predominant type in mcr-1-positive E. coli in Shanghai but the other types of mcr-1-harboring plasmids are highly diverse in genetic context.

CONCLUSION

These data suggest that mcr-1 is prevalent in E. coli strains, especially those identified in diarrheal patients in Shanghai, and strengthening the surveillance of mcr-1 transmission, especially in children, is essential.

Atmospheric black carbon in urban and traffic areas in Shanghai: Temporal variations, source characteristics, and population exposure

Black carbon (BC) measurements were performed at Pudong (PD) urban supersite and Gonghexin (GH) roadside station from December 1, 2017 to August 10, 2020 to investigate the variations, source characteristics, and population exposure levels of BC in traffic and urban areas in Shanghai, China. The BC median concentration at GH was more than two-fold that at PD. Absorption Ångström exponent (AAE) values were 1.27 ± 0.17 and 1.31 ± 0.17 at PD and GH, respectively, suggesting the dominance of liquid fossil fuel combustion sources (i.e., traffic exhaust) at these stations. The higher BC and AAE values in winter at PD indicated the relatively increasing contribution of solid fuels (i.e., biomass burning) to BC concentration in urban Shanghai. The diurnal variation in BC showed similar twin-peak patterns at PD and GH, implying that traffic emission mainly contributed to ambient BC concentration in urban Shanghai. The estimated daily intakes (EDIs) of BC were generally higher in males than in females at both PD and GH. The highest BC EDIs at PD were found in age subgroups 1-<2 and 2-<3 years. In contrast, the BC EDIs at GH were observed in age subgroups 6-<9, 12-<15, and 15-<18 years, which were higher than those determined at PD, indicating that more attention must be paid to BC exposure of the population in these age subgroups. These results provide scientific insights into variations, source characteristics, and population exposure levels of BC in urban and traffic areas and could help in the development of BC control strategies in Shanghai.

Implementation effect of municipal solid waste mandatory sorting policy in Shanghai

In Shanghai, the biggest metropolis in China, the source classification of domestic waste began in the 1990s but achieved little success over the past thirty years. Surprisingly, the compulsory classification provision of Shanghai residents' domestic waste since 2019 has been successful. In this work, the overall status, and challenges of municipal solid waste (MSW) management in Shanghai under compulsory waste sorting rules are investigated. We tracked the classification efficiency of municipal solid waste, physicochemical characteristics of separated waste, and the carbon emissions arising from waste disposal system. It was found that almost 83.62 % of household food waste has been effectively separated with high purity of 99.50 %, while the lower heating value (LHV) of residual waste was increased by 96.4 % compared to previous years. With effective waste classification, the net carbon emission of separated processing was reduced to 0.11 ton CE/ton waste. However, this system generated some negative outcomes as well such as the lower recovery value of metal in bottom ash and the higher chloride content in fly ash. Moreover, we have documented and discussed several challenges of sustainable waste management system in Shanghai in the text. In order to overcome those challenges, we recommend to: (i) establish a finer source separation and recycling system; (ii) develop highly-efficient resource recovery technologies of byproducts from waste disposal system; and (iii) propose optimization adjustment strategy for overcapacity in incineration facilities.

Interaction of Urban Rivers and Green Space Morphology to Mitigate the Urban Heat Island Effect: Case-Based Comparative Analysis

The spatial morphology of waterfront green spaces helps generate cooling effects to mitigate the urban heat island effect (UHI) in metropolis cities. To explore the contribution and influence of multi-dimensional spatial indices on the mitigation of UHIs, the green space of the riparian buffer along 18 river channels in Shanghai was considered as a case study. The spatial distribution data of the land surface temperature (LST) in the study area were obtained by using remote sensing images. By selecting the related spatial structure morphological factors of the waterfront green space as the quantitative description index, the growth regression tree model (BRT) was adapted to analyze the contribution of various indexes of the waterfront green space on the distribution of the LST and the marginal effect of blue–green synergistic cooling. In addition, mathematical statistical analysis and spatial analysis methods were used to study the influence of the morphological group (MG) types of riparian green spaces with different morphological characteristics on the LST. The results showed that in terms of the spatial structure variables between blue and green spaces, the contribution of river widths larger than 30 m was more notable in decreasing the LST. In the case of a larger river width, the marginal effect of synergistic cooling could be observed in farther regions. The green space that had the highest connectivity degree and was located in the leeward direction of the river exhibited the lowest LST. In terms of the spatial morphology, the fractional cover values of the vegetation (Fv) and area (A) of the green space were the main factors affecting the cooling effect of the green space. For all MG types, a large green patch that had a high green coverage and connectivity degree, as well as was distributed in the leeward direction of the river, corresponded to the lowest LST. The research presented herein can provide methods and development suggestions for optimizing spatial thermal comfort in climate adaptive cities.

Reflections Based on Pollution Changes Brought by COVID-19 Lockdown in Shanghai

COVID-19 and its variants have been changing the world. The spread of variants brings severe effects to the global economy and to human's lives and health, as well as to society. Lockdown is proven to be effective in stopping the spread. It also provides a chance to study natural environmental changes with humanity's limited interference. This paper aims to evaluate the impact of lockdown on five major airborne pollutants, i.e., NO2, SO2, O3, PM2.5 and PM10, in the three different functional regions of Chongming, Xuhui and Jinshan of Shanghai. Changes in the same pollutants from the three regions over the same/different periods were all studied and compared. Overall, the COVID-19 lockdown has changed pollutant concentrations in the long and short terms. Concentrations of four pollutants decreased, except for that of earth surface O3, which increased. SO2 had significant correlations with all other pollutants. PM2.5 and PM10 are more externally input than locally produced. NO2, SO2 and PM levels sharply reduced in Jinshan and Xuhui due to the limited usage of fossil fuel. Lockdown improved the air quality. People now have a chance to rethink the value of life and the harmony between economic progress and environmental protection. This is helpful to establish sustainable societies.

Hourly measurement of PM2.5-bound nonpolar organic compounds in Shanghai: Characteristics, sources and health risk assessment

Fine particulate matter (PM2.5)-bound nonpolar organic compounds (NPOCs), including polycyclic aromatic hydrocarbons (PAHs) and alkanes, are commonly used as typical molecular markers for detailed source identification. Online thermal desorption aerosol gas chromatography-mass spectrometry (TAG) system can obtain ambient data with hourly resolution, which is of great importance for investigating the diurnal characteristics and refined source identification of NPOCs. From June to October 2020, hourly ambient aerosol samples were collected and analyzed to investigate the characteristics and sources of 14 PAHs and 15 alkanes (C21-C35) in PM2.5 using TAG at a suburban site of Baoshan district in Shanghai, China. The average concentration of summed PAHs and alkanes during the sampling period was 1.27 ± 1.4 ng/m3 and 8.87 ± 3.46 ng/m3, respectively, in which Benzo[b]fluoranthene (BbF), Benzo[ghi]perylene (BghiP) and Indeno[1,2,3-cd]pyrene (IcdP) are the dominant PAHs species, with n-Heptacosane (C27), n-Nonacosane (C29) and n-Hentriacontane (C31) being the most abundant n-alkane species. Carbon preference index (CPI) and carbon maximum (Cmax) number indicated that the sources of alkanes shifted from biogenic-oriented (such as plant wax) in the summer to anthropogenic-dominated (such as fossil fuels) in the autumn. Results from trajectory cluster analysis and potential source contribution function (PSCF) modeling showed that alkanes were mainly from the middle and lower reaches of the Yangtze River Plain including Anhui, Jiangxi, and Zhejiang provinces, while PAHs were mainly from northeastern China. Positive Matrix Factorization (PMF) model results indicated that gasoline (41.48%) and diesel (21.82%) were the two major sources of PM2.5-bound PAHs in summer and fall of 2020 in Shanghai, followed by coal consumption or catering (19.96%) and biomass burning (16.74%). Diurnal variation of PAHs sources resolved by PMF showed characteristic features consistent with the corresponding anthropogenic activities. For example, gasoline vehicle exhaust showed higher concentrations during traffic rush hours; while coal consumption or catering presented higher concentrations during lunch times from 10:00 to 12:00. In addition, the TAG data coupling with PMF also can be capable for source appointment of short-duration episodes. Health risk assessment showed that adult women were at greater lifetime cancer risk (ILCR) than people in other age groups, and people may subject to higher health risks at morning and night time. This work demonstrates that hourly NPOCs measured by TAG are uniquely specific on refined source identification and investigation into the characteristics of diurnal variations.

The usage of enzyme replacement treatments, economic burden, and quality of life of patients with four lysosomal storage diseases in Shanghai, China

Lysosomal storage diseases (LSDs) are a group of rare diseases that cause progressive physical dysfunction and organ failure, which significantly affected patients' quality of life. The objective of this study was to explore the characteristics and usage of Enzyme Replacement Treatments (ERTs), which is the only specific therapy for LSDs, of patients with the four different LSDs (Gaucher, Fabry, Pompe disease and Mucopolysaccharidosis) in Shanghai, and then evaluate the economic burden and quality of life of these patients. A total of 31patients, involving 5, 14, 4 and 8 patients with Gaucher, Fabry, Pompe disease and Mucopolysaccharidosis, respectively, were included in analysis. The result showed that only five Gaucher disease (GD) patients in Shanghai used Imiglucerase in 2019, while the other 26 patients with the other three LSDs did not receive ERTs. The total health expenditure of GD patients was 2,273,000CNY on average mainly resulted by the high cost of Imiglucerase. The total health expenditure of the other 26 patients was 37,765CNY on average. Though the cost-sharing mechanism between basic medical insurance, charity fund and patients had been explored for Gaucher disease in Shanghai, the out-of-pocket part, which was 164,301 CNY, still laid a heavy economic burden on the patients and their families. The mean EQ-VAS score of GD patients was 76.4 ± 15.5, which was higher than that of the other three LSDs. It is recommended that the scope of drug reimbursement list and the reimbursement level should be further expanded and raised to help improve the living conditions of patients with LSDs.

Jiangnan dietary pattern actively prevents muscle mass loss: Based on a cohort study

BACKGROUND

The proportion of sarcopenia in the elderly is very high, although muscle mass loss before sarcopenia covers a wider population. The present study aimed to analyse the effects of different dietary patterns on muscle mass.

METHODS

In both 2015 and 2018, using multilayer random sampling, the same participants were selected, and the same questionnaires and machines were used.

RESULTS

In total, 502 participants were selected. The >65-year-old group showed maximum muscle mass loss in males and females (-1.53 kg ± 4.42 and -1.14 kg ± 2.6 on average, respectively). The cumulative variance of four dietary patterns reached 52.28%. Logistical regression revealed significant differences between 'Jiangnan Dietary' groups: Q2 vs. Q1 [odds ratio (OR) = 0.356, 95% confidence interval (CI) = 0.202-0.629]; Q3 vs. Q1 (OR = 0.457, 95% CI = 0.262-0.797). Relative influence factors for muscle mass loss were age (>65 vs. <45, OR = 2.027, 95% CI = 1.117-3.680), physical activity (OR = 0.550, 95% CI = 0.315-0.960), income (high vs. low, OR = 0.413, 95% CI = 0.210 -0.810), sex (female vs. male, OR = 0.379, 95% CI = 0.235-0.519).

CONCLUSIONS

After 3 years of follow-up, participants' muscle mass declined significantly. The 'Jiangnan Dietary' pattern prevented muscle mass loss and is recommended to the wider population.

Estimation of the Rural Dog Population Within a Mega-City: An Example in Jiading District, Shanghai

Rural dog populations have long been recognized to be inadequately managed in terms of disease control and prevention. In this study we consider dog management in rural Shanghai and its implications for rabies control in the entire metropolitan area of Shanghai. The prerequisite to improve rabies vaccination coverage in rural Shanghai depends on a proper enumeration of the total rural dog population. In this study we selected one of the nine administrative districts in Shanghai (Jiading), within which there are 7 towns and 2 industrial zones (township-level division) that contain agricultural areas. A total of 9 villages (rabies model villages) were chosen from each township-level division in Jiading, and an additional 3 non-model villages were also included in the study. A household questionnaire survey was implemented in all 12 villages recruited. In 3 of the model villages and the 3 non-model villages chosen as a comparison, two methods of enumeration—a sight-resight survey and a household census survey—were implemented. Results from the household survey in these 6 villages showed that among the total 1,560 owned dogs, 80.4% were Chinese Garden Dogs, 69.1% were aged 1 to 3 years, 49.2% were homebred, and 88.3% were kept for the purpose of guarding the house. However, only 3.7% of the owned dogs were desexed. There was a higher proportion of chained or confined dogs in model compared to non-model villages. The model villages had an absolute rabies vaccination coverage of 100% among its owned dog population and a smaller number of stray dogs. It was also identified that the two enumeration methods yielded similar counts (P = 0.12), particularly within smaller villages. From the questionnaire survey implemented within all 12 villages and based on the average human-to-dog ratio, the total rural dog population of Jiading district was estimated to be 24,058. This study generated information on the general demographics of the rural dog population in Jiading, and demonstrates an approach to the study of rural dog populations within the context of a megacity. In such a context, rural dog populations need to be considered as a critical component of animal and public health.

Vitamin D status and vitamin D deficiency risk factors among pregnancy of Shanghai in China

Background

There is increasing awareness that vitamin D deficiency in pregnant women may be associated with several adverse effects for the mother and newborn. The risks for vitamin D deficiency are unclear. This study was to assess vitamin D nutritional status and vitamin D deficiency risk factors among pregnant women in Shanghai in China.

Methods

This study is a cross-sectional study conducted in the Sixth Affiliated People’s Hospital of Shanghai Jiao Tong University. A total of 953 healthy pregnant women participated, serological examinations and other variables included serum 25-hydroxyvitamin D [25(OH)D], total blood cholesterol (TCh), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very-low-density lipoprotein (VLDL) cholesterol, triglycerides at the first antenatal visit (12–14 weeks) pregnancy parity and age, body mass index (BMI) before pregnancy, and completed OGTTs test. Associations between vitamin D deficiency and possible predictors (age group, pre-pregnancy BMI, parity, and gestational hyperlipemia) were assessed with a multinomial logistic regression analysis. And also used to investigate the effects of 25(OH)D and the other variables on the occurrence of gestational diabetes mellitus.

Results

The mean vitamin D level of pregnancy was 16 (a range from 11 to 21) ng/ml, and severe vitamin D deficiency was 31.8% (303); vitamin D deficiency was 40.7% (388); vitamin D insufficiency was 25.1% (239); normal vitamin D was 2.4%(23). Vitamin D deficiency risk factors were age over 30, parity over 2, overweight, obese, and hyperlipemia. The increasing level of vitamin D nutritional status in pregnancy is significantly related to reducing gestational diabetes mellitus. Vitamin D deficiency is a risk factor for gestational diabetes mellitus.

Conclusions

It is a high prevalence of vitamin D deficiency in Chinese pregnancy in Shanghai. Aging more than 30 years, the parity of more than 2, overweight and obesity, and hyperlipemia are risk factors for vitamin D deficiency. Vitamin D deficiency is a risk factor for gestational diabetes mellitus. Public health strategies to prevent vitamin D deficiency should focus on those risks to promote health pregnancy of Shanghai in China.

Demographics, in-hospital analysis, and prevalence of 33 rare diseases with effective treatment in Shanghai

BACKGROUND

Rare diseases are ailments which impose a heavy burden on individual patients and global society as a whole. The rare disease management landscape is not a smooth one-a rare disease is quite often hard to diagnose, treat, and investigate. In China, the country's rapid economic rise and development has brought an increased focus on rare diseases. At present, there is a growing focus placed on the importance and public health priority of rare diseases and on improving awareness, definitions, and treatments.

METHODS

In this work we utilized clinical data from the Shanghai HIE System to characterize the status of 33 rare diseases with effective treatment in Shanghai for the time period of 2013-2016.

RESULTS AND CONCLUSION

First, we describe the total number of patients, year-to-year change in new patients with diagnosis in one of the target diseases and the distribution of gender and age for the top six (by patient number) diseases of the set of 33 rare diseases. Second, we describe the hospitalization burden in terms of in-hospital ratio, length of stay, and medical expenses during hospitalization. Finally, rare disease period prevalence is calculated for the rare diseases set.

Seasonal variation of aerosol compositions in Shanghai, China: Insights from particle aerosol mass spectrometer observations

The variations of non-refractory submicron aerosol (NR-PM₁) were characterized using an high-resolution time-of-flight aerosol mass spectrometer (HR-ToF-AMS) and other online instruments measurements sampled at an urban site in Shanghai from 2016 to 2017. Spring (from 18 May to 4 June 2017), summer (from 23 August to 10 September 2017) and winter (from 28 November 2016 to 23 January 2017) seasons were chosen for detail investigating the seasonal variations in the aerosol chemical characteristics. The average PM₁ (NR-PM₁ + BC) mass concentration showed little difference in the three seasons in Shanghai. The average mass concentrations of total PM₁ during spring, summer, and winter observations in Shanghai were 23.9 ± 20.7 μg/m³, 28.5 ± 17.6 μg/m³, and 31.9 ± 22.7 μg/m³, respectively. The seasonal difference on chemical compositions was more significant between them. Organic aerosol (OA) and sulfate were dominant contributor of PM₁ in summer, whereas OA and nitrate primarily contribution to the increase of PM₁ mass loading in spring and winter. As an abundant component in PM₁ (accounting for 39%-49%), OA were resolved into two primary organic aerosol (POA) factors and two secondary aerosol (SOA) factors by using positive matrix factorization (PMF), of which OA was overwhelmingly dominated by the SOA (50-60%) across the three seasons in Shanghai. Correlation analysis with relative humidity and odd oxygen indicated that aqueous-phase processing and played an important role in more aged SOA formation in summer and winter. In spring, both aqueous-phase and photochemical processing contributed significantly to fresh SOA formation. Our results suggest the significant role of secondary particles in PM pollution in Shanghai and highlight the importance of control measures for reducing emissions of gaseous precursors, especially need to consider seasonal characteristics.

[Changes and Potential Sources of Atmospheric Black Carbon Concentration in Shanghai over the Past 40 Years Based on MERRA-2 Reanalysis Data]

As an important component of atmospheric aerosols, black carbon (BC) has a great influence on the regional and global radiation balance, climate, and human health due to its small particle size, large specific surface area, and radiative forcing potential. Here, the spatio-temporal characteristics of atmospheric BC were investigated based on modern-era retrospective analysis for research and applications version 2 (MERRA-2) reanalysis data and ground observation data during 1980-2019 in Shanghai, a highly urbanized city in mainland China. The influences of local emissions and regional transmission on regional-scale BC concentrations were examined using the M-K trend test, backward trajectory analysis, and the potential source contribution function (PSCF). The results showed that:① MERRA-2 BC and ground observation datasets showed good consistency (R∈[0.68, 0.72]), indicating that MERRA-2 reanalysis data can be used to reveal long-term changes in ground-level atmospheric BC concentrations; ② Atmospheric BC concentrations in Shanghai over the past 40 years can be divided into three stages:a "low value" stage of slow growth[1980-1986, (1.75±0.17) μg·m^-3], a relatively stable "median value" stage[1987-1999, (2.18 ±0.07) μg·m^-3], and a fluctuating "high value" stage[2000-2019, (3.07±0.31) μg·m^-3]. Seasonally, Shanghai's BC concentrations generally show a "U" pattern with low concentrations in summer and high concentrations in winter. As a result of black carbon emissions from marine diesel engines and other engines used for water transportation, a small peak also occurs in July; ③ The diagnostic quality ratio of air pollutants and the bivariate correlation analysis[R(BC-NO₂)>R(BC-CO)>R(BC-SO₂)] indicated that traffic emissions were the main sources of atmospheric BC in Shanghai, especially by heavy diesel vehicles; ④ The backward trajectory and PSCF analyses found that the air mass of Shanghai in summer was dominated by a clean sea breeze, accounting for 77.18%. In contrast, during the other seasons, more than 50% of the air mass came from the north. The potential source regions of atmospheric BC in Shanghai are mainly distributed in eastern China, expanding outwards and centering on the Yangtze River Delta, and the expansion direction is consistent with the directions of the backward trajectories.

Cost-Effectiveness Analysis of 23-Valent Pneumococcal Polysaccharide Vaccine Program for the Elderly Aged 60 Years or Older in Shanghai, China

Background: The pneumococcal vaccine has been considered as the most effective measure to prevent pneumococcal diseases. In 2013, Shanghai launched a major public health program to vaccinate people aged 60 years or older with 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV-23) free of charge. By the end of June 2020, a total of 1.56 million old people had been vaccinated free of charge. Objective: To evaluate the cost-effectiveness of PPSV-23 vaccination program in Shanghai from the health system perspective. Methods: According to the actual number of people aged 60 years or older with PPSV-23 vaccination in Shanghai from 2013 to 2018, a multi-cohort Markov model for life-time was developed to compare health and economic outcomes of vaccinated people vs. if they were not vaccinated for PPSV-23. Cost effectiveness was reported as incremental cost effectiveness ratio (ICER). A 5% discount rate was used for both costs and health outcomes. In addition, one-way sensitivity analysis was used to test the model's robustness. Results: By the end of 2018, a total of 1,091,967 people aged 60 years or older were vaccinated with PPSV-23 in Shanghai, China. Comparing with the unvaccinated circumstances, PPSV-23 vaccination would cost US $19.62 million more and receive an additional 10,321.3 quality-adjusted life-year (QALY). PPSV-23 was associated with the ICER of $190.1 per QALY gained. The Results were sensitive to the variation of vaccine effectiveness against community-acquired pneumonia (CAP), and disease incidence, mortality, and costs of CAP. In all sensitivity analysis, the PPSV-23 was economical. Conclusion: The PPSV-23 vaccination program in Shanghai was cost-effective. With the further development of the project, the administrative costs of the vaccine will be reduced, making it more cost-effective.

The precision of epidemiological investigation of COVID-19 transmission in Shanghai, China

Background

Shanghai had a local outbreak of COVID-19 from January 21 to 24. Timely and precise strategies were taken to prevent further spread of the disease. We discussed and shared the experience of COVID-19 containment in Shanghai.

Process

The first two patients worked at two hospitals but no staff from the two hospitals were infected. The suspected case and his two close contacts were confirmed to be infected within 12 h. The testing rate of individuals was low. The scope of screening was minimized to two related districts and the close contact tracing was completed within 12 h, which were precise and cost-effective.

Conclusions

Active monitoring, precise epidemiological investigation and timely nucleic acid testing help discover new cases, minimize the scope of screening, and interrupt the transmission.

Graphic abstract

Well-being losses by providing informal care to elderly people: Evidence from 310 caregivers in Shanghai, China

A series of policies aimed toward rational resource allocation of long-term care have being actively discussed since the launch of the social long-term care insurance in Shanghai, and it is important to take a societal perspective for informed decision-making. This study aims to explore factors that are associated with well-being of informal caregivers in Shanghai, and to provide empirical evidence of application of an established well-being valuation method to monetise informal caregivers' well-being losses in a developing country. 310 informal caregivers of applicants for social long-term care insurance in Shanghai were interviewed. Univariate and multivariate analyses were conducted to explore the associated factors with life satisfaction of the caregivers. The monetary values of an additional hour of caregiving with and without specification of care tasks were estimated by the well-being valuation method. Life satisfaction was consistently associated with monthly income, health status, and caring hours of the caregivers. The money needed to compensate one additional hour of caring per week was 12.58 CNY (0.3% of the monthly income), and 96.95 CNY (2.0% of the monthly income) for activities of daily living (ADL) tasks. Income, health status, and caregiving are significantly associated with well-being of informal caregivers. Caregivers in relatively poor health condition and/or involved in more ADL tasks should be particularly considered in supporting policies in Shanghai.

Mitigated PM2.5 Changes by the Regional Transport During the COVID-19 Lockdown in Shanghai, China

Intensive observations and WRF-Chem simulations are applied in this study to investigate the adverse impacts of regional transport on the PM2.5 (fine particulate matter; diameter ≤2.5 μm) changes in Shanghai during the Coronavirus Disease 2019 lockdown. As the local atmospheric oxidation capacity was observed to be generally weakened, strong regional transport carried by the frequent westerly winds is suggested to be the main driver of the unexpected pollution episodes, increasing the input of both primary and secondary aerosols. Contributing 40%-80% to the PM2.5, the transport contributed aerosols are simulated to exhibit less decreases (13.2%-21.8%) than the local particles (37.1%-64.8%) in urban Shanghai due to the lockdown, which largely results from the less decreased industrial and residential emissions in surrounding provinces. To reduce the influence of the transport, synergetic emission control, especially synergetic ammonia control, measures are proved to be effective strategies, which need to be considered in future regulations.

From malaria elimination to post-elimination: a 10-year surveillance data study in Shanghai

Background

The aim of this study was to investigate and analyse the characteristics of malaria in Shanghai from 2010 to 2019 and to provide suggestions for areas with a similar elimination process in China in order to prompt development of strategies and interventions in the post-elimination stage.

Methods

This was a cross-sectional study exploring the malaria characteristics during 2010–2019 in Shanghai, China. Malaria data from the Infectious Diseases Information Reporting Management System (IDIRMS) between 2010 and 2012 and data from the Parasitic Diseases Information Reporting Management System (PDIRMS) between 2013 and 2019 were combined for analysis in this study.

Results

From 2010 to 2019, a total of 436 malaria cases were reported in Shanghai. Among them, 415 (95.18%) were imported from abroad, 19 (4.36%) were domestically acquired from other provinces, 1 (0.23%) case was caused by blood transfusion, and 1 (0.23%) had a long incubation. Only Plasmodium vivax was found in domestically indigenous cases; Plasmodium falciparum accounted for the largest proportion of imported cases. Domestically acquired cases were only reported in 2010–2011 and 88% occurred in June to September; no significant seasonal difference was observed for imported cases over the 10 years. No local transmission has occurred in Shanghai since 2012. The median interval from fever onset to diagnosis was 3 days. Between 2010 and 2019, among 308 foci, 33 were classified as potential transmission and dispersed in suburb areas (Minhang, Baoshan, Jiading, Pudong, Jinshan, Songjiang, Qingpu, Fengxian, and Chongming). Only Anopheles sinensis was present and the proportion of Anopheles sinensis in different species of mosquitoes under surveillance in Shanghai decreased from 2011 to 2019.

Conclusions

Shanghai faces the challenge of malaria re-establishment caused by imported malaria in the post-elimination stage. Therefore, risk investigation and assessment should be carried out, and receptivity and susceptibility should be assessed for every point of focus. Training should be continued to strengthen facility staff capability, and multisectoral coordination and cooperation need to be conducted efficiently to maintain malaria elimination in Shanghai.

Are Essential Women's Healthcare Services Fully Covered? A Comparative Analysis of Policy Documents in Shanghai and New York City from 1978-2017

This study aimed to analyze the changes in the 10 major categories of women's healthcare services (WHSs) in Shanghai (SH) and New York City (NYC) from 1978 to 2017, and examine the relationship between these changes and maternal mortality ratio (MMR). Content analysis of available public policy documents concerning women's health was conducted. Two indicators were designed to represent the delivery of WHSs: The essential women's healthcare service coverage rate (ESCR) and the assessable essential healthcare service coverage rate (AESCR). Spearman correlation was used to analyze the relationship between the two indicators and MMR. In SH, the ESCR increased from 10% to 90%, AESCR increased from 0% to 90%, and MMR decreased from 24.0/100,000 to 1.01/100,000. In NYC, the ESCR increased from 0% to 80%, the AESCR increased from 0% to 60%, and the MMR decreased from 24.7/100,000 to 21.4/100,000. The MMR significantly decreased as both indicators increased (p < 0.01). Major advances have been made in women's healthcare in both cities, with SH having a better improvement effect. A common shortcoming for both was the lack of menopausal health service provision. The promotion of women's health still needs to receive continuous attention from governments of SH and NYC. The experiences of the two cities showed that placing WHSs among policy priorities is effective in improving service status.

Medical Treatment Behaviour of the Elderly Population in Shanghai: Group Features and Influencing Factor Analysis

BACKGROUND

While Chinese cities are pursuing economic development, meeting citizen demand for medical treatment has only gradually been put on the agenda. Theoretically, in the second half of a person's life, demand for medical treatment will rise sharply. Given limited medical resources, the match between demand and supply becomes more difficult. We conducted questionnaires in Shanghai to describe whether there are obvious group differences in the elderly population's medical treatment options and provide empirical evidence on the determinants.

METHOD

We collected 439 Shanghai Elderly Medical Demand Characteristics Questionnaires, which included five parts: personal information, health status, elderly person's medical preference and expectation, satisfaction level for hospitals services, and medical insurance. We set up virtual explanatory variables according to the different medical behaviours of the elderly, and control variables composed of individual characteristics, socioeconomic characteristics, medical needs, medical resource availability, and medical expenditure. We used the MLR model to investigate medical treatment behaviour choice.

RESULTS

The medical treatment behaviour of the elderly population in Shanghai is affected by multiple factors. When experiencing physical discomfort, most of them choose to go to the hospital (64.69%). Age, income, household registration, and medical insurance reimbursement policy play a role in their decision-making. For general diseases, the proportion choosing specialist hospitals or community clinics is the highest (40.78%). Age, marital status, residential status, physical state, objective distance, medical expenses, and other factors have a significant impact. For severe diseases, they are more inclined (71.07%) to visit general hospitals, with the individual's physical condition, living status, and accessibility to hospital resources more likely to affect their behaviour.

CONCLUSION

Firstly, the importance of each factor varies depending on the conditions. Secondly, it may be more appropriate for China's elderly health insurance system to set reimbursement rates based on the patient's condition and disease type. Thirdly, medical behaviour has a distance friction effect, but the allocation of public service resources shows a strong centripetal concentration. It is necessary for the government to show due care about the regional distribution of the elderly population and to promote the rational distribution of medical resources in Shanghai.

Internet use and mental health problems among older people in Shanghai, China: the moderating roles of chronic diseases and household income

Objectives: This study investigates whether the impact of Internet use on old adults' mental health problems differs across health conditions and income groups in Shanghai, China.Methods: This study uses data from a large-scale sample of 2117 respondents aged 60-80 years in Shanghai, China. This study measures mental health problems with the 10-item version of the Hopkins Symptom Checklist, assesses Internet use with a 4-item scale and chronic diseases with a 12-item scale. This study applies ordinary least square regression models to assess associations between Internet use and mental health problems across income groups and health conditions.Results: Elderly people using the Internet more frequently have substantially lower odds of having mental health problems. Further analyses find the moderating roles of chronic diseases and household income on mental health problems. Chronic diseases significantly increase the correlation of Internet use with mental health problems. Meanwhile, Internet use reduces more elders' mental health problems in the low-income group than in the high-income group.Conclusion: This study sheds evidence on the negative correlation of Internet use with mental health problems. It also indicates that Internet use may reduce more mental health problems in the low-income group and the unhealthy group. Therefore, increasing Internet use in the low-income group and the unhealthy group is suggested as a promising strategy to promote elders' mental health.

Burnout in nurses during the COVID-19 pandemic in China: New challenges for public health

During the COVID-19 pandemic, frontline nurses have faced extraordinary personal and professional challenges. These challenges have had mental health consequences, and concerning reports of burnout have emerged globally. We conducted a cross-sectional survey at a designated COVID-19 hospital in Shanghai at the peak of the pandemic, i.e. about 2 months after the onset of the outbreak from February to April 2020. Findings revealed burnout in 6.85% of nurses. Of 336 respondents, 87 (25.89%) had a high level of emotional exhaustion, 61 (18.15%) had a high level of depersonalization, and 100 (29.76%) had a low level of personal accomplishment. Burnout can be prevented by offering more support from families and supervisors, paying attention to health monitoring and personal protection, and creating a rational human resource allocation and shift management system. Specific training on infection control and self-protection, mental health guidance, and stress coping techniques must be implemented. As the current health crisis ultimately abates, moving the focus from mental health issues to public health issues, more attention and support at the national and organizational levels are needed to reduce occupational discrimination, nurse autonomy and status need to be promoted, and public health emergency teams need to be created. A positive and fair working environment is essential to effective healthcare delivery.

Identification of long-term evolution of ozone sensitivity to precursors based on two-dimensional mutual verification

Tropospheric ozone pollution has been continuously worsening in China during the past decade. Identification of long-term evolution of ozone sensitivity to precursors is essential to evaluating the impact of emission reduction measures on ozone pollution. Traditional observation-based model and 3-d numerical model are not suitable for analyzing long-term variation of ozone sensitivity to precursors. In this study, by transforming the conventional ozone isopleth plot into a VOCR isopleth plot in the functional space of NO_x and ozone concentrations, we developed a novel approach to identify ozone sensitivity to precursors by simply using long-term monitoring data of ozone, NO_x and temperature. This approach estimated ozone formation regimes (OFR) by ozone sensitivity to NO_x and temperature separately, and the convergence of OFR serves as a way of mutual verification. We found that ozone formation was generally in the VOCR-limited or transitional regime in Shanghai, the largest metropolitan area in China. However, OFR was shifted to NO_x-limited at Pudong station during 2017-19 due much to the stringent NO_x emission control. OFR was also shifted to NO_x-limited along with the increasing temperature. When temperature was over 30 °C, Shanghai was mostly in a NO_x-limited OFR. This highlights that the NO_x emission control measures need to be strengthened to reduce peak ozone levels more efficiently. Jinshan station exhibited a different trend with OFR shifted to VOCR-limited in 2017-19, which proved the effectiveness of VOCs emission control on petrochemical sector. However, OFR was shifted to NO_x-limited when temperature was over 30 °C, suggesting more stringent VOCs emissions control should be targeted on days with higher temperature.

Effects of Physical Activity and Counselling Interventions on Health Outcomes among Working Women in Shanghai

Working women in Shanghai are a high-risk group of suffering work stress and burnout. Women have been found to be affected by work-family conflicts, which results in lower health-related quality of life (HRQoL), higher job stress, and burnout. This study evaluated the potential physical activity and counselling intervention effects on health outcomes of working women in Shanghai. Participants were randomly recruited from eight communities of Shanghai using the stratified cluster sampling method. A total of 121 female workers took part in this study, who were randomly divided into three groups: a control group and two intervention groups (individual-based and group-based intervention). The first intervention involved a moderate physical activity program and an individual based counselling intervention, while the second included the same physical activity program, but with a group counselling approach. Both interventions lasted 12 weeks. Subjective perceptions of work stress, burnout, and HRQoL were measured before and after the intervention. In the control group, the HRQoL value decreased after the intervention, with the mean value falling from 91.59 to 87.10, while there was no significant difference found between participants for stress (p = 0.752) and burnout (p = 0.622) before and after the intervention. After the intervention, the value of stress and burnout decreased, and the value of HRQoL increased in the two intervention groups. At the intervention's completion, there were significant differences compared between the two intervention groups and the control group separately regarding changes in burnout and HRQoL (all p = 0.000). For stress, the group-based intervention group exhibited a significant difference compared to the control group (p = 0.000), while the individual-based intervention group did not (p = 0.128). A Physical activity and counselling intervention delivered either in a group or individual format could reduce stress, burnout, and improve HRQoL of working women in Shanghai, and the group interventions were potentially more effective than those targeted at individuals.

Full recovery of elective orthopedic surgery in the age of COVID-19: an 8-month retrospective cohort study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has led to dramatic disruptions to orthopedic services. The purpose of this study is to quantify the reinstatement of elective orthopedic surgeries of our institution in Shanghai, China, and share our first-hand experiences of how this region is managing the post-outbreak period.

METHODS

The number of patients receiving elective orthopedic surgeries was analyzed in the timeframe of 8 months since the start of the pandemic (from January 20 to September 16) and compared with the patients receiving the same treatment during the same period in 2019. And a detailed workflow for handling patients about to receive elective surgeries in the COVID-19 post-outbreak period was described.

RESULTS

The number of the selective surgeries in the first 3 months only accounted for 31.72% of the same period in 2019 (p = 0.0031), and the ratio reached 97.47% when it came to the last 5 months (p > 0.9999). The selective surgeries even surpassed the pre-epidemic level in months 7 and 8. And the difference of the surgeries was not significant in the whole eight observed months between 2019 and 2020 (p = 0.1526). No health care providers or hospitalized patients in orthopedic departments in Shanghai have been infected nosocomially.

CONCLUSIONS

Elective orthopedic surgeries have been fully recovered from the COVID-19 pandemic in our institution, and the new normalcy established during the post-outbreak period helped this region co-exist with the impact of the virus well.

TRIAL REGISTRATION

Retrospectively registered, registration number: ChiCTR2000039711 , date of registration: November 6, 2020.

Source apportionment of PAHs in roadside agricultural soils of a megacity using positive matrix factorization receptor model and compound-specific carbon isotope analysis

Polycyclic aromatic hydrocarbon (PAH) contamination in agricultural soils (n = 41) along Shanghai road net was systematically investigated to characterize pollution distribution and to apportion sources. Total PAH (Σ₁₆PAH) concentrations in roadside agricultural soils varied from 17.2 to 3775 ng/g with an average of 339 ± 594 ng/g, 43.9 % of which corresponded to weakly - heavily contaminated levels. The spatial distribution of pollution hotspots depended on heavy traffic volume and intensive industrial activities in adjacent areas. A positive matrix factorization receptor model identified that vehicle emission and combustion of coal, biomass and natural gas were the predominant sources, accounting for 66.0 % and 23.7 % of Σ₁₆PAH loadings, respectively. Stable carbon isotope analysis was applied for the first time in seven sites with high Σ₁₆PAH concentrations for tracing their unique sources. It was concluded that PAHs in the heavily contaminated soil site G18 predominantly came from vehicle emission sources, different from the six other sites controlled by coal-processing and biomass combustion sources. Future studies should focus on quantifying the source contribution of PAHs in roadside agricultural soils based on the combination of multi-isotope approaches due to the data overlap of δ¹³C in certain sources.

Riverside Greenway in Urban Environment: Residents' Perception and Use of Greenways along the Huangpu River in Shanghai, China

Urban greenways improve green coverage rates in urban environments and transform these environments in a people-oriented manner. This study adopted semantic differential (SD) methods and an importance-performance analysis (IPA) model to evaluate resident perceptions and preferences of riverside greenways. A survey of 588 residents was conducted on typical natural greenways, built greenways, and mixed greenways along the Huangpu River in Shanghai. The results showed that resident perceptions of style, space, and distance differed markedly, whereas their perceptions of environmental and psychological characteristics were relatively similar. There were strong correlations between residents' characteristics and their perceptions, especially for their perceptions of greenway style, sense of order, and distance from the river. By comparison, most residents preferred mixed greenways. Additionally, respondents from areas with natural and mixed greenways believed that they benefited, whereas those from areas with built greenways displayed a potential sense of deprivation. The results of IPA analysis provide further support for the above conclusions. As a whole, the relatively simple methods demonstrated here could be useful to quantitatively analyze the subjective perceptions of urban residents.

The ecology of medical care in Shanghai

Background

To better understand the distribution and consumption patterns of resources in different ethnic groups and at different levels of economic development, this paper chose to describe the healthcare seeking behavior in Shanghai.

Methods

The data are from the Sixth Health Service Survey of Shanghai, which encompasses 23,198 permanent residents. Descriptive analyses were conducted to estimate the number of patients who reported health-related symptoms and healthcare-seeking behaviors per 1,000 residents. Logistic regression analyses were conducted to examine differences in reporting health-related symptoms and healthcare-seeking behaviors by age, gender and area of residence.

Results

This paper have mapped the ecology of healthcare in Shanghai in 2018. Of 1000 individuals considered during a 1-month period, 444 reported sickness, 433 received treatment, 288 went to medical institutions, 195 went to primary medical institutions, 86 took a self-healing approach, 26 received TCM services, 7 were hospitalized, and 3 underwent surgery.

Conclusions

Age is a risk factor leading to disease, medical treatment, self-medication, medical institution visits, TCM service, hospitalization and surgery. But age is a protective factor in the use of primary health care services. By gender, the number of people receiving medical services was similar, but women were statistically more likely to have surgery. As the income level increased, the number of patients and people receiving medical services showed a decreasing trend. Compared with the local population, the probability of non-local people visiting medical institutions was lower and statistically significant. Compared with the people who had health insurance, fewer uninsured people reported sickness and utilized healthcare services.

Yearly variation in characteristics and health risk of polycyclic aromatic hydrocarbons and nitro-PAHs in urban shanghai from 2010-2018

This study encompassed the regular observation of nine polycyclic aromatic hydrocarbons (PAHs) and three nitro-PAHs (NPAHs) in particulate matter (PM) in Shanghai in summer and winter from 2010 to 2018. The results showed that the mean concentrations of ƩPAHs in summer decreased by 24.7% in 2013 and 18.1% in 2017 but increased by 10.2% in 2015 compared to the data in 2010. However, the mean concentrations of ƩPAHs in winter decreased by 39.7% from 2010 (12.8 ± 4.55 ng/m³) to 2018 (7.72 ± 3.33 ng/m³), and the mean concentrations of 1-nitropyrene in winter decreased by 79.0% from 2010 (42.3 ± 16.1 pg/m³) to 2018 (8.90 ± 2.09 pg/m³). Correlation analysis with meteorological conditions revealed that the PAH and NPAH concentrations were both influenced by ambient temperature. The diagnostic ratios of PAHs and factor analysis showed that they were mainly affected by traffic emissions with some coal and/or biomass combustion. The ratio of 2-nitrofluoranthene to 2-nitropyrene was near 10, which indicated that the OH radical-initiated reaction was the main pathway leading to their secondary formation. Moreover, backward trajectories revealed different air mass routes in each sampling period, indicating a high possibility of source effects from the northern area in winter in addition to local and surrounding influences. Meanwhile, the mean total benzo[a]pyrene-equivalent concentrations in Shanghai in winter decreased by 50.8% from 2010 (1860 ± 645 pg/m³) to 2018 (916 ± 363 pg/m³). These results indicated the positive effects of the various policies and regulations issued by Chinese authorities.

Long-term urbanization impacts the eastern golden frog (Pelophylax plancyi) in Shanghai City: Demographic history, genetic structure, and implications for amphibian conservation in intensively urbanizing environments

Understanding the mechanisms of how urbanization influences the evolution of native species is vital for urban wildlife ecology and conservation in the Anthropocene. With thousands of years of agriculture-dominated historical urbanization followed by 40 years of intensive and rapid urbanization, Shanghai provides an ideal environment to study how the two-stage urbanization process influences the evolution of indigenous wildlife, especially of anuran species. Therefore, in this study, we used mitochondrial Cyt-b gene, microsatellite (SSR), and single nucleotide polymorphism (SNP) data to evaluate the demographic history and genetic structure of the eastern golden frog (Pelophylax plancyi), by sampling 407 individuals from 15 local populations across Shanghai, China. All local populations experienced bottlenecks during historical urbanization, while the local populations in urban areas maintained comparable contemporary effective population sizes (N e) and genetic diversity with suburban and rural populations. Nevertheless, the rapid modern urbanization has already imposed significant negative effects to the integrity of populations. The 15 local populations were differentiated into eight genetic clusters, showing a spatial distribution pattern consistent with the current urbanization gradient and island-mainland geography. Although moderate gene flow still occurred from the rural peripheral cluster to urban and suburban clusters, population fragmentation was more serious in the urban and suburban populations, where higher urbanization levels within 2-km radius areas showed significant negative relationships to the N e and genetic diversity of local populations. Therefore, to protect urban wildlife with limited dispersal ability, improving conditions in fragmented habitat remnants might be most essential for local populations living in more urbanized areas. Meanwhile, we highlight the need to preserve large unfragmented rural habitats and to construct corridor networks to connect discrete urban habitat remnants for the long-term wildlife conservation in intensively urbanizing environments.

Synoptic condition-driven summertime ozone formation regime in Shanghai and the implication for dynamic ozone control strategies

Regarding the continuous worsening of tropospheric ozone pollution, the scenario in Shanghai is a microcosm of the entire China. Understanding the ozone formation regimes (OFRs), their variations, and driving factors is a prerequisite for formulating effective ozone control strategies. Traditional OFR estimation by numerical model, which often involves sensitivity analysis on at least tens of scenarios, is labor-intensive and time-consuming; therefore, it is not appropriate to make OFR forecasts to guide ozone contingency control. In this study, by using a localized modeling system consisting of the Weather Research and Forecasting, Sparse Matrix Operator Kernel Emissions, and Community Multiscale Air Quality models and considering the latest emission inventory over the Yangtze River Delta of China, we discovered a strong connection between the variations of large-scale circulation (LSC) and OFRs over Shanghai in July 2017, thereby providing an alternative way to infer OFR. During the northward movement of Western Pacific Subtropical High from South China Sea, the wind field over Shanghai changed from weak westerly to moderate southwesterly and to one without a distinct direction. The local OFR shifted from anthropogenic volatile organic compounds (AVOCs)-limited to NO_x-limited and ultimately to the transitional regime. Such a variation in OFR is essentially driven by the spatial heterogeneity of NO_x and AVOC emissions in different directions of Shanghai, brought on by the wind under different LSC patterns. With the existing weather forecasting technology, the LSC patterns can be well-predicted 48-72 h in advance. Hence, we propose the adoption of a dynamic ozone control strategy for Shanghai with the priority control target on AVOC or NO_x emission sources adjusted according to the LSC pattern and OFR forecasts in a forthcoming O₃ pollution episode. This would serve to maximize the peak ozone reduction under varying pollution conditions.

Comparative Study on the Cooling Effects of Green Space Patterns in Waterfront Build-Up Blocks: An Experience from Shanghai

Different structural patterns of waterfront green space networks in built-up areas have different synergistic cooling characteristics in cities. This study’s aim is to determine what kinds of spatial structures and morphologies of waterfront green spaces offer a good cooling effect, combined with three different typical patterns in Shanghai. A multidimensional spatial influence variable system based on the cooling effect was constructed to describe the spatial structural and morphological factors of the green space network. The ENVI-met 4.3 software, developed by Michael Bruse at Bochum, German, was used to simulate the microclimate distribution data, combined with the boosted regression tree (BRT) model and the correlation analysis method. The results showed that at the network level, the distance from the water body and the connectivity of green space had a stronger cooling correlation. The orientation of green corridors consistent with a summer monsoon had larger cooling effect ranges. In terms of spatial morphology, the vegetation sky view factor (SVF) and Vegetation Surface Albedo (VS_Albedo) had an important correlation with air temperature (T), and the green corridor with a 20–25 m width had the largest marginal effect on cooling. These results will provide useful guidance for urban climate adaptive planning and design.

Air-pollutant mass concentration changes during COVID-19 pandemic in Shanghai, China

To curb the spread of the coronavirus, China implemented lockdown policies on January 23, 2020. The resulting extreme changes in human behavior may have influenced the air pollutants concentration. However, despite these changes, hazy weather persisted in Shanghai and became a public issue. This study aims to investigate air pollutant mass concentration changes during the lockdown in Shanghai. Air pollutant mass concentration data and meteorological data during the pre-lockdown period and the level I response lockdown period were analyzed by statistical analysis and a Lagrangian particle diffusion model. The data was classified in three periods: P1 (pre-lockdown: 10 days before the Spring Festival), P2 (the first 10 days after lockdown: during the Spring Festival celebration), and P3 (the second 10 days after lockdown: after the Spring Festival). Data for the same period in 2019 were used as a reference. The results indicate that the Spring Festival holiday in 2019 resulted in a reduction in energy consumption, which led to a decrease in PM_2.5 (26.4%) and NO₂ (43.41%) mass concentration, but an increase in ozone mass concentration (31.39%) in P2 compared with P1. The integrated effect of the Spring Festival holiday and lockdown in 2020 resulted in a decrease in PM_2.5 (36.5%) and NO₂ (51.9%) mass concentrations, but an increase in ozone mass concentration (43.8%) in P2 compared with P1. After the Spring Festival, the mass concentrations of PM_2.5, SO₂, and NO₂ increased by 74.41%, 5.52%, and 53.28%, respectively in P3 compared with P2 in 2019. However, PM_2.5 and SO₂ concentrations in 2020 continued to decrease, by 14.74% and 4.61%, respectively, while NO₂ mass concentration increased by 7.82% in P3 compared with P2. We also found that PM_2.5 mass concentration is susceptible to regional transmission from the surrounding cities. PM_2.5 and other gaseous pollutants show different correlations in different periods, while NO₂ and O₃ always show a strong negative correlation. The principal components before the Spring Festival in 2019 were O₃ and NO₂, and after the Spring Festival, they were PM_2.5 and CO, while the principal components before the lockdown in 2020 were PM_2.5 and CO, and during lockdown they were O₃ and NO₂.

Cross-Sectional Seroepidemiologic Study of Coronavirus Disease 2019 (COVID-19) among Close Contacts, Children, and Migrant Workers in Shanghai

(1) Background: Along with an increasing risk caused by migrant workers returning to the urban areas for the resumption of work and production and growing epidemiological evidence of possible transmission during the incubation period, a study of Coronavirus Disease 2019 (COVID-19) is warranted among key populations to determine the serum antibody against the SARS-CoV-2 and the carrying status of SARS-CoV-2 to identify potential asymptomatic infection and to explore the risk factors. (2) Method: This is a cross-sectional seroepidemiologic study. Three categories of targeted populations (close contacts, migrant workers who return to urban areas for work, and school children) will be included in this study as they are important for case identification in communities. A multi-stage sampling method will be employed to acquire an adequate sample size. Assessments that include questionnaires and blood, nasopharyngeal specimens, and feces collection will be performed via home-visit survey. (3) Ethics and Dissemination: The study was approved by the Institute Review Board of School of Public Health, Fudan University (IRB#2020-04-0818). Before data collection, written informed consent will be obtained from all participants. The manuscripts from this work will be submitted for publication in quality peer-reviewed journals and presented at national or international conferences.

[Analysis of cataract surgery status in public hospitals of Shanghai from 2013 to 2015]

Objective: To analyze the reasons that restrict the growth of cataract surgery service capacity in public hospitals in Shanghai in recent years. Methods: The status of surgeries performed in public hospitals are analyzed based on the data related to cataract surgery collected from the database of Shanghai Eye Disease Treatment. Meanwhile, the surgeries performed by ophthalmologists working in the public hospitals are studied based on the National ophthalmology service capacity questionnaire. Results: The cataract surgery volume performed in public hospitals of Shanghai increased from 45 480 in 2013 to 51 941 in 2015. In 2014, the year on year growth rate of cataract surgery volume in tertiary hospitals was 8.54%, while in 2015, it was -0.21% on an annual basis. More than 70% cataract surgeries were performed in tertiary public hospitals. For those performed in tertiary public hospitals, 80% were performed in urban area. The actual surgeons in tertiary account for 70% of the actual surgeons in all public hospitals. Among all cataract surgeries performed in secondary hospitals, half were performed in urban areas. The volume of cataract surgery by cataract surgeon and the number of the ophthalmologist were higher than those in secondary hospitals. The average cataract surgery volume of tertiary hospitals in urban areas and the average annual cataract surgery volume of the actual surgeons are much higher than those of the secondary hospitals in the urban areas, but it is contrary in exurban areas. Conclusion: The excessive density of tertiary hospitals in urban area and poor ophthalmology service capacity in secondary hospitals in suburban and exurban areas have restricted the rapid growth rate of cataract surgery and even a decline in Shanghai public hospitals. (Chin J Ophthalmol, 2020, 56: 615-620).

Regional and Urban-Scale Environmental Influences of Oceanic DMS Emissions over Coastal China Seas

Marine biogenic dimethyl sulfide (DMS) is an important natural source of sulfur in the atmosphere, which may play an important role in air quality. In this study, the WRF-CMAQ model is employed to assess the impact of DMS on the atmospheric environment at the regional scale of eastern coastal China and urban scale of Shanghai in 2017. A national scale database of DMS concentration in seawater is established based on the historical DMS measurements in the Yellow Sea, the Bohai Sea and the East China Sea in different seasons during 2009~2017. Results indicate that the sea-to-air emission flux of DMS varies greatly in different seasons, with the highest in summer, followed by spring and autumn, and the lowest in winter. The annual DMS emissions from the Yellow Sea, the Bohai Sea and the East China Sea are 0.008, 0.059, and 0.15 Tg S a⁻¹, respectively. At the regional scale, DMS emissions increase atmospheric sulfur dioxide (SO₂) and sulfate (SO42−) concentrations over the East China seas by a maximum of 8% in summer and a minimum of 2% in winter, respectively. At the urban scale, the addition of DMS emissions increase the SO₂ and SO42− levels by 2% and 5%, respectively, and reduce ozone (O₃) in the air of Shanghai by 1.5%~2.5%. DMS emissions increase fine-mode ammonium particle concentration distribution by 4% and 5%, and fine-mode nss-SO42− concentration distributions by 4% and 9% in the urban and marine air, respectively. Our results indicate that although anthropogenic sources are still the dominant contributor of atmospheric sulfur burden in China, biogenic DMS emissions source cannot be ignored.

[Spatial and Temporal Variation of Phytoplankton Community Structure and Its Influencing Factors in Shanghai River Channels]

In order to explore the spatial and temporal characteristics of the phytoplankton community structure and its influencing factors in Shanghai rivers, the water quality and phytoplankton community structure at 44 river channel sites in a central urban area, new town area, and rural area in Shanghai were investigated from September to October 2018 (autumn) and July to August 2019 (summer). The results showed that:① Chlorophyta was the dominant phyla during the autumn and summer, and was followed by Cyanobacteria and Bacillariophyta. Cyanobacteria dominated the phytoplankton community in terms of density. The number of species and density of phytoplankton were 24% and 2.77 times higher, respectively, than those during the summer and autumn. The dominance of Microcystis sp. was obvious during the autumn (Y=0.16), but there was no absolute dominant species during the summer. ② The difference in the number of phytoplankton species among the three regions was not significant, and the density of the total phytoplankton and cyanobacteria species showed a similar spatial pattern:rural area > new town area > central urban area. Additionally, no significant difference was observed in the total phytoplankton and Cyanobacteria density among the three regions during the autumn (P>0.05), whereas it was 1.82 and 1.93 times higher, respectively, in the rural area in comparison to the central urban area during the summer (P<0.05). Montecarlo test results revealed that the main factors affecting the phytoplankton community structure during the autumn were secchi disk transparency (SD), total phosphorus (TP), total nitrogen (TN), and turbidimetry (Turb), whereas these were TN, Turb, SD, and pH during the summer. ③ The results of a redundancy analysis (RDA) indicated that during the autumn, the phytoplankton in the rivers of the new town area were mainly affected by Turb, TN, and TP, while the rural rivers were mainly affected by SD. During the summer, the phytoplankton in the rivers of the new town and rural areas were mainly affected by TN and Turb. The influencing factors in the central urban area were complex.