Exposure to traffic-related air pollution and acute bronchitis in children: season and age as modifiers

Impact of fine particulate matter on latent tuberculosis infection and active tuberculosis in older adults: a population-based multicentre cohort study

Evidence showed that air pollution was associated with an increased risk of tuberculosis (TB). This study aimed to study the impact of long-term exposure to ambient particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5) on the acquisition of LTBI and on the risk of subsequent active disease development among rural older adults from a multicentre cohort, which have not yet been investigated to date. A total of 4790 older adults were included in a population-based, multicentre, prospective cohort study (LATENTTB-NSTM) from 2013 to 2018. The level of long-term exposure to PM2.5 for each participant was assessed by aggregating satellite-based estimates. Logistic regression and time-varying Cox proportional hazards models with province-level random intercepts were employed to assess associations of long-term exposures to PM2.5 with the risk of LTBI and subsequent development of active TB, respectively. Out of 4790 participants, 3284 were LTBI-free at baseline, among whom 2806 completed the one-year follow-up and 127 developed newly identified LTBI. No significant associations were identified between PM2.5 and the risk of LTBI. And among 1506 participants with LTBI at baseline, 30 active TB cases were recorded during the 5-year follow-up. Particularly, an increment of 5 μg/m3 in 2-year moving averaged PM2.5 was associated with a 50.6% increased risk of active TB (HR = 1.506, 95% CI: 1.161-1.955). Long-term air pollution might be a neglected risk factor for active TB development from LTBI, especially for those living in developing or less-developed areas where the air quality is poor.

Association of Fine Particulate Matter and Residential Greenness With Risk of Pulmonary Tuberculosis Retreatment: Population-Based Retrospective Study

Background

The evidence on the association of fine particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5) with pulmonary tuberculosis (PTB) retreatment is limited. There are no data on whether greenness exposure protects air pollution-related PTB retreatment in patients with prior PTB.

Objective

In a population-based retrospective study, we aimed to investigate the influence of PM2.5 and residential greenness on the risk of PTB retreatment.

Methods

A total of 26,482 patients with incident PTB, registered in a mandatory web-based reporting system between 2012 and 2019 in Zhengzhou, China, were included in the analysis. The exposure to PM2.5 was assessed based on the China High Air Pollutants dataset, and the level of greenness was estimated using the Normalized Difference Vegetation Index (NDVI) values. The associations of PTB retreatment with exposure to PM2.5 and greenness were evaluated, respectively, considering the local socioeconomic level indicated by the nighttime light index.

Results

Among the 26,482 patients (mean age 46.86, SD 19.52 years) with a median follow-up time of 1523 days per patient, 1542 (5.82%) PTB retreatments were observed between 2012 and 2019. Exposure to PM2.5 was observed to be significantly associated with the increased risk of PTB retreatment in fully adjusted models with a hazard ratio of 1.97 (95% CI 1.34-2.83) per 10 μg/m3 increase in PM2.5. Patients living in the regions with relatively high quartiles of NDVI values had a 45% lower risk of PTB retreatment than those living in the regions with the lowest quartile for the 500 m buffers (hazard ratio 0.55, 95% CI 0.40-0.77). Such a protective effect of residential greenness was more pronounced among patients living in lower nighttime light areas. The strength of the association between PM2.5 exposure and the risk of PTB retreatment was attenuated by greenness. No significant association was observed between NDVI and the incidence of drug resistance.

Conclusions

Long-term exposure to PM2.5 might be a risk factor for PTB retreatment, while an increased level of residential greenness was found to be associated with reduced risks of PTB retreatment. Our results suggest strengthening the control of ambient air pollution and improving residential greenness may contribute to the reduction of PTB retreatment.

The association between long-term exposure to ambient formaldehyde and respiratory mortality risk: A national study in China

INTRODUCTION

While ambient formaldehyde (HCHO) concentrations are increasing worldwide, there was limited research on its health effects.

OBJECTIVES

To assess the association of long-term exposure to ambient HCHO with the risk of respiratory (RESP) mortality and the associated mortality burden in China.

METHODS

Annual and seasonal RESP death and tropospheric HCHO vertical columns data were collected in 466 counties/districts across China during 2013-2016. A difference-in-differences approach combined with a generalized linear mixed-effects regression model was employed to assess the exposure-response association between long-term ambient HCHO exposure and RESP mortality risk. Additionally, we computed the attributable fraction (AF) to gauge the proportion of RESP mortality attributable to HCHO exposure.

RESULTS

This analysis encompassed 560,929 RESP deaths. The annual mean ambient HCHO concentration across selected counties/districts was 8.02×1015 ± 2.22×1015 molec.cm-2 during 2013-2016. Each 1.00×1015 molec.cm-2 increase in ambient HCHO was associated with a 1.61 % increase [excess risk (ER), 95 % confidence interval (CI): 1.20 %, 2.03 %] in the RESP mortality risk. The AF of RESP mortality attributable to HCHO was 12.16 % (95 %CI:9.33 %, 14.88 %), resulting in an annual average of 125,422 (95 %CI:96,404, 153,410) attributable deaths in China. Stratified analyses suggested stronger associations in individuals aged ≥65 years old (ER=1.87 %, 95 %CI:1.43 %, 2.32 %), in cold seasons (ER=1.00 %, 95 %CI:0.56 %, 1.44 %), in urban areas (ER=1.65 %, 95 %CI:1.15 %, 2.16 %), and in chronic obstructive pulmonary disease patients (ER=1.95 %, 95 %CI:1.42 %, 2.48 %).

CONCLUSIONS

This study suggested that long-term HCHO exposure may significantly increase the risk of RESP mortality, leading to a substantial mortality burden. Targeted measures should be implemented to control ambient HCHO pollution promptly.

Perinatal exposure to traffic related air pollutants and the risk of infection in the first six months of life: a cohort study from a low-middle income country

OBJECTIVE

There is limited study from low-and-middle income countries on the effect of perinatal exposure to air pollution and the risk of infection in infant. We assessed the association between perinatal exposure to traffic related air pollution and the risk of infection in infant during their first six months of life.

METHODS

A prospective cohort study was performed in Jakarta, March 2016-September 2020 among 298 mother-infant pairs. PM2.5, soot, NOx, and NO2 concentrations were assessed using land use regression models (LUR) at individual level. Repeated interviewer-administered questionnaires were used to obtain data on infection at 1, 2, 4 and 6 months of age. The infections were categorized as upper respiratory tract (runny nose, cough, wheezing or shortness of breath), lower respiratory tract (pneumonia, bronchiolitis) or gastrointestinal tract infection. Logistic regression models adjusted for covariates were used to assess the association between perinatal exposure to air pollution and the risk of infection in the first six months of life.

RESULTS

The average concentrations of PM2.5 and NO2 were much higher than the WHO recommended levels. Upper respiratory tract infections (URTI) were much more common in the first six months of life than diagnosed lower respiratory tract or gastro-intestinal infections (35.6%, 3.5% and 5.8% respectively). Perinatal exposure to PM2.5 and soot suggested increase cumulative risk of upper respiratory tract infection (URTI) in the first 6 months of life per IQR increase with adjusted OR of 1.50 (95% CI 0.91; 2.47) and 1.14 (95% CI 0.79; 1.64), respectively. Soot was significantly associated with the risk of URTI at 4-6 months age interval (aOR of 1.45, 95%CI 1.02; 2.09). All air pollutants were also positively associated with lower respiratory tract infection, but all CIs include unity because of relatively small samples. Adjusted odds ratios for gastrointestinal infections were close to unity.

CONCLUSION

Our study adds to the evidence that perinatal exposure to fine particles is associated with respiratory tract infection in infants in a low-middle income country.

Short-term effects of air pollutants on hospital admissions for asthma among older adults: a multi-city time series study in Southwest, China

Background

This study aimed to explore the relationship between air pollution and hospital admissions for asthma in older adults, and to further assess the health and economic burden of asthma admissions attributable to air pollution.

Methods

We collected information on asthma cases in people over 65 years of age from nine cities in Sichuan province, as well as air pollution and meteorological data. The relationship between short-term air pollutant exposure and daily asthma hospitalizations was analyzed using the generalized additive model (GAM), and stratified by gender, age, and season. In addition, we assessed the economic burden of hospitalization for air pollution-related asthma in older adults using the cost of disease approach.

Results

The single pollutant model showed that every 1 mg/m3 increase in CO was linked with an increase in daily hospitalizations for older adults with asthma, with relative risk values of 1.327 (95% CI: 1.116-1.577) at lag7. Each 10 μg/m3 increase in NO2, O3, PM10, PM2.5 and SO2, on asthma hospitalization, with relative risk values of 1.044 (95% CI: 1.011-1.078), 1.018 (95% CI: 1.002-1.034), 1.013 (95% CI: 1.004-1.022), 1.015 (95% CI: 1.003-1.028) and 1.13 (95% CI: 1.041-1.227), respectively. Stratified analysis shows that stronger associations between air pollution and asthma HAs among older adult in females, those aged 65-69 years, and in the warm season, although all of the differences between subgroups did not reach statistical significance. During the study period, the number of asthma hospitalizations attributable to PM2.5, PM10, and NO2 pollution was 764, 581 and 95, respectively, which resulted in a total economic cost of 6.222 million CNY, 4.73 million CNY and 0.776 million CNY, respectively.

Conclusion

This study suggests that short-term exposure to air pollutants is positively associated with an increase in numbers of asthma of people over 65 years of age in Sichuan province, and short-term exposure to excessive PM and NO2 brings health and economic burden to individuals and society.

Traffic safety and public health in China - Past knowledge, current status, and future directions

Transportation-related harms have developed into a social disease, threatening public safety and health in China. We aimed to increase the global understanding of traffic safety and public health in China from past knowledge, current status, and future directions by collecting, collating, and analyzing the Chinese traffic incidents reported in the published literature. A systematic search of China National Knowledge Infrastructure, Weipu, and published articles referenced in PubMed, Web of Science and ProQuest between January 1, 1988 and April 30, 2023 was performed. China encountered the first recorded traffic accident as early as three thousand years ago in the Shang Dynasty. An increase in vehicle capacity and velocity increased the traffic risks during the transition from rickshaws and livestock to motor vehicles in varying traffic environments. Humans are not only the decisive factor of a large number of vehicles, traffic routes, and environmental variables, but also the victims at the end and starting point of traffic accidents. Injuries (mechanical force, burns) and diseases (traffic-related air pollution, noise) caused by traffic activities not only threaten public health, but also cause risks to safe driving. Analysis of traffic activities and biomarkers promotes the treatment of traffic injuries in ethology and medicine. China prepared for the construction of healthy transportation in the "decade of road safety" toward an estimation of worldwide road traffic injuries in 2030. Improvement of traffic safety concerning public health under the "Outline of the National Comprehensive Three-dimensional Transportation Network Planning" in China will propel the realization of worldwide traffic environmental advancement.

Impact of short-term exposure to ambient air pollution on osteoarthritis: a multi-city time-series analysis in Central-Eastern China

Osteoarthritis (OA) is a threat to public health issue with high morbidity and disability worldwide. However, unequivocal evidence on the link between air pollution and OA remains little, especially in multi-study sites. This study aimed to explore the relationship between short-term exposure to main air pollutants and the risk of OA outpatient visits in multi-study sites. A multi-city time-series analysis was performed in Anhui Province, Central-Eastern China from January 1, 2015, to December 31, 2020. We used a two-stage analysis to assess the association between air pollution and daily OA outpatient visits. City-specific associations were estimated with a distributed lag nonlinear model and then pooled by random-effects or fixed-effects meta-analysis. Stratified analysis was conducted by gender, age, and season. Additionally, the disease burden of OA attributable to air pollutant exposure was calculated. A total of 35,700 OA outpatients were included during the study period. The pooled exposure-response curves showed that PM2.5 and PM10 concentrations below the reference values could increase the risk of OA outpatient visits. Concretely, per 10 ug/m3 increase in PM2.5 concentration was linked to an elevated risk of OA outpatient visits at lag 2 and lag 3 days, where the effect reached its highest value on lag 2 day (RR: 1.023, 95%CI: 1.005-1.041). We observed that a 10 μg/m3 increase in PM10 was positively correlated with OA outpatient visits (lag2 day, RR: 1.011, 95%CI: 1.001-1.025). Nevertheless, no statistical significance was discovered in gaseous pollutants (including SO2, O3, and CO). Additionally, a significant difference was found between cold and warm seasons, but not between different genders or age groups. This study reveals that particulate matter is an important factor for the onset of OA in Anhui Province, China. However, there is no evidence of a relationship of gaseous pollutants with OA in this area.

Short-term effects of high-resolution (1-km) ambient PM2.5 and PM10 on hospital admission for pulmonary tuberculosis: a case-crossover study in Hainan, China

Introduction

There is limited evidence regarding particulate matter (PM)'s short-term effects on pulmonary tuberculosis (PTB) hospital admission. Our study aimed to determine the short-term associations of the exposure to ambient PM with aerodynamic diameters <2.5 μm (PM2.5) and < 10 μm (PM10) with hospital admission for PTB in Hainan, a tropical province in China.

Methods

We collected individual data on patients hospitalized with PTB, PM2.5, PM10, and meteorological data from 2016 to 2019 in Hainan Province, China. Conditional logistic regression models with a time-stratified case-crossover design were used to assess the short-term effects of PM2.5 and PM10 on hospital admission for PTB at a spatial resolution of 1 km  ×  1 km. Stratified analyses were performed according to age at admission, sex, marital status, administrative division, and season of admission.

Results

Each interquartile range (IQR) increases in the concentrations of PM2.5 and PM10 were associated with 1.155 (95% confidence interval [CI]: 1.041-1.282) and 1.142 (95% CI: 1.033-1.263) hospital admission risks for PTB at lag 0-8 days, respectively. The stratified analyses showed that the effects of PM2.5 and PM10 were statistically significant for patients aged ≥65 years, males, married, and those residing in prefecture-level cities. Regarding seasonal differences, the associations between PM and hospital admission for PTB were statistically significant in the warm season but not in the cold season. The effect of PM2.5 was consistently stronger than that of PM10 in most subgroups.

Conclusion

Short-term exposure to PM increases the risk of hospital admission for PTB. The potential impact of PM with smaller aerodynamic diameter is more detrimental. Our findings highlight the importance of reducing ambient PM level to alleviate the burden of PTB.

Association Between Exposure to Ozone (O3) and the Short-Term Effect on Tuberculosis Outpatient Visits: A Time-Series Study in 16 Cities of Anhui Province, China

Introduction

Evidence has shown that air pollutant exposure plays a vital role in the progression of tuberculosis (TB). The aim of this research was to assess the short-term effects of ozone (O₃) exposure and TB outpatient visits in 16 prefecture-level cities of Anhui, China, 2015-2020.

Methods

Distributed lag nonlinear model (DLNM), Poisson generalized linear regression model and random effects model were applied in this study. The effects of different age and gender on TB were investigated by stratified analysis, and then we performed sensitivity analyses to verify the stability of the results.

Results

A total of 186,623 active TB cases were registered from January 1, 2015 to December 31,2020 in Anhui. The average concentration of ozone is 92.77 ± 42.95 μg/m³. The maximum lag-specific and cumulative relative risk (RR) of TB outpatient visits was 1.0240 (95% CI: 1.0170-1.0310, lag 28 days) for each 10 µg/m³ increase in O₃ in the single-pollutant model. Estimation for 16 prefecture-level cities indicated that the strong association between O₃ and the risk of TB outpatient visits was in tongling (RR = 1.0555, 95% CI: 1.0089-1.1042), Suzhou (RR = 1.0475, 95% CI: 1.0268-1.0687), wuhu (RR = 1.0358, 95% CI: 1.0023-1.0704). Stratified analysis showed that the health effects of ozone exposure remained significant in male and older adults, and there was no significant association between exposure to ozone in children and adolescents and the risk of tuberculosis.

Discussion

We found that ozone exposure increases the risk of TB infection in outpatient patients, with males and the elderly being more susceptible, and it is necessary for government departments to develop targeted publicity and prevention measures in response to the local air quality conditions.

Association between traffic-related air pollution and osteoporotic fracture hospitalizations in inland and coastal areas: evidences from the central areas of two cities in Shandong Province, China

Our result showed that short-term exposure to traffic-related air pollutants (TRAPs) might increase the risk of hospitalizations for osteoporotic fractures. It was suggested that government should formulate emission reduction policies to protect the health of citizens.

INTRODUCTION

As the main source of urban air pollution in China, exhaust emissions of motor vehicles have been linked to adverse health outcomes, but evidence of the relationship between short-term exposure to TRAPs and osteoporotic fractures is still relatively rare.

METHODS

In this study, a total of 5044 inpatients from an inland city (Jinan) and a coastal city (Qingdao), two cities with developed transportation in Shandong Province, were included. A generalized additive model (GAM) was used to investigate the association between TRAPs and hospitalizations for osteoporotic fractures. The stratified analyses were performed by gender and age.

RESULTS

Positive associations between TRAPs and osteoporotic fracture hospitalizations were observed. We found that short-term exposure to TRAPs was associated with increased numbers of hospitalizations for osteoporotic fractures. PM2.5 and PM10 were statistically significant associated with hospitalizations for osteoporotic fractures at both single-day and multiday lag structures only in Qingdao, with the strongest associations at lag06 and lag07 [RR=1.0446(95%CI: 1.0018,1.0891) for PM2.5, RR=1.0328(95%CI: 1.0084,1.0578) for PM10]. For NO2 and CO, we found significant associations at lag4 in the single lag structure in Jinan [RR=1.0354 (95%CI: 1.0071, 1.0646) for NO2, RR=1.0014 (95%CI: 1.0002, 1.0025) for CO], while only CO at lag4 was significantly associated with hospitalizations for osteoporotic fractures in Qingdao [1.0038 (1.0012, 1.0063)]. Stratified analyses indicated that the associations were stronger in females and older individuals (65 + years).

CONCLUSION

This study implied that short-term exposure to TRAPs pollution was associated with an increased risk of hospitalizations for osteoporotic fractures. Female patients and patients aged 65 + years appeared to be more vulnerable to TRAPs, suggesting that poor air quality is a modifiable risk factor for osteoporotic fractures.

Phytoremediation as a potential technique for vehicle hazardous pollutants around highways

With the synchronous development of highway construction and the urban economy, automobiles have entered thousands of households as essential means of transportation. This paper reviews the latest research progress in using phytoremediation technology to remediate the environmental pollution caused by automobile exhaust in recent years, including the prospects for stereoscopic forestry. Currently, most automobiles on the global market are internal combustion vehicles using fossil energy sources as the primary fuel, such as gasoline, diesel, and liquid or compressed natural gas. The composition of vehicle exhaust is relatively complex. When it enters the atmosphere, it is prone to a series of chemical reactions to generate various secondary pollutants, which are very harmful to human beings, plants, animals, and the eco-environment. Despite improving the automobile fuel quality and installing exhaust gas purification devices, helping to reduce air pollution, the treatment costs of these approaches are expensive and cannot achieve zero emissions of automobile exhaust pollutants. The purification of vehicle exhaust by plants is a crucial way to remediate the environmental pollution caused by automobile exhaust and improve the environment along the highway by utilizing the ecosystem's self-regulating ability. Therefore, it has become a global trend to use phytoremediation technology to restore the automobile exhaust pollution. Now, there is no scientific report or systematic review about how plants absorb vehicle pollutants. The screening and configuration of suitable plant species is the most crucial aspect of successful phytoremediation. The mechanisms of plant adsorption, metabolism, and detoxification are reviewed in this paper to address the problem of automobile exhaust pollution.

Emergency Department Visits in Children Associated with Exposure to Ambient PM1 within Several Hours

BACKGROUND

Emerging evidence has integrated short-term exposure to PM₁ with children's morbidity and mortality. Nevertheless, most available studies have been conducted on a daily scale, ignoring the exposure variations over the span of a day.

OBJECTIVE

The main intention of this study was to examine the association between pediatric emergency department visits (PEDVs) and intra-day exposures to PM₁ and PM_2.5. We also aimed to investigate whether a high PM₁/PM_2.5 ratio elevated the risk of PEDVs independent from PM_2.5 exposure within several hours.

METHODS

We collected hourly data on aerial PM₁ and PM_2.5 concentrations, all-cause PEDVs, and meteorological factors from two megacities (i.e., Guangzhou and Shenzhen) in southern China during 2015-2016. Time-stratified case-crossover design and conditional logistic regression analysis were used to assess the associations of PEDVs with exposures to PM₁ and PM_2.5 at different lag hours. The contribution of PM₁ to PM_2.5-associated risk was quantified by introducing PM₁/PM_2.5 ratio as an additional exposure indicator in the analysis adjusting for PM_2.5. Subgroup analyses were performed stratified by sex, age, and season.

RESULTS

During this study period, 97,508 and 101,639 children were included from Guangzhou and Shenzhen, respectively. PM₁ and PM_2.5 exposures within several hours were both remarkably related to an increased risk of PEDVs. Risks for PEDVs increased by 3.9% (95% confidence interval [CI]: 2.7-5.0%) in Guangzhou and 3.2% (95% CI: 1.9-4.4%) in Shenzhen for each interquartile range (Guangzhou: 21.4 μg/m³, Shenzhen: 15.9 μg/m³) increase in PM₁ at lag 0-3 h, respectively. A high PM₁/PM_2.5 ratio was substantially correlated with increased PEDVs, with an excess risk of 2.6% (95% CI: 1.2-4.0%) at lag 73-96 h in Guangzhou and 1.2% (95% CI: 0.4-2.0%) at lag 0-3 h in Shenzhen. Stratified analysis showed a clear seasonal pattern in PM-PEDVs relationships, with notably stronger risks in cold months (October to March of the following year) than in warm months (April to September).

CONCLUSIONS

Exposures to ambient PM₁ and PM_2.5 within several hours were related to increased PEDVs. A high PM₁/PM_2.5 ratio may contribute an additional risk independent from the short-term impacts of PM_2.5. These findings highlighted the significance of reducing PM₁ in minimizing health risks due to PM_2.5 exposure in children.

Associations of exposures to air pollution and greenness with mortality in a newly treated tuberculosis cohort

Some previous studies had linked air pollutants and greenness to the risk of death from tuberculosis (TB). Only a few studies had examined the effect of particulate matter (PM_2.5) on the mortality of TB, and few studies had assessed the impact and interaction of multiple air pollutants and greenness on the mortality of newly treated TB patients. The study included 29,519 newly treated TB patients from three cities in Anhui province. We collected meteorological data and five pollutants data from The National Meteorological Science Center and air quality monitoring stations. Greenness data were generated by remote sensing inversion of medium-resolution satellite images. We geocoded each patient based on the residential address to calculate the average exposure to air pollutants and the average greenness exposure for each patient during treatment. The Cox proportional risk regression model was used to evaluate the effects of air pollutants and greenness on mortality in newly treated tuberculosis patients. Our results found that the higher the concentration of air pollutants in the living environment of newly treated TB patients, the greater the risk of death: HR 1.135 (95% CI: 1.123-1.147) and HR 1.333 (95% CI: 1.296-1.370) per 10 μg/m³ of PM_2.5 and SO₂, respectively. Greenness reduced the mortality among newly treated TB patients: HR for NDVI exposure 0.936 (95% CI: 0.925-0.947), HR for NDVI_250m exposure 0.927 (95% CI: 0.916-0.938), and HR for NDVI_500m exposure 0.919 (95% CI: 0.908-0.931). Stratifying the cohort by median greenness exposure, HRs for air pollutants were lower in the high greenness exposure group. Mortality in newly treated TB patients is influenced by air pollutants and greenness. Higher green exposure can mitigate the effects of air pollution. Improving air quality may help reduce mortality among newly treated TB patients.

Short-term effect of ambient air pollution on outpatient visits for children in Guangzhou, China

This study examined the short-term relationship between ambient air pollutants and children's outpatient visits, and identified the effect of modifications by season. Daily recordings of air pollutants (CO, NO₂, O₃, SO₂, PM₁₀, and PM_2.5) and children's outpatient visit data were collected in Guangzhou from 2015 to 2019. A generalized additive model adjusted for potential confounding was introduced to verify the association between ambient air pollution and outpatient visits for children. Subgroup analysis by season was performed to evaluate the potential effects. A total of 5,483,014 children's outpatient visits were recorded. The results showed that a 10 μg/m³ increase in CO, NO₂, O₃, SO₂, PM₁₀, and PM_2.5 corresponded with a 0.19% (95% CI: 0.15-0.24%), 2.46% (2.00-2.92%), 0.27% (0.07-0.46%), 7.16% (4.80-9.57%), 1.16% (0.83-1.49%), and 1.35% (0.88-1.82%) increase in children's outpatient visits on the lag0 of exposure, respectively. The relationships were stronger for O₃, PM₁₀, and PM_2.5 in the warm seasons, and for CO, NO₂, and SO₂ in the cool seasons. When adjusting for the co-pollutants, the effects of CO, NO₂, and PM₁₀ were robust. The results of this study indicate that six air pollutants might increase the risk of children's outpatient visits in Guangzhou, China, especially in the cool season.

Short-term effects and economic burden of air pollutants on acute lower respiratory tract infections in children in Southwest China: a time-series study

BACKGROUND

There are few studies on the effects of air pollutants on acute lower respiratory tract infections (ALRI) in children. Here, we investigated the relationship of fine particulate matter (PM_2.5), inhalable particulate matter (PM₁₀), sulfur dioxide (SO₂), and nitrogen dioxide (NO₂) with the daily number of hospitalizations for ALRI in children in Sichuan Province, China, and to estimate the economic burden of disease due to exposure to air pollutants.

METHODS

We collected records of 192,079 cases of childhood ALRI hospitalization between January 1, 2017 and December 31, 2018 from nine municipal/prefecture medical institutions as well as the simultaneous meteorological and air pollution data from 183 monitoring sites in Sichuan Province. A time series-generalized additive model was used to analyze exposure responses and lagged effects while assessing the economic burden caused by air pollutant exposure after controlling for long-term trends, seasonality, day of the week, and meteorological factors.

RESULTS

Our single-pollutant model shows that for each 10 μg/m³ increase in air pollutant concentration (1 μg/m³ for SO₂), the effect estimates of PM_2.5, PM₁₀, SO₂, and NO₂ for pneumonia reached their maximum at lag4, lag010, lag010, and lag07, respectively, with relative risk (RR) values of 1.0064 (95% CI, 1.0004-1.0124), 1.0168(95% CI 1.0089-1.0248), 1.0278 (95% CI 1.0157-1.0400), and 1.0378 (95% CI, 1.0072-1.0692). By contrast, the effect estimates of PM_2.5, PM₁₀, SO₂, and NO₂ for bronchitis all reached their maximum at lag010, with RRs of 1.0133 (95% CI 1.0025-1.0242), 1.0161(95% CI 1.0085-1.0238), 1.0135 (95% CI 1.0025-1.0247), and 1.1133(95% CI 1.0739-1.1541). In addition, children aged 5-14 years were more vulnerable to air pollutants than those aged 0-4 years (p < 0.05). According to the World Health Organization's air quality guidelines, the number of ALRI hospitalizations attributed to PM_2.5, PM₁₀, and NO₂ pollution during the study period was 7551, 10,151, and 7575, respectively, while the incurring economic burden was CNY 2847.06, 3827.27, and 2855.91 million.

CONCLUSION

This study shows that in Sichuan Province, elevated daily average concentrations of four air pollutants lead to increases in numbers of childhood ALRI hospitalizations and cause a serious economic burden.

Air pollution and pediatric respiratory hospital admissions in Bursa, Turkey: A time series study

We aimed to investigate the relation between air pollution and the number of daily hospitalizations due to pneumonia, asthma, bronchitis in children aged 0-18 in Bursa city of Turkey, between the years 2013-2018. The daily values of air pollutants (PM10, SO2, NO2, NOx, CO, and O3) from 2013 until 2018, were obtained. Adjusted Quasi-Poisson regression models including distributed lags, controlled for climate variables were used for data analysis. Increases in SO2, ozone, PMs, and nitrogen oxides were associated with pneumonia hospitalizations, increases in SO2 NOx and PMs were associated with asthma hospitalizations, and increases in SO2 and ozone were associated with bronchitis hospitalizations. Male hospitalization was related with SO2, ozone, and NOx; while female hospitalization was only related with SO2. This study showed that short-term exposure to air pollution is associated with an increased risk of pneumonia, asthma, and bronchitis hospitalization among children in Bursa.

Association between short-term exposure to air pollution and respiratory diseases among children in China: a systematic review and meta-analysis

OBJECTIVE

To assess the quantitative association between short-term exposure to air pollution and respiratory disease outpatient visits among children in China.

METHODS

We searched articles from 1 January 2000 to 31 December 2020 in six peer-reviewed literature databases following PRISMA guidelines.

RESULTS

Of 2668 records, 33 were included in meta-analysis. The pooled excess risks of respiratory disease outpatient visits among children in China per 10 μg/m³ increase were 0.75% (95% CI: 0.54%, 0.96%) for PM_2.5, 0.70% (95% CI: 0.50%, 0.89%) for PM₁₀, 0.82% (95% CI: 0.58%, 1.05%) for SO₂, 1.61% (95% CI: 1.25%, 1.98%) for NO₂ and 0.74% (95% CI: 0.01%, 1.46%) for O₃. In subgroup analysis, air pollution had a greater impact in southern or central cities, cold seasons, and areas with high relative humidity.

CONCLUSIONS

Short-term exposure to air pollution was significantly associated with an increased excess risk of respiratory disease outpatient visits among children in China.

Examining the role of nuclear and renewable energy in reducing carbon footprint: Does the role of technological innovation really create some difference?

The deployment of energy sources is considered the compassion of several United Nations Sustainable Development Goals (SDGs). Countries should keep balance with the three major proportions of the global energy trilemma: energy security, affordability, energy access, and ecological balance to construct a solid basis for competitiveness and prosperity. In this regard, this study examines the influence of nuclear energy, technological innovations, renewable energy, non-renewable energy, and natural resources on carbon footprint in the highest nuclear energy-producing countries from 1990 to 2019. To do this, we developed an inclusive and comprehensive empirical investigation and applied modern econometric approaches. Panel second-generation long-run cointegration advocates long-run associations among the series. The findings reveal that nuclear and renewable energy consumption extensively improve environmental excellence. Conversely, technological innovations and non-renewable energy significantly reduce environmental sustainability. Moreover, natural resources play an adverse role in long-run. The findings of the panel causality test discovered unidirectional causality is running from carbon footprint to nuclear energy. Additionally, bidirectional causality exists between technological innovations, renewables, non-renewables, and natural resources with carbon footprint. This recommends that these nations should integrate energy policy activities and develop energy strategy consistency by harmonizing the vital global nuclear energy aspects to assist a well-calibrated energy structure.

Roles of Ambient Temperature and PM2.5 on Childhood Acute Bronchitis and Bronchiolitis from Viral Infection

Studies have associated the human respiratory syncytial virus which causes seasonal childhood acute bronchitis and bronchiolitis (CABs) with climate change and air pollution. We investigated this association using the insurance claims data of 3,965,560 children aged ≤ 12 years from Taiwan from 2006−2016. The monthly average incident CABs increased with increasing PM2.5 levels and exhibited an inverse association with temperature. The incidence was 1.6-fold greater in January than in July (13.7/100 versus 8.81/100), declined during winter breaks (February) and summer breaks (June−August). The highest incidence was 698 cases/day at <20 °C with PM2.5 > 37.0 μg/m3, with an adjusted relative risk (aRR) of 1.01 (95% confidence interval [CI] = 0.97−1.04) compared to 568 cases/day at <20 °C with PM2.5 < 15.0 μg/m3 (reference). The incidence at ≥30 °C decreased to 536 cases/day (aRR = 0.95, 95% CI = 0.85−1.06) with PM2.5 > 37.0 μg/m3 and decreased further to 392 cases/day (aRR = 0.61, 95% CI = 0.58−0.65) when PM2.5 was <15.0 μg/m3. In conclusion, CABs infections in children were associated with lowered ambient temperatures and elevated PM2.5 concentrations, and the high PM2.5 levels coincided with low temperature levels. The role of temperature should be considered in the studies of association between PM2.5 and CABs.

Association of short-term exposure to air pollution with emergency visits for respiratory diseases in children

Ambient air pollutants are health hazards to children. This study comprised 773,504 emergency department visits (EDVs) at 0–14 years of age with respiratory diseases in southern China. All air pollutants were positively associated with EDVs of total respiratory diseases, especially pneumonia. NO₂, PM₁₀, and PM_2.5 had intraday effects and cumulative effects on asthma EDVs. The effect of SO₂, PM₁₀, and PM_2.5 on pneumonia EDVs was stronger in girls than in boys. The effect of NO₂ on acute upper respiratory tract infection EDVs was greater in children aged 0–5 years old; however, the effect of PM₁₀ on acute upper respiratory tract infection EDVs was greater in the 6–14 years group. In a two-pollutant model, NO₂ was associated with bronchitis and pneumonia, and PM₁₀ was associated with acute upper respiratory tract infection. In this time-series study, NO₂ and PM₁₀ were risk indicators for respiratory diseases in children.

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Air pollution associates with children emergency visits for respiratory diseases

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NO₂ and PM₁₀ are risk indicators for respiratory diseases in children

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Young children are more sensitive to gaseous pollutants

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School-age children are more sensitive to PM₁₀

Ambient ozone exposure induces ROS related-mitophagy and pyroptosis via NLRP3 inflammasome activation in rat lung cells

OBJECTIVE

To study the regulatory relationship between ozone-induced mitophagy and pyroptosis in lung epithelial cells.

RESULTS

First, type I primary alveolar epithelial cells and male Wistar rats were treated with ozone at different dosages. The ATP content and mitochondrial membrane potential significantly decreased in type I primary alveolar epithelial cells. The mitophagy-related markers and PINK1/Parkin pathway-related proteins, and the co-localization of LC3, Parkin, and mitochondria in type I alveolar epithelial cells indicated that ozone exposure triggered mitophagy. On the other hand, the reactive oxygen species (ROS) inhibitor NAC could significantly alleviate mitophagy in epithelial cells. After treatment with the mitophagy inhibitor MDIVI-1, the levels of the NLRP3 inflammasome, cleaved caspase-1, and N-gasdermin D (N-GSDMD) significantly decreased in the cells. Altogether, these results indicated that mitophagy can be triggered by ozone exposure, and subsequently induces cell death mediated by the NLRP3 inflammasome. Finally, the overexpression and knockdown of NLRP3 confirmed this conclusion.

CONCLUSION

Ozone exposure induced oxidative damage, leading to mitochondrial structural and functional damage. Ozone-induced ROS triggered mitophagy through the activation of the PINK1/Parkin signaling pathway, then pyroptosis through activation of the NLRP3 inflammasome.

The association between short-term exposure to ambient carbon monoxide and hospitalization costs for bronchitis patients: A hospital-based study

Ambient carbon monoxide (CO) is associated with bronchitis morbidity, but there is no evidence concerning its correlation with hospitalization costs for bronchitis patients. This study aimed to investigate the relationship between short-term ambient CO exposure and hospitalization costs for bronchitis patients in Chongqing, China. Baseline data for 3162 hospitalized bronchitis patients from November 2013 to December 2019 were collected. Multiple linear regression analysis was used to determine the association, delayed and cumulative, between short-term CO exposure and hospitalization costs. Additionally, subgroup analyses were performed by gender, age, season, and comorbidity. Positive association between CO and hospitalization costs for bronchitis patients was observed. The strongest association was observed at lag 015 days, with per 1 mg/m³ increase of CO concentrations corresponded to 5834.40 Chinese Yuan (CNY) (95% CI: 2318.71, 9350.08; P < 0.001) (845.97 US dollars) increment in hospitalization costs. Stratified analysis results showed that the association was more obvious among those males, elderly, with comorbidities, and in warm seasons. More importantly, there was strongest correlation between CO and bronchitis patients with coronary heart disease. In summary, short-term exposure to ambient CO, even lower than Chinese and WHO standards, can be associated with increased hospitalization costs for bronchitis. Controlling CO exposure can be helpful to reduce medical burden associated with bronchitis patients. The results also suggest that when setting air quality standards and formulating preventive measures, susceptible subpopulations ought to be considered.

Children's exposure to air pollution in a natural gas industrial area and their risk of hospital admission for respiratory diseases

The rapid expansion of the natural gas industry to meet the global demand have raised environmental health concerns. Few studies have found that areas with natural gas industrial activity have poor air quality. However, the negative health impacts of ambient air pollution in a natural gas industrial area remain unclear. This study aimed to explore the relationship between short-term exposure to air pollution and hospital admissions for respiratory diseases among children in a natural gas industrial area in Bintulu, Malaysia. Daily hospital admissions for respiratory diseases among children were collected from a hospital in Bintulu from 2010 to 2019. Data on six air pollutants (PM₁₀, PM_2.5, SO₂, NO₂, O₃, and CO) in the study area were obtained from the Department of Environment Malaysia. Quasi-Poisson time series regressions with distributed lag non-linear models (DLNM) were applied to explore the associations between ambient air pollution and childhood hospitalisations for respiratory diseases. Stratification analyses were performed by gender and age group to identify the vulnerable populations. A 10 μg/m³ increased PM_2.5 and SO₂ was associated with hospital admissions for respiratory diseases among children with the greatest relative risk of RR 1.089 (95% CI 1.001-1.183) at cumulative lag 0-2 days and RR 1.229 (95% CI 1.073-1.409) at cumulative lag 0-6 days, respectively. There was no significant association between short-term exposure of PM₁₀, NO₂, CO, and O₃ with childhood respiratory hospitalisation. The association between PM_2.5 and SO₂ exposure and hospital admissions for childhood respiratory diseases in the two pollutants model remained statistically significant. There were stronger associations in younger children aged 0-4 years and girls. This study reveals that short-term exposure to SO₂ was associated with a higher risk of respiratory hospitalisations among children in Bintulu than PM_2.5. Better air quality control is necessary for children's health living in the natural gas industrial area.

Association between traffic-related air pollution and anxiety hospitalizations in a coastal Chinese city: are there potentially susceptible groups?

Motor vehicle exhaust emissions have become the main source of urban air pollution in China, but few studies have explored the association of short-term exposure to traffic-related air pollutants (TRAPs) with anxiety disorders. Thus, we used an overdispersed, generalized additive model (GAM) to investigate the association between TRAPs and hospital admissions (HAs) for anxiety in Qingdao, a coastal Chinese city with high vehicle ownership. In addition, stratified analyses were performed by gender, age, season and hospitalization frequency (first admission and readmission). A positive association between TRAPs and HAs for anxiety was observed. Both inhalable particulate matter (PM₁₀) and nitrogen dioxide (NO₂) showed significant effects at lag 3 in the single-day lag structure, and each 10 μg/m³ increase in the concentrations was significantly associated with increases of 0.88% [95% confidence interval (CI): 0.04%, 1.72%] for PM₁₀ and 2.74% (0.45%, 5.08%) for NO₂ on anxiety hospitalizations. For fine particulate matter (PM_2.5) and carbon monoxide (CO), the strongest effects were found at lag05 and lag04 [2.67% (0.77%, 4.62%) and 0.19% (0.04%, 0.34%), respectively] in the multiday lag structure. The estimates of PM_2.5 were relatively robust after adjusting for other pollutants in the two-pollutant model. Stratified analyses indicated that the associations were stronger in females and younger individuals (<45 in age) than in males and elderly individuals (≥45 in age). Furthermore, the effects of PM_2.5 and CO were most obvious during the cold season. Regarding hospitalization frequency, only PM_2.5 was found to have a significant effect in the first-admission group. The results showed that short-term exposure to TRAPs, especially to PM_2.5, was significantly associated with the increased risk of daily HAs for anxiety, which can help clinicians and policymakers better understand the effects of TRAPs to implement targeted interventions.

Comparison of exposure to traffic-related pollutants on different commuting routes to a primary school in Jinan, China

Traffic-related pollutants seriously affect human health, and the commute time to and from school is the time when students are exposed greatest to traffic pollution sources. Field measurements were conducted with hand-held instruments while walking along two selected commuting routes in winter and spring. The measured data were then compared with background monitoring data, and the respiratory deposition dose (RDD) was calculated to assess the exposure risk. Particulate matter intake from 2018 to 2020 was calculated. In winter, the average concentrations of PM_2.5 and PM₁₀ were higher in the afternoon than in the morning. The highest concentration was 2.94 times greater than the background value. The low-concentration distribution area of the low-traffic route that is off the main road (route B) was more significant than that of the high-traffic route that is near the main road (route A). Moreover, the RDD of route B was consistently lower than that of route A, while the average annual amount of PM_2.5 inhalation on route B in 3 years was 16.3% lower than that on route A. Overall, route B is more suitable than route A for students to commute on foot. Based on the findings, a walking route located within a community is a good choice.

Short-term effect of ambient air pollutant change on the risk of tuberculosis outpatient visits: a time-series study in Fuyang, China

There is growing evidence that air pollution plays a role in TB, and most studies have been conducted in the core countries with inconsistent results. Few studies have comprehensively included the six common air pollutants, so they cannot consider whether various pollutants interact with each other. Our objectives were to investigate the association between short-term exposure to six common air pollutants and the risk of tuberculosis outpatient visits in Fuyang, China, 2015-2020. We combined the two models to explore the effects of exposure to six air pollutants on the risk of tuberculosis outpatient visits, including the Poisson generalized linear regression model and distributed lag non-linear model (DLNM). We performed stratified analyses for the season, type of cases, gender, and age. We used the lag-specific relative risks and cumulative relative risk obtained by increasing pollutant concentration by per 10 units to evaluate the connection between six air pollutants and TB; PM_2.5 (RR = 1.0018, 95% CI: 1.0004-1.0032, delay of 12 days) and SO₂ (RR = 1.0169, 95% CI: 1.0007-1.0333, lag 0-16 days) were 0.9549 (95% CI: 0.9389-0.9712, lag 0 day) and 0.8212 (95% CI: 0.7351-0.9173, 0-20-day lag). Stratified analyses showed that seasonal differences had a greater impact on TB, males were more likely to develop TB than females, older people were more likely to develop TB than younger people, and air pollution had a great impact on new cases. Exposure to O₃, CO, PM₁₀, PM_2.5, and NO₂ increases the risk of TB outpatient visits, except SO₂ which reduces the risk. The incidence of TB has seasonal fluctuations. It is necessary for the government to establish a sound environmental monitoring and early warning system to strengthen the monitoring and emission management of pollutants in the atmosphere. Management, prevention, and treatment measures should be developed for high-risk groups (males and older people), reducing the risk of TB by reducing their specific behaviors and changing their lifestyle. We need to pay more attention to the impact of seasonal effects on TB to protect TB patients and avoid a shortage of medical resources, and it is necessary for the government to develop some seasonal preventive measures in the future.

Cold Climate Impact on Air-Pollution-Related Health Outcomes: A Scoping Review

In cold temperatures, vehicles idle more, have high cold-start emissions including greenhouse gases, and have less effective exhaust filtration systems, which can cause up to ten-fold more harmful vehicular emissions. Only a few vehicle technologies have been tested for emissions below -7 °C (20 °F). Four-hundred-million people living in cities with sub-zero temperatures may be impacted. We conducted a scoping review to identify the existing knowledge about air-pollution-related health outcomes in a cold climate, and pinpoint any research gaps. Of 1019 papers identified, 76 were selected for review. The papers described short-term health impacts associated with air pollutants. However, most papers removed the possible direct effect of temperature on pollution and health by adjusting for temperature. Only eight papers formally explored the modifying effect of temperatures. Five studies identified how extreme cold and warm temperatures aggravated mortality/morbidity associated with ozone, particles, and carbon-monoxide. The other three found no health associations with tested pollutants and temperature. Additionally, in most papers, emissions could not be attributed solely to traffic. In conclusion, evidence on the relationship between cold temperatures, traffic-related pollution, and related health outcomes is lacking. Therefore, targeted research is required to guide vehicle regulations, assess extreme weather-related risks in the context of climate change, and inform public health interventions.

Influence of air pollutants on varicella among adults

Little attention has been paid to the relationship between air pollutants and varicella among adults. We used data collected in Qingdao, China from 2014 to 2019. A combination of quasi-Poisson generalized linear model (GLM) and distributed lag non-linear model (DLNM) was applied to evaluate the association between exposure to air pollutants and varicella. And the effects of exposure to extremely high concentration (at 97.5th percentile) and low concentration (at 2.5th percentile) of air pollutants on varicella were also calculated. The level II of GB3095-2012 was used as the reference. A 10 μg/m³ increase of PM_2.5 was significantly associated with an increased risk of varicella (lag day: 4, 5 and 6). The negative associations were found for NO₂ per 10 μg/m³ increase from lag 15 to 19 day. The high PM_2.5 concentration (135 μg/m³) was significantly associated with the increased risk of varicella (lag day: 6, 7). For NO₂, the negative association was found at high concentration (75 μg/m³) on lag 15 to 20 day; and the positive relationship was shown at low concentration (10 μg/m³) on lag 15 to 20 day. Exposure to PM_2.5 and NO₂ were significantly associated with the risk of varicella among adults.

Effects of Air Pollutants on Airway Diseases

Air pollutants include toxic particles and gases emitted in large quantities from many different combustible materials. They also include particulate matter (PM) and ozone, and biological contaminants, such as viruses and bacteria, which can penetrate the human airway and reach the bloodstream, triggering airway inflammation, dysfunction, and fibrosis. Pollutants that accumulate in the lungs exacerbate symptoms of respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). Asthma, a heterogeneous disease with complex pathological mechanisms, is characterized by particular symptoms such as shortness of breath, a tight chest, coughing, and wheezing. Patients with COPD often experience exacerbations and worsening of symptoms, which may result in hospitalization and disease progression. PM varies in terms of composition, and can include solid and liquid particles of various sizes. PM concentrations are higher in urban areas. Ozone is one of the most toxic photochemical air pollutants. In general, air pollution decreases quality of life and life expectancy. It exacerbates acute and chronic respiratory symptoms in patients with chronic airway diseases, and increases the morbidity and risk of hospitalization associated with respiratory diseases. However, the mechanisms underlying these effects remain unclear. Therefore, we reviewed the impact of air pollutants on airway diseases such as asthma and COPD, focusing on their underlying mechanisms.

Association between ambient air pollution and tuberculosis risk: A systematic review and meta-analysis

There is a growing body of evidence suggesting an association between air pollution exposure and tuberculosis (TB) incidence, but no meta-analysis has assembled all evidence so far. This review and meta-analysis aimed to derive a more reliable estimation on the association between air pollution and TB incidence. PubMed, Embase and Web of Science electronic databases were systemically searched for eligible literature. The PECO framework was used to form the eligibility criteria. Effect estimates and 95% confidence intervals (CIs) published in the included studies were pooled quantitatively. Seventeen articles met the inclusion criteria. The pooled estimates showed that long-term exposure to particulate matter with an aerodynamic diameter ≤10 μm (PM₁₀) was associated with increased incidence of TB (per 10 μg/m³ increase in concentrations of PM₁₀: risk ratios (RR) = 1.058, 95% CI: 1.021-1.095). Besides, long-term exposure to sulfur dioxide (SO₂) and nitrogen dioxide (NO₂) were significantly associated with TB incidence (per 1 ppb increase, SO₂: RR = 1.016, 95% CI: 1.001-1.031; NO₂: 1.010, 95% CI: 1.002-1.017). We did not find a significant association of PM_2.5, ozone (O₃) or carbon monoxide (CO) with TB risk, regardless of long-term or short-term exposure. However, in view of the 2016 ASA Statement and the biological plausibility of PM_2.5 damaging host immunity, the association between PM_2.5 and TB risk remains to be further established. This meta-analysis shows that long-term exposure to PM₁₀, SO₂ or NO₂ is associated with increased odds of TB, and the specific biological mechanisms warrant further research.

Associations of ultrafine and fine particles with childhood emergency room visits for respiratory diseases in a megacity

BACKGROUND

Ambient fine particulate matter with aerodynamic diameter less than 2.5 µm (PM_2.5) has been associated with deteriorated respiratory health, but evidence on particles in smaller sizes and childhood respiratory health has been limited.

METHODS

We collected time-series data on daily respiratory emergency room visits (ERVs) among children under 14 years old in Beijing, China, during 2015-2017. Concurrently, size-fractioned number concentrations of particles in size ranges of 5-560 nm (PNC_5-560) and mass concentrations of PM_2.5, black carbon (BC) and nitrogen dioxide (NO₂) were measured from a fixed-location monitoring station in the urban area of Beijing. Confounder-adjusted Poisson regression models were used to estimate excessive risks (ERs) of particle size fractions on childhood respiratory ERVs, and positive matrix factorisation models were applied to apportion the sources of PNC_5-560.

RESULTS

Among the 136 925 cases of all-respiratory ERVs, increased risks were associated with IQR increases in PNC_25-100 (ER=5.4%, 95% CI 2.4% to 8.6%), PNC_100-560 (4.9%, 95% CI 2.5% to 7.3%) and PM_2.5 (1.3%, 95% CI 0.1% to 2.5%) at current and 1 prior days (lag0-1). Major sources of PNC_5-560 were identified, including nucleation (36.5%), gasoline vehicle emissions (27.9%), diesel vehicle emissions (18.9%) and secondary aerosols (10.6%). Emissions from gasoline and diesel vehicles were found of significant associations with all-respiratory ERVs, with increased ERs of 6.0% (95% CI 2.5% to 9.7%) and 4.4% (95% CI 1.7% to 7.1%) at lag0-1 days, respectively. Exposures to other traffic-related pollutants (BC and NO₂) were also associated with increased respiratory ERVs.

CONCLUSION

Our findings suggest that exposures to higher levels of PNC_5-560 from traffic emissions could be attributed to increased childhood respiratory morbidity, which supports traffic emission control priority in urban areas.

Short-term effects of ambient temperature and pollutants on the mortality of respiratory diseases: A time-series analysis in Hefei, China

BACKGROUND

The air pollution has become an important environmental health problem due to its adverse health effect. The objective of this study was to investigate the effects of ambient temperature and pollutants on mortality of respiratory diseases (RD) in Hefei, China, a typical inland city.

METHODS

Nonlinear exposure-response dependencies and delayed effects of urban daily mean temperature (DMT) and pollutants were evaluated by distributed lag non-linear models (DLNM). To further explore this effect, different genders and ages were also examined by stratified analysis.

RESULTS

A total of 12876 deaths from RD were collected from January 1, 2014 to December 31, 2018 in Hefei, China. There was a U-shaped correlation between DMT and RD mortality, and the RD mortality rised by 11.6% (95% CI: 2.2-22.0%) when the DMT was 35.8 °C (reference temperature is 20 °C). The results show that risk of death with short-term exposure to elevated concentrations of PM₁₀ and SO₂ was not significant. The maximum hysteresis and cumulative relative risk (RR) of RD mortality were 1.012 (95% CI: 1.003 ~ 1.021, lag 0 day) and 1.072 (95% CI: 1.014 ~1.133, lag 10 days) for each 10 μg/m³ augment in NO₂; 1.005 (95% CI: 1.001-1.009, lag 0 day) and 1.027 (95% CI: 1.004-1.051, lag 10 days) for each 10 μg/m³ augment in O_3; a negative association between CO exposure and the cumulative risk of death was observed (RR = 0.964, 95% CI: 0.935-0.993, lag 07 days). Subgroup analysis showed the effect of high temperatures, NO_2, O₃ and CO exposure was still statistically significant for the elderly and male.

CONCLUSION

The present study found that short-term exposure to high temperature, NO_2, O₃ and CO were significantly associated with the risk of RD mortality and male as well as elderly are more susceptible to these factors.

Air Pollution Increases the Incidence of Upper Respiratory Tract Symptoms among Polish Children

A substantial proportion of airway disease’s global burden is attributable to exposure to air pollution. This study aimed to investigate the association between air pollution, assessed as concentrations of particulate matter PM2.5 and PM10 on the upper respiratory tract symptoms (URTS) in children. A nation-wide, questionnaire-based study was conducted in Poland in winter 2018/2019 in a population of 1475 children, comparing URTS throughout the study period with publicly available data on airborne particulate matter. A general regression model was used to evaluate the lag effects between daily changes in PM10 and PM2.5 and the number of children reporting URTS and their severity. PM10 and PM2.5 in the single-pollutant models had significant effects on the number of children reporting URTS. The prevalence of URTS: “runny nose”, “sneezing” and “cough” was positively associated with 12-week mean PM2.5 and PM10 concentrations. In the locations with the highest average concentration of PM, the symptoms of runny nose, cough and sneezing were increased by 10%, 9% and 11%, respectively, compared to the cities with the lowest PM concentrations. This study showed that moderate-term exposure (12 week observation period) to air pollution was associated with an increased risk of URTS among children aged 3–12 years in Poland. These findings may influence public debate and future policy at the national and international levels to improve air quality in cities and improve children’s health.

Epidemiological characteristics of tuberculosis and effects of meteorological factors and air pollutants on tuberculosis in Shijiazhuang, China: A distribution lag non-linear analysis

BACKGROUND

Tuberculosis (TB) is a serious public health problem in China. There is evidence to prove that meteorological factors and exposure to air pollutants have a certain impact on TB. But the evidence of this relationship is insufficient, and the conclusions are inconsistent.

METHODS

Descriptive epidemiological methods were used to describe the distribution characteristics of TB in Shijiazhuang in the past five years. Through the generalized linear regression model (GLM) and the generalized additive model (GAM), the risk factors that affect the incidence of TB are screened. A combination of GLM and distribution lag nonlinear model (DLNM) was used to evaluate the lag effect of environmental factors on the TB. Results were tested for robustness by sensitivity analysis.

RESULTS

The incidence of TB in Shijiazhuang showed a downward trend year by year, with seasonality and periodicity. Every 10 μg/m³ of PM₁₀ changes, the RR distribution is bimodal. The first peak of RR occurs on the second day of lag (RR = 1.00166, 95% CI: 1.00023, 1.00390); the second risk period starts from 13th day of lag and peaks on15th day (RR = 1.00209, 95% CI: 1.00076, 1.00341), both of which are statistically significant. The cumulative effect of increasing 10 μg/m³ showed a similar bimodal distribution. Time zones where the RR makes sense are days 4-6 and 13-20. RR peaked on the 18th day (RR = 1.02239, 95% CI: 1.00623, 1.03882). The RR has a linear relationship with the concentration. Under the same concentration, the RR peaks within 15-20 days.

CONCLUSION

TB in Shijiazhuang City showed a downward trend year by year, with obvious seasonal fluctuations. The air pollutant PM₁₀ increases the risk of TB. The development of TB has a short-term lag and cumulative lag effects. We should focus on protecting susceptible people from TB in spring and autumn, and strengthen the monitoring and emission management of PM₁₀ in the atmosphere.

Foreign investment and CO2 emissions: do technological innovation and institutional quality matter? Evidence from system GMM approach

The study examines the moderating role of institutional quality and technological innovation on the empirical relationship between FDI inflows and four indicator variables of CO2emissions in 40 Asian countries for the period 1996-2016, by using generalized method of moment (GMM) estimation. First, from non-interactive regression, FDI inflows have positive impacts on CO2emissions; over all, from our empirical results, we conclude that the moderating role of institutional quality and technological innovation is crucial in the nexus between FDI and carbon CO2emissions and the interaction between institutional quality indicators and FDI inflows significantly reduce the level of CO2 emissions. Furthermore, the significant moderating effect of technological innovation is observed on the association between FDI and CO2 emissions. The results are important for policy makers in setting up long- and short-term policy to protect environmental quality.

Differential effects of size-specific particulate matter on lower respiratory infections in children: A multi-city time-series analysis in Sichuan, China

Evidence on the short-term effects of size-specific particulate matter with aerodynamic diameter ≤2.5 μm (PM_2.5), ≤10 μm (PM₁₀), and their difference (PM_C) on children's Lower Respiratory Infections (LRI) is scare. This study aimed to estimate the differential effects of three size-specific PM on hospitalizations of children aged <18 years for pneumonia and bronchitis in 18 cities of southwestern China. The city-specific association was firstly estimated using the over-dispersed generalized additive model and then combined to obtain the regional average association. Further, to evaluate the robustness of the key findings, subgroup analyses and co-pollutant models were constructed. PM-related risks of LRI differed by PM fractions and cause-specific LRI. A 10 μg/m³ increment in PM_2.5_lag03, PM₁₀_lag06, and PM_C_lag06 was associated with a 0.79% (95% CI: 0.29%, 1.29%), 0.77% (95% CI: 0.13%, 1.41%), and 2.33% (95% CI: 1.23%, 3.44%) increase in children's LRI hospitalizations, respectively. After adjustment for gaseous pollutants, adverse effects of the three types of size-specific PM on pneumonia hospitalizations were stable, ranging from 0.29% (95% CI: 0.05%, 0.54%) for PM_2.5-2.50% (95% CI: 1.38%, 3.64%) for PM_C. Additionally, PM_C-related risk of bronchitis hospitalizations remained stable after adjustment for gaseous pollutants. Associations of pneumonia with PM_C and PM₁₀ in infants, bronchitis with PM_2.5 in children aged 6-17 years, pneumonia and bronchitis with PM_2.5, PM_C, and PM₁₀ in children aged 1-5 years were all statistical significant. Specifically, the effects of PM_2.5 on LRI hospitalizations increased by age, with the highest effect of 1.72% (95%CI: 1.01%, 2.43%) in children aged 6-17 years. Our study provided evidence for short-term effects of different PM fractions on children LRI hospitalizations in Southwestern China, which will be useful for making and promoting policies on air quality standards in order to protect children's health.

Intraday effects of outdoor air pollution on acute upper and lower respiratory infections in Australian children

Children's respiratory health are particularly vulnerable to outdoor air pollution, but evidence is lacking on the very acute effects of air pollution on the risk of acute upper respiratory infections (AURI) and acute lower respiratory infections (ALRI) in children. This study aimed to evaluate the risk of cause-specific AURI and ALRI, in children within 24 h of exposure to air pollution. We obtained data on emergency cases, including 11,091 AURI cases (acute pharyngitis, acute tonsillitis, acute obstructive laryngitis and epiglottitis, and unspecified acute upper respiratory infections) and 11,401 ALRI cases (pneumonia, acute bronchitis, acute bronchiolitis, unspecified acute lower respiratory infection) in Brisbane, Australia, 2013-2015. A time-stratified case-crossover analysis was used to examine the hourly association of AURI and ALRI with high concentration (95th percentile) of four air pollutants (particulate matters with aerodynamic diameter <10 μm (PM₁₀) and <2.5 μm (PM_2.5), ozone (O₃), nitrogen dioxide (NO₂)). We observed increased risk of acute tonsillitis associated with PM_2.5 within 13-24 h (odds ratio (OR), 1.45; 95% confidence interval [CI], 1.02-2.06) and increased risk of unspecified acute upper respiratory infections related to O₃ within 2-6 h (OR, 1.38, 95%CI, 1.12-1.70), NO₂ within 1 h (OR, 1.19; 95%CI, 1.01-1.40), and PM_2.5 within 7-12 h (OR, 1.21; 95%CI, 1.02-1.43). Cold season and nigh-time air pollution has greater effects on AURI, whereas greater risk of ALRI was seen in warm season and daytime. Our findings suggest exposures to particulate and gaseous air pollution may transiently increase risk of AURI and ALRI in children within 24 h. Prevention measures aimed at protecting children's respiratory health should consider the very acute effects of air pollution.

Short-term exposure to ambient particulate matter and outpatient visits for respiratory diseases among children: A time-series study in five Chinese cities

There was limited evidence regarding the association between short-term exposure to ambient particulate matter (PM) and respiratory outpatient visits among children at a multicity level. In this study, a time-series study was conducted among children aged 0-14 years in five Chinese cities from 2013 to 2018. City-specific effects of fine particles (PM_2.5), inhalable particles (PM₁₀) and coarse particles (PM_10-2.5) were estimated for time lags of zero up to seven previous days using the overdispersed generalized additive models after adjusting for time trends, meteorological variables, day of the week and holidays. Meta-analyses were applied to pool the overall effects, while the exposure-response (E-R) curves were evaluated using a cubic regression spline. The overall effects of PM were significantly associated with total and cause-specific respiratory outpatients among children, even at PM_2.5 and PM₁₀ levels below the current Chinese Ambient Air Quality Standards (CAAQS) Grade II. Each 10 μg/m³ increment in PM_2.5, PM₁₀ and PM_10-2.5 at lag 07 was associated with a 1.39% (95% CI: 0.38%, 2.40%), 1.10% (95% CI: 0.38%, 1.83%) and 2.93% (95% CI: 1.05%, 4.84%) increase in total respiratory outpatients, respectively. An E-R relationship was observed except for PM_2.5 in Beijing and PM₁₀ and PM_10-2.5 in Shanghai. The effects of PM were stronger in cold season in 3 southern cities, while it was stronger in transition season in 2 northern cities. In conclusion, short-term PM exposures were dose-responsive associated with increased respiratory outpatient visits among children, even for PM_2.5 and PM₁₀ levels below current CAAQS II in certain cities.

Review of epidemiological studies on air pollution and health effects in children

There is a growing body of literature on the adverse health effects of ambient air pollution. Children are more adversely affected by air pollution due to their biological susceptibility and exposure patterns. This review summarized the accumulated epidemiologic evidence with emphasis on studies conducted in Korea and heterogeneity in the literature. Based on systematic reviews and meta-analyses, there is consistent evidence on the association between exposure to ambient air pollution and children's health, especially respiratory health and adverse birth outcomes, and growing evidence on neurodevelopmental outcomes. Despite these existing studies, the mechanism of the adverse health effects of air pollution and the critical window of susceptibility remain unclear. There is also a need to identify causes of heterogeneity between studies in terms of measurement of exposure/outcome, study design, and the differential characteristics of air pollutants and population.

Particulate matter exposure and biomarkers associated with blood coagulation: A meta-analysis

OBJECTIVE

Find the correlation between particulate matter (PM) and biomarkers related to blood coagulation, offer medical evidence to sensitive indicators and carry out early diagnosis of cardiovascular diseases.

METHOD

A combination of computer and manual retrieval was used to search for the keywords in PubMed (584 records), Cochrane Library (28 records), Web of Science (162 records) and Embase (163 records). Finally, a total of 25 articles were included in this meta-analysis. Stata 13.0 was applied to examine the heterogeneity among the studies and to calculate the combined effect estimates, percent variation (%) and 95% CI by selecting corresponding models. Additionally, sensitivity analysis and publication bias test were also conducted.

RESULTS

Meta-analysis indicated that there was an association between PM_2.5 exposure (per 10 µg/m³ increase) and fibrinogen. With the increase of PM_2.5 exposure (per 10 µg/m³ increase), the content of fibrinogen revealed a high level (2.26%; 95% CI: 1.08-3.44%); and the increase of UFPs exposure (per 5000/cm³ increase) was correlated with some biomarkers such as cell surface antigen and protein ligand including ICAM-1, sCD40L, P-selectin, E-selectin and PAI-1 that indirectly related to blood coagulation, yielding a percent variation of 10.83% (95% CI: 3.49%-18.17%).

CONCLUSION

This meta-analysis expounded that PM-related biomarkers were associated with blood coagulation, and the relationship with fibrinogen was much stronger.

Changes in children's respiratory morbidity and residential exposure factors over 25 years in Chongqing, China

Background

Respiratory morbidity and mortality during childhood remains a major challenge for global health. Due to the rapid economic development in Chongqing, we expect substantial temporal changes in respiratory health status and environmental risk factors in children. By leveraging a historical dataset, this study aims to assess the changes in prevalence of respiratory symptoms and diseases, residential exposure factors, and their associations in school-age children over a period of 25 years.

Methods

This study involved two cross-sectional surveys conducted in Chongqing with a 25-year interval (2017 vs. 1993). Purpose sampling was used to conduct questionnaire surveys on school-age children in both surveys. Information collected include children’s respiratory health outcomes, family residential exposures, demographic information, and parental respiratory disease history. The changes of residential exposures as well as demographics were determined by chi-square test. Odds ratios were calculated to compare the prevalence of children’s respiratory symptoms and diseases between the two periods. Associations between children’s respiratory outcomes and exposure indicators were assessed using multivariate logistic regressions.

Results

The majority of residential exposure indicators improved in 2017, including sleep in shared room, cooking with coal, poor kitchen ventilation, cooking frequency, and parental smoking. Compared to the 1993 study, the adjusted risk for children’s wheezing was lower (OR: 0.38, 95% CI: 0.29, 0.49), but the risk for bronchitis was higher (OR: 1.89, 95% CI: 1.54, 2.31) in the 2017 study. Poor kitchen ventilation and parental smoking were linked to an increased risk of children’s wheezing (OR: 1.39, 95% CI: 1.02, 1.90) and bronchitis (OR: 1.51, 95% CI: 1.02, 2.21), respectively, while heating in winter was linked to an increased risk of phlegm (OR: 1.40, 95% CI: 1.03, 1.90) and wheezing (OR: 1.47, 95% CI: 1.07, 2.01) in the 1993 study. However, these residential exposure factors were no longer associated with the children’s respiratory diseases in the 2017 study.

Conclusions

Our study found improvement of residential exposures in Chongqing, a decline of prevalence of children’s wheezing but an increase of that of bronchitis from 1993 to 2017. Poor kitchen ventilation, heating in winter, and parental smoking were significant risk factors in the 1993 survey but, with significantly reduced prevalence in 2017, were not significantly associated with children’s respiratory morbidity in the latter survey.

Short term effects of air pollutants on hospital admissions for respiratory diseases among children: A multi-city time-series study in China

Evidence concerning short-term acute association between air pollutants and hospital admissions for respiratory diseases among children in a multi-city setting was quite limited. We conducted a time-series analysis to evaluate the association of six common air pollutants with hospital admissions for respiratory diseases among children aged 0-14 years in 4 cities (Guangzhou, Shanghai, Wuhan and Xining), China during 2013-2018. We used generalized additive models incorporating penalized smoothing splines and random-effect meta-analysis to calculate city-specific and pooled estimates, respectively. The exposure-response relationship curves were fitted using the cubic spline regression. Subgroup analyses by gender, age, season and disease subtype were also performed. A total of 183,036 respiratory diseases hospitalizations were recorded during the study period, and 94.1% of the cases were acute respiratory infections. Overall, we observed that increased levels of air pollutants except O₃, were significantly associated with increased hospital admissions for respiratory disease. Each 10 μg/m³ increase in PM_2.5, SO₂ and NO₂ at lag 07, PM₁₀ at lag 03 and per 1 mg/m³ increase in CO at lag 01 corresponded to increments of 1.19%, 3.58%, 2.23%, 0.51% and 6.10% in total hospitalizations, respectively. Generally, exposure-response relationships of PM_2.5 and SO₂ in Guangzhou, SO₂, NO₂ and CO in Wuhan, as well as SO₂ and NO₂ in Xining with respiratory disease hospitalizations were also found. Moreover, the adverse effects of these pollutants apart from PM_2.5 in certain cities remained significant even at exposure levels below the current Chinese Ambient Air Quality Standards (CAAQS) Grade II. Children aged 4-14 years appeared to be more vulnerable to the adverse effects of PM_2.5, SO₂ and NO₂. Furthermore, with the exception of O₃, the associations were stronger in cold season than in warm season. Short-term exposure to PM_2.5, SO₂, NO₂ and CO were associated, in dose-responsive manners, with increased risks of hospitalizations for childhood respiratory diseases, and adverse effects of air pollutants except PM_2.5 held even at exposure levels below the current CAAQS Grade II in certain cities.

Deep learning for predicting the occurrence of cardiopulmonary diseases in Nanjing, China

The efficiency of disease prevention and medical care service necessitated the prediction of incidence. However, predictive accuracy and power were largely impeded in a complex system including multiple environmental stressors and health outcome of which the occurrence might be episodic and irregular in time. In this study, we established four different deep learning (DL) models to capture inherent long-term dependencies in sequences and potential complex relationships among constituents by initiating with the original input into a representation at a higher abstract level. We collected 504,555 and 786,324 hospital outpatient visits of grouped categories of respiratory (RESD) and circulatory system disease (CCD), respectively, in Nanjing from 2013 through 2018. The matched observations in time-series that might pose risk to cardiopulmonary health involved conventional air pollutants concentrations and metrological conditions. The results showed that a well-trained network architecture built upon long short-term memory block and a working day enhancer achieved optimal performance by three quantitative statistics, i.e., 0.879 and 0.902 of Nash-Sutcliffe efficiency, 0.921% and 0.667% of percent bias, and 0.347 and 0.312 of root mean square error-standard deviation ratio for RESD and CCD hospital visits, respectively. We observed the non-linear association of nitrogen dioxide and ambient air temperature with CCD hospital visits. Furthermore, these two environmental stressors were identified as the most sensitive predictive variables, and exerted synergetic effect for two health outcomes, particular in winter season. Our study indicated that high-quality surveillance data of atmospheric environments could provide novel opportunity for anticipating temporal trend of cardiopulmonary health outcomes based on DL model.

[Monitoring metrics for short-term exposure to ambient ozone and pulmonary function and airway inflammation in healthy young adults]

OBJECTIVE

To assess the associations of different monitoring metrics for short-term exposure to ambient ozone (O3) with pulmonary function and airway inflammation in healthy young adults.

METHODS

A total of 97 healthy young college students were recruited and followed in a panel study conducted from December 2017 to June 2018. Each participant underwent 3 follow-up visits, and lung function and fractional exhaled nitric oxide (FeNO) were measured at each visit. Ambient air pollutant concentrations were obtained from the environment monitoring station of Beijing closest to the participant residences, and meteorological data were collected from China Meteorological Data Service Center. Linear mixed-effect models were applied to assess the associations between different monitoring metrics for ambient O3 short-term exposure with pulmonary function or airway inflammation in the healthy young adults.

RESULTS

During the study period, the P50 (P25, P75) values for ambient O3 concentration expressed as daily 1-hour maximum (O3-1 h max), daily maximum 8-hour average (O3-8 h max) and 24-hour average (O3-24 h avg) were 102.5 (76.8, 163.0) μg/m3, 91.1 (68.3, 154.3) μg/m3 and 61.6 (36.9, 81.7) μg/m3, respectively. The different monitoring metrics for short-term exposure to ambient O3 were significantly associated with reduced forced expiratory volume in the first second (FEV1) and increased FeNO. An interquartile range (IQR) increase in 6-d moving average of O3-1 h max (IQR=71.5 μg/m3) was associated with a 6.2% (95%CI: －11.8%, －0.5%) decrease in FEV1 and a 63.3% (95%CI: 13.8%, 134.3%) increase in FeNO. An IQR increase in 7-d moving average of O3-8 h max (IQR=62.0 μg/m3) was associated with a 6.2% (95%CI: －11.6%, －0.7%) decrease in FEV1and a 75.5% (95%CI: 19.3%, 158.0%) increase in FeNO. An IQR increase in 5-d moving average of O3-24 h avg (IQR=32.9 μg/m3) was associated with a 3.7% (95%CI: －7.1%, －0.2%) decrease in FEV1and a 25.3% (95%CI: 3.6%, 51.6%) increase in FeNO. There was no significant association between the three monitoring metrics for O3 exposure and peak expiratory flow (PEF).

CONCLUSION

Short-term exposure to ambient O3 was associated with decreased lung function and increased airway inflammation among the healthy young adults, and daily 1-hour maximum was more sensitively to the respiratory effects of O3.

Foreign investment and air pollution: Do good governance and technological innovation matter?

This article examines how good governance and technological innovation complement foreign direct investment (FDI) to mitigate carbon emissions in twenty-three emerging economies for the period 1996-2014. Based on the Generalized Method of Moments (GMM) approach, we established the following results: First, from the non-interactive regressions, FDI inflows have positive effects on the four indicators of carbon emissions while increasing governance quality and technological innovation have negative effects on these indicators. Second, from the interactive regressions, the interactions between FDI and both political and institutional governance decrease the level of CO₂ emissions. Moreover, the interactions between technological innovation and FDI reduce CO₂ emissions in all the estimated models, except in the model pertaining to CO₂ emissions from electricity and heat production; as a result, environmental quality is improved. Policy implications and future research directions are also discussed.

Effect modification of the short-term effects of air pollution on morbidity by season: A systematic review and meta-analysis

Studies of the health effects of air pollution have traditionally controlled for ambient temperature as a confounder, and vice versa. However, season might be an important factor contributing to adverse health effects of air pollution. Given the current inconsistencies in results of previous studies on the effect modification of air pollution on morbidity by season, a systematic review and meta-analysis was conducted to synthesize the current evidence on effects of season on air pollution and morbidity. The electronic databases including PubMed, Web of Science, Embase, CNKI, and Wanfang were used to identify papers published up to the 30st of November in 2019. We identified 4284 articles, after screening, eighty papers met the inclusion criteria. Significant effect modification of CO, O₃, SO₂ and NO₂ on morbidity by season was observed, with corresponding ratio of relative risk of 1.0009 (95% CI: 1.0001-1.0018), 1.0080 (95% CI: 1.0021-1.0138), 0.9828 (95% CI: 0.9697-0.9962) and 0.9896 (95% CI: 0.9824-0.9968), respectively. Season significantly modified the effect of CO on pneumonia, the effect of SO₂ on cardiovascular disease, the effect of PM₁₀ on stroke, and the effect of O₃ on stroke, asthma and pneumonia. The effect modifications of air pollution by season were similar among males and females, while the effect estimates seem to be higher among children under 18 years old and the elderly aged 75 or over. Further research is needed to better understand the mechanisms underlying the seasonal variance of the effect of air pollutants on morbidity.

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

BACKGROUND

The current evidence has presented mixed results between air pollutants exposure and the progression of tuberculosis (TB). The purpose of this study was to explore the association between short-term exposure to air pollutants and the risk of TB outpatient visits in Hefei, China.

METHODS

Time-series analysis was used to assess the effect of short-term exposure to ambient air pollutants on the risk of TB outpatient visits. A Poisson generalized linear regression model combined with a distributed lag non-linear model (DLNM) was applied to explore the association. The effects of different gender (male, female), age (≤65 years old, >65 years old) and season (cold season, warm season) on the risk of TB were investigated by stratified analysis. Sensitivity analyses were conducted to test the robustness of our findings.

RESULTS

A total of 22,749 active TB cases were identified from November 1, 2013 to December 31, 2018 in Hefei. The overall exposure-response curve showed that the concentration of particulate matter with aerodynamic diameter less than 2.5 μm (PM_2.5) and nitrogen dioxide (NO₂) exposure were positively correlated with the risk of TB outpatient visits, while ozone (O₃) and sulfur dioxide (SO₂) exposure were negatively correlated with the risk of TB outpatient visits. The maximum lag-specific and cumulative relative risk (RR) of TB outpatient visits were 1.057 [95%CI: 1.002-1.115, lag 3 day] and 1.559 (95%CI: 1.057-2.300, lag 13 days) for each 10 μg/m³ increase in PM_2.5; 1.026 (95% CI: 1.008-1.044, lag 0 day) and 1.559 (95%CI: 1.057-2.300, lag 07 days) for each 10 μg/m³ increase in NO₂; 0.866 (95% CI: 0.801-0.935, lag 5 day) and 0.852 (95%CI: 1.01-1.11, lag 0-14 days) for each 10 μg/m³ increase in SO₂ in the single-pollutant model. There was only a negative association between O₃ exposure and the cumulative risk of TB outpatient visits (RR = 0.960, 95%CI: 0.936-0.984, lag 07 days). Stratified analyses showed that the effects of SO₂ and O₃ exposure were different between warm and cold seasons. The effect of NO₂ exposure remained statistically significant in male, younger, and cold season subgroups. Besides, elderly people are more susceptible to PM_2.5 exposure.

CONCLUSION

This study suggests that exposure to PM_2.5, NO₂, SO₂, and O₃ are associated with the risk of TB outpatient visits. Seasonal variation may have a greater impact on the risk of TB outpatient visits compared with gender and age.

The correlation between PM2.5 exposure and hypertensive disorders in pregnancy: A Meta-analysis

OBJECTIVE

To find the correlation between exposure to PM_2.5 (fine particulate matter) and hypertensive disorders in pregnancy (HDP), and provide medical evidence for decreasing the incidence of hypertensive disorders in pregnancy.

METHOD

A combination of computer and manual retrieval was used to search for keywords in PubMed (385 records), Cochrane Library (20 records), Web of Science (419 records) and Embase (325 records). Finally, ten epidemiological articles were considered in this meta-analysis. Stata 13.0 was used to examine the heterogeneity among the studies and to calculate the combined effect value (OR, odds ratio) by selecting the corresponding models. Sensitivity analysis and publication bias test were also performed.

RESULTS

Meta-analysis indicated that there was an association between PM_2.5 exposure (per 10 µg/m³ increase) and hypertensive disorders in pregnancy (OR = 1.52, 95% CI: 1.24-1.87). Exposure to PM_2.5 (per 10 µg/m³ increase) enhanced the risk of pre-eclampsia (OR = 1.31, 95% CI: 1.07-1.61), but there was no evidence relating exposure to PM_2.5 to gestational hypertension (OR = 1.35, 95% CI: 0.98-1.87).

CONCLUSION

There is a significant link between exposure to PM_2.5 and hypertensive disorders in pregnancy. The first and the third trimester were more susceptible to PM_2.5 exposure. It is recommended to further strengthen protective measures against PM_2.5 during pregnancy.

A systematic review protocol of Tuina for children with acute bronchitis: A protocol for systematic review

BACKGROUND

Acute bronchitis (AB) is a common cause of childhood morbidity. Tuina, a kind of Chinese massage, is frequently used for the treatment of AB in children by traditional Chinese medicine doctors. However, there is no relevant systematic review show its effectiveness and safety. The study aims to evaluate the effectiveness and safety of Tuina for children with AB.

METHODS

The following electronic databases will be searched from the respective dates of database inception to January 1st, 2020: The Cochrane Library, Web of Science, the World Health Organization International Clinical Trials Registry Platform, Springer, EMBASE, MEDLINE, China National Knowledge Infrastructure, the Chinese Biomedical Literature Database, Wanfang database, the Chinese Scientific Journal Database, and other sources. All published randomized controlled trials and blinded researches that are relevant to the subject of interest only will be contained. Two independent researchers will operate article retrieval, duplication removing, screening, quality evaluation, and data analyses by Review Manager (V.5.3.5). Meta-analyses, subgroup analysis and/or descriptive analysis will be performed based on the included data conditions.

RESULTS

High-quality synthesis and/or descriptive analysis of current evidence will be provided from the bronchitis severity score, symptom, and quality-of-life questionnaires, the questionnaire of clinical symptoms of cough and sputum, Patient Satisfaction Scale and adverse reactions.

CONCLUSION

This study will provide the evidence of whether Tuina is an effective and safe intervention for children with AB.

PROSPERO REGISTRATION NUMBER

CRD42019140667.