Short-term association of particulate matter and cardiovascular disease mortality in Shanghai, China between 2003 and 2020

Objective

Evidence regarding the effects of particulate matter (PM) pollutants on cardiovascular disease (CVD) mortality remains limited in Shanghai, China. Our objective was to thoroughly evaluate associations between PM pollutants and CVD mortality.

Methods

Daily data on CVD mortality, PM (PM10 and PM2.5) pollutants, and meteorological variables in Shanghai, China were gathered from 2003 to 2020. We utilized a time-series design with the generalized additive model to assess associations between PM pollutants and CVD mortality. Additionally, we conducted stratified analyses based on sex, age, education, and seasons using the same model.

Results

We found that PM pollutants had a significant association with CVD mortality during the study period. Specifically, there was a 0.29% (95%CI: 0.14, 0.44) increase in CVD mortality for every 10 μg/m3 rise in a 2-day average (lag01) concentration of PM10. A 0.28% (95% CI: 0.07, 0.49) increase in CVD mortality was associated with every 10 μg/m3 rise in PM2.5 concentration at lag01. Overall, the estimated effects of PM10 and PM2.5 were larger in the warm period compared with the cold period. Furthermore, males and the older adult exhibited greater susceptibility to PM10 and PM2.5 exposure, and individuals with lower education levels experienced more significant effects from PM10 and PM2.5 than those with higher education levels.

Conclusion

Our findings suggested that PM pollutants have a substantial impact on increasing CVD mortality in Shanghai, China. Moreover, the impacts of air pollution on health may be altered by factors such as season, sex, age, and educational levels.

Iodine Excess May Lead to Low Exam Score in Children Aged 8-10 Years

Recent research has shown that iodine excess may damage children's intelligence. Years of monitoring results in Shanghai show the iodine status has approached the upper limit of the appropriate range for children aged 8-10 years, indicating a risk of iodine excess. We used multi-stage random sampling to select children. Sixteen districts of Shanghai were divided into five units based on geographic location, and one primary school was randomly selected from each unit. In each selected school, about 40 children aged 8-10 years were randomly recruited to measure their urinary iodine concentration (UIC), household salt iodine concentration (SIC), the score of the final unified exam of the last semester, and school canteen salt iodine concentration. The median UIC of 3213 children aged 8-10 years in Shanghai was 195.4 (122.0, 285.8) µg/L and exceeded 200 µg/L in 48.8% of the population. Household and school canteen iodized salt coverage rates were 60.3% and 82.5% respectively, and mean household and school canteen SICs were 21.51 ± 9.30 mg/kg and 25.29 ± 3.40 mg/kg respectively. By correcting for potential confounding factors, logistic regression demonstrated that compared to the adequate iodine status group, students in the slight iodine excess group were less likely to get "A" (score > 90) in math, Chinese, and English exams (Math: OR = 0.775, 95% CI = 0.660-0.911, P = 0.002; Chinese: OR = 0.707, 95% CI = 0.543-0.842, P < 0.001; English: OR = 0.720, 95% CI = 0.610-0.849, P < 0.001). In Shanghai, the iodine status of 8-10-year-old children is approaching the upper limit of the adequate range. Iodine excess in Shanghai may lead to low exam scores for students.

Analysis of the dynamics of common industrial solid waste based on input-output: A case study of Shanghai international metropolis in China

Rapid economic development inevitably leads to the discharge of a large amount of common industrial solid waste (CISW), which not only pollutes the environment but also restricts economic development in turn. In this study, a dynamic common industrial solid waste (DCISW) model is developed to analyze the retrospectively CISW development in Shanghai from 2000 to 2017 and simulate prospectively multi-perspective emission reduction measures. Specifically, the dynamic linkages between CISW and socio-economics are established at both the systematic and sectoral levels through input-output analysis, ecological network analysis, and related socio-economic indicators. Abatement measure simulations are conducted using RAS and other methods. The findings reveal that the growth of CISW in Shanghai is closely related to its fast-growing economy. The Others sector (OS) receives the most CISW from other sectors, while the Mining industry (MI) sends the most CISW to others. From production-based, consumption-based, and income-based perspectives, Chemical Products (CP) consistently remain the largest contributors. For the proposed waste generation intensity (WGI) indicator, the Mining industry (MI) is regarded as the main sector in all three perspectives. Moreover, the MI consistently emerges as the key sector of the system. CISW simulations indicate that improving the MI emission technology and increasing the MI output value will be top priorities for CISW emission reduction in Shanghai. This study is expected to provide scientific support to address the CISW problem in Shanghai and other similar fast-growing metropolises.

Pesticide residue and dietary intake risk of vegetables grown in Shanghai under modern urban agriculture in 2018-2021

Shanghai as an international metropolis is representative of modern urban agriculture in China, so it is of great significance to analyse the pesticide residue in vegetables grown in Shanghai. This study investigated the residue of 68 commonly used pesticides (divided into insecticides, fungicides, herbicides and plant growth regulators) in 7028 vegetable samples in Shanghai from 2018 to 2021, and estimated the dietary intake risk of these pesticides. These samples were divided into 6 categories. A total of 29.21% of vegetable samples had pesticide residues, and 0.47% of samples exceeded the maximum residue limits (MRLs) set by the national food safety standard of China. Leafy vegetables had the highest detection rate of pesticide residues (32.9%), multiple detection rate (12.2%), pesticide residue concentration (35.7 mg/kg), and the number of samples exceeding the MRL (30). There were 36 out of 68 pesticides detected in vegetables, and the top 3 were dimethomorph, propamocarb and acetamiprid. The target hazard quotient (THQ) and hazard index (HI) of these noticeablepesticides were all less than 1, illustrating that there may be no obvious health hazard for residents exposed to the pesticide levels. This study can promote the green development of the pesticide industry and provide important reference data for the monitoring of pesticide residues and their hazards under modern urban agriculture.

[Characteristics of Ozone Concentration in Shanghai and Its Associated Atmospheric Circulation Background During Summer Half-years from 2006 to 2021]

It is of great importance to scientifically evaluate the impact of weather and climate conditions on the occurrence of O3 pollution in order to improve the accuracy of O3 pollution forecasts， as well as to reasonably control and reduce the adverse effects of O3 pollution. The characteristics of O3 concentration and climate background were analyzed based on daily O3 concentration data， meteorological factors， and NCEP/NCER reanalysis data from 2006 to 2021 in Shanghai. In addition， the differences in atmospheric circulation situations during years with anomalous O3 concentrations were compared and diagnosed from the perspective of climatology. Additionally， the monthly O3 concentration prediction model （seasonal autoregressive integrated moving average with exogenous regressors， SARIMAX） was further established by adding the key meteorological factors. The results indicated that both the whole-year average and summer half-year average O3 concentrations in Shanghai were increasing with fluctuation， and the summer half-year average was much higher than the annual average， up to 36.2%. Furthermore， there was a significant negative correlation between O3 concentration and wind speed （correlation coefficient of -0.826） and a significant positive correlation with the frequency of static wind and the number of days in which the low cloud cover was less than 20% （correlation coefficients of 0.836 and 0.724， respectively）. The monthly mean O3 concentration had a clear periodicity， showing a pattern with a high concentration in the middle period （April to September） and a low concentration at the beginning and end of the periods. High O3 concentration years （2013-2021） were accompanied by more polluted days， lower average wind speed， more small wind （≤1.5 m·s-1） days， more days of low cloud cover of less than 20%， more days of high temperature， higher direct solar radiation， and more sunshine hours. When the location of the stronger West Pacific subtropical high was westward and southward in the summer half-year， Shanghai was influenced by an anomalous westerly wind， which was not conducive to the transportation of clean air from the sea to Shanghai and thus led to the high concentration of O3 pollution. When the long wave radiation emitted from the ground was low in the summer half-year， it was favorable for the increase in ground temperature and caused a high concentration of O3 pollution. Adding direct solar radiation， maximum temperature， and wind speed as exogenous variables to the monthly O3 forecast model could significantly improve the effectiveness of the monthly forecast， with the root mean square error decreasing by 47.7% （from 22 to 11.5） and the correlation coefficient increasing by 11.2% （from 0.819 to 0.911）， which could be applied to the practical prediction of monthly O3 concentration.

Impact of the COVID-19 pandemic on the prevalence of respiratory viral pathogens in patients with acute respiratory infection in Shanghai, China

Objective

This study aimed to evaluate the impact of nonpharmaceutical interventions (NPIs) taken to combat COVID-19 on the prevalence of respiratory viruses (RVs) of acute respiratory infections (ARIs) in Shanghai.

Methods

Samples from ARI patients were collected and screened for 17 respiratory viral pathogens using TagMan low density microfluidic chip technology in Shanghai from January 2019 to December 2020. Pathogen data were analyzed to assess changes in acute respiratory infections between 2019 and 2020.

Results

A total of 2,744 patients were enrolled, including 1,710 and 1,034 in 2019 and 2020, respectively. The total detection rate of RVs decreased by 149.74% in 2020. However, detection rates for human respiratory syncytial virus B (RSVB), human coronavirus 229E (HCoV229E), human coronavirus NL63 (HCoVNL63), and human parainfluenza virus 3 (HPIV3) increased by 91.89, 58.33, 44.68 and 24.29%, in 2020. The increased positive rates of RSVB, HPIV3, resulted in more outpatients in 2020 than in 2019. IFV detection rates declined dramatically across gender, age groups, and seasons in 2020.

Conclusion

NPIs taken to eliminate COVID-19 had an impact on the prevalence of respiratory viral pathogens, especially the IFVs in the early phases of the pandemic. Partial respiratory viruses resurged with the lifting of NPIs, leading to an increase in ARIs infection.

Development of Colloidal Gold-Based Immunochromatographic Strips for Rapid Detection and Surveillance of Japanese Encephalitis Virus in Dogs across Shanghai, China

Japanese encephalitis virus (JEV) causes acute encephalitis in humans and is of major public health concern in most Asian regions. Dogs are suitable sentinels for assessing the risk of JEV infection in humans. A neutralization test (NT) or an enzyme-linked immunosorbent assay (ELISA) is used for the serological detection of JEV in dogs; however, these tests have several limitations, and, thus, a more convenient and reliable alternative test is needed. In this study, a colloidal gold immunochromatographic strip (ICS), using a purified recombinant EDIII protein, was established for the serological survey of JEV infection in dogs. The results show that the ICSs could specifically detect JEV antibodies within 10 min without cross-reactions with antibodies against other canine viruses. The test strips could detect anti-JEV in serum with dilution up to 640 times, showing high sensitivity. The coincidence rate with the NT test was higher than 96.6%. Among 586 serum samples from dogs in Shanghai examined using the ICS test, 179 (29.98%) were found to be positive for JEV antibodies, and the high seropositivity of JEV in dogs in China was significantly correlated with the season and living environment. In summary, we developed an accurate and economical ICS for the rapid detection of anti-JEV in dog serum samples with great potential for the surveillance of JEV in dogs.

Urinary neonicotinoids and metabolites are associated with obesity risk in Chinese school children

BACKGROUND

Neonicotinoids are the most widely used insecticides. Laboratory studies have suggested that neonicotinoids are one potential obesogen, but relevant data are limited in human.

OBJECTIVE

To examine the association between exposure to neonicotinoids and childhood obesity.

METHODS

We investigated 442 children in Shanghai, East China and measured eight neonicotinoids (thiamethoxam, clothianidin, acetamiprid, imidacloprid, thiacloprid, nitenpyram, dinotefuran, and imidaclothiz) and four metabolites (N-desmethyl-thiamethoxam, N-desmethyl-clothianidin, N-desmethyl-acetamiprid, and 5-OH-imidacloprid) in urine. Body mass index (BMI) and waist circumference (WC) were used to identify general overweight/obesity and central obesity, respectively. Linear and logistic regression models based on generalized estimating equations were used to investigate the associations of urinary neonicotinoids and metabolites with BMI z-score, WC z-score, general overweight/obesity, and central obesity.

RESULTS

Children with a positive detection of clothianidin and its metabolite had a marginally higher BMI z-score (regression coefficient (β): 0.08, 95% confidence interval (95% CI): 0.01, 0.14) after adjusted for relevant covariates. After creatinine-adjusted concentration was trichotomized, compared to children with a negative detection, children in the high urinary concentration of acetamiprid and its metabolite had a low BMI z-score (β: -0.19, 95%CI: -0.30, -0.08), children in the medium urinary concentration of neonicotinoids and metabolites other than thiamethoxam, clothianidin, acetamiprid, and their metabolites had a marginally higher BMI z-score (β: 0.25, 95%CI: 0.03, 0.46), a higher WC z-score (β: 0.24, 95%CI: 0.14, 0.33), and a higher odds of central obesity (odds ratio (OR): 2.16, 95% CI: 1.28, 3.63), and children in the medium urinary concentration of all neonicotinoids and metabolites had a higher odds of central obesity (OR: 1.55, 95%CI: 1.04, 2.33). Some associations showed sex- and age- related differences.

CONCLUSION

Urinary neonicotinoids and metabolites were found to be differently associated with obesity-related indexes, which suggested that exposure to neonicotinoids might have a mixed effect on childhood obesity.

The Outbreak of Acute Primary Angle-Closure Cases During the COVID-19 Omicron Variant Pandemic at a Tertiary Eye Center in Shanghai

Purpose

This study aimed to investigate the outbreak of acute primary angle-closure (APAC) during the COVID-19 Omicron variant pandemic in Shanghai.

Methods

This single-center retrospective observational study included all newly diagnosed patients with APAC in Eye, Ear, Nose, and Throat Hospital of Fudan University from December 15, 2022, to January 14, 2023 (pandemic group) during the COVID-19 pandemic of Omicron Variant, and from November 15, 2021, to February 14, 2022 (control group) when the infection rate of COVID-19 is very low in Shanghai. Demographic features, intraocular pressure, axial length, anterior chamber depth, lens thickness and pupil diameter were compared between the two groups.

Results

A total of 223 patients (261 eyes) were included in the pandemic group and 75 patients (82 eyes) in the control group. The number of APAC patients and eyes in the pandemic group is 8.92-fold and 9.55-fold of the monthly average number in the control group. The onset dates of acute angle-closure were mainly between December 17 and December 31, 2022. In the pandemic group, 72.65% of patients with APAC had a recent COVID-19 infection. Among the COVID-19-positive patients, 72% suffered APAC attacks within 24h of the occurrence of COVID-19 symptoms and 92% within 3 days. The pandemic group showed a longer time from symptoms to treatment and larger pupil diameter than the control group (7.92 ± 6.14 vs 3.63 ± 2.93 days, p = 0.006; 4.53 ± 1.17 vs 3.78 ± 1.24 mm, p = 0.003, respectively).

Conclusion

An outbreak of APAC attack was observed in our eye center during the COVID-19 Omicron variant pandemic in Shanghai. There may be a correlation between the onset of APAC and new COVID-19 Omicron variant infection, but the exact reason needs to be investigated further.

Multi-class organic pollutants in PM2.5 in mixed area of Shanghai: Levels, sources and health risk assessment

The occurrence of 25 multi-class pollutants comprising phthalate esters (PAEs), polycyclic aromatic hydrocarbons (PAHs), and synthetic musks (SMs) were studied in PM2.5 samples collected at an industrial/commercial/residential/traffic mixed area in Shanghai during four seasons. During the whole period, a slight exceedance of the PM2.5 annual limit was observed, with an average of 36.8 μg/m3, and PAEs were the most predominant, accounting for >70 % of the studied organic pollutants in PM2.5, followed by PAHs and SMs. Statistically significant differences were observed for the concentrations of PM2.5, PAEs, PAHs, and SMs in winter and summer. This seasonal variation could be derived from anthropogenic activities and atmospheric dynamics. Principal component analysis (PCA) and PAHs ratios suggested a mixed source mainly derived from vehicle emissions and industrial processes. Moreover, gaseous pollutants were also accounted for, indicating the emission of PAHs might accompany the NO2 emission process. Finally, inhalation of PM2.5-bound organic pollutants for carcinogenic and non-carcinogenic risks were estimated as average values for each season, showing outside the safe levels in autumn and winter in some cases, suggesting that new policies should be to developed to reduce their emissions and protect human health in this area.

Heavy metal contamination in Shanghai agricultural soil

As heavy metals in soil could enrich in biomass and pose health risk to human, it is vital to monitor their contaminations to ensure qualified agricultural production. In this study, we collected >4000 soil samples from agricultural fields in Shanghai during 2010∼2020, and unveiled heavy metal contamination status in this metropolitan. We found that although Shanghai has a long industrialization history, the heavy metal levels in agricultural soil are within safe ranges according to national standard. Specifically, the median levels of Cd, Hg, As, Pb, Cr and Cu are 0.11, 0.13, 7.47, 23.80, 41.00 and 28.30 mg/kg, respectively, which are as good as, or even better than national averages. However, there are spatial and temporal heterogeneities for heavy metal contaminations in Shanghai. For example, the levels of Cd, Hg and Cr are relatively higher in some districts with high industry density, which should be further monitored in the future. Moreover, while the levels for Cd, Cr and Pb have decreased, the level for Hg has mildly increased during this period which needs counteractive measures. Correlation analysis of heavy metal levels and soil fertility parameters suggested overuse of fertilizers may be related to heavy metal contamination in some regions. In summary, our study present by far the largest and most comprehensive landscape of heavy metal contamination in Shanghai agricultural soil, which will be useful for future policy-design and land use planning to ensure safe agricultural production.

Identifying spatial heterogeneity of COVID-19 transmission clusters and their built-environment features at the neighbourhood scale

The identification of high-risk areas for infectious disease transmission and its built-environment features are crucial for targeted surveillance and early prevention efforts. While previous research has explored the association between infectious disease incidence and urban built environment, the investigation of spatial heterogeneity of built-environment features in high-risk areas has been insufficient. This paper aims to address this gap by analysing the spatial heterogeneity of COVID-19 clusters in Shanghai at the neighbourhood scale and examining associated built-environment features. Using a spatiotemporal clustering algorithm, the study analysed 1395 reported cases in Shanghai from March 6 to March 17, 2022. Both global Poisson regression (GPR) and geographically weighted Poisson regression (GWPR) models were applied to examine the association between built-environment variables and the size of COVID-19 clusters. Our findings suggest that larger COVID-19 clusters emerging in the suburbs compared with the downtown and multiple built-environment features are significantly associated with this pattern. Specifically, neighbourhoods with a higher proportion of commercial, public service and industrial land, higher centrality of metro stations, and proximity to hospitals are positively associated with larger COVID-19 clusters, while neighbourhoods with higher land use mix and green/open spaces density are associated with smaller COVID-19 clusters. Moreover, we identified that metro stations with high centrality present the highest risk in the downtown, while commercial and public service places exhibit the highest risk in the suburbs. By highlighting the overlooked spatial heterogeneity of built-environment features for high-risk areas, this study aims to provide valuable guidance for public health departments in implementing place-based interventions to effectively prevent the spread of potential epidemics.

Determination of Urban Formaldehyde Emission Ratios in the Shanghai Megacity

We analyzed two data sets of atmospheric formaldehyde (FA) at an urban site in the Shanghai megacity during the summer of 2017 and the winter of 2017/18, with the primary objective of determining the emission ratio of formaldehyde versus carbon monoxide (CO). Through the photochemical age method and the minimum R squared (MRS) method, we derived the summer urban formaldehyde release ratios of 3.37 ppbv (ppmv of CO)-1 and 4.04 ppbv (ppmv of CO)-1, respectively. The error of both estimations is within ±20%, indicating the consistency of the results. We recognized the hourly minimum emission ratios determined from the MRS method to be indicative of actual formaldehyde emission ratios. Similarly, the emission ratio in winter is determined to be 2.10 ppbv (ppmv of CO)-1 utilizing the MRS method. The findings provide significant insights into the potential impact of motor vehicle exhaust on formaldehyde emissions in urban areas. This work demonstrates that the formaldehyde emission ratio determined by the MRS method can be used to represent the emissions of the freshest air mass. Formaldehyde photolysis contributed an average of 9% to the free radical primary reaction rate (P(ROx)) as a single chemical species during the daytime in summer, which was lower than the 11% recorded in winter. Formaldehyde emission reduction positively impacts local ozone production, so models describing ozone formation in Shanghai during summer need to reflect these emissions accurately. Evidence of the crucial catalytic role of formaldehyde in particulate matter formation has been confirmed by recent research. A potentially effective way to decrease the incidence of haze days in autumn and winter in the future is therefore to focus on reducing formaldehyde emissions.

Variation in vitamin D status in infants and children: a two-year cross-sectional study in Shanghai, China

BACKGROUND

Vitamin D deficiency (VDD) is a public health problem. The variation in vitamin D status across regions and populations remains unclear, and there is a lack of consensus regarding the screening for VDD in individuals.

METHODS

Children who visited the hospital from January 2019 to December 2020 were included in this study. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured using an enzyme-linked immunosorbent assay. The cutoffs for serum 25(OH)D concentrations to define deficiency, insufficiency, and sufficiency were < 20 ng/mL, 20-30 ng/mL, and ≥ 30 ng/mL, respectively.

RESULTS

A total of 7285 children aged 0-11 years were assessed; the mean 25(OH)D level was 31.4 ng/mL, and the median 25(OH)D level was 30.7 (interquartile range 24.4, 37.5) ng/mL. The 25(OH)D level declined with age in clinical visiting children aged 0-11 years, but maintained a consistently high level in health examination children aged 4-11 years. The percentages of 25(OH)D < 20 ng/mL and 25(OH)D < 30 ng/mL were 10.0% and 43.8%, respectively. Higher percentages of VDD were found in clinical visiting children than in health examination children within the 6-11-year group (53.3% vs. 14.7%) and winter (44.3% vs. 15.4%).

CONCLUSION

Low vitamin D status (deficiency and insufficiency) was more common in clinic-visiting children than in health examinations, especially in schoolchildren and in the winter. The study implies the positive effects of vitamin D assessments included in child health checkups to optimize vitamin D status.

Characteristics of ambient air quality and its air quality index (AQI) model in Shanghai, China

Long-term observations indicate that, the ambient air quality in Shanghai continues to improve, however the synergistic effects between the air pollutants PM2.5, O3 and NO2 are also increasing. The concentration of chemical components included in PM2.5 is higher in moderately polluted air containing multiple pollutants. This suggests that air pollution metrics based on multi-pollutant synergy are more descriptive of ambient air quality than single-pollutant air quality index (AQI) models that may ignore the effect of synergy between pollutants on ambient air quality forecasts. Therefore, this study proposes a new multi-pollutant air quality index model (NMAQI) based on four air pollutants (PM2.5, SO2, NO2 and O3) that emphasizes the relationship between PM2.5, NO2 and O3 in ambient air. The model successfully categorized observational data into classes of good, moderate, and polluted air quality ratings. Verification of the NMAQI model using the PM2.5 chemical composition spectrum shows that the NMAQI model can more accurately classify samples with high concentrations of chemical components (often misclassified by AQI) into high pollution levels. The model has an improved capacity to assess the degree of pollution in urban ambient air and to reduce the risk of public exposure to highly polluted atmospheric environments.

Ambient black carbon variations and emission characteristics of typical Chinese vessels in the Yangtze River Delta, China

Black carbon (BC) has a significant impact on air quality, climate change, and human health. Studies on BC from vessel exhaust have been focused on in recent years. To realize the contribution of BC from vessels to ambient air quality, 28 months of BC variation were observed from February 2019 to May 2022, including 3 fishing moratoriums and 2 normal periods. The results showed that the average daily concentration of BC in the fishing moratorium was significantly lower than that in the normal period. The difference proportion of the BC concentration between 370 and 880 nm was calculated over the whole period. As a result, the mean difference value in the fishing moratorium from February to May was 0.06 ± 0.07, and the normal period was -0.02 ± 0.05. The aethalometer model indicated that BC was greatly affected by fossil fuel combustion in the normal period. The effect of vessel emissions on regional BC concentrations was considerable. In addition, 16 PAHs and 21 elements in PM emitted from 24 vessels of different types were sampled and analyzed in Dianshan Lake and the Taipu River. EC accounted for the highest proportion (23.64%) in the sample of small trawlers compared to the emissions from cargo ships with large tonnages. The component profiles of vessel exhaust showed that Zn, As, phenanthrene (Phe), anthracene (Ant), fluoranthene (Fla), and pyrene (Pyr) were the dominant species, although some of these species were mainly recognized as characteristic factors of coal combustion. To improve the accuracy of identifying the vessel source, the diagnostic ratios of Ant/(Ant + Phe), BaA/(BaA + Chr), Phe/Ant, and BaA/Chr were provided, and they exhibited the obvious characteristics of fuel combustion.

Characterization of avian influenza A (H4N2) viruses isolated from wild birds in Shanghai during 2019 to 2021

The H4 subtype of avian influenza viruses has been widely distributed among wild birds. During the surveillance of the avian influenza virus in Shanghai from 2019 to 2021, a total of 4,451 samples were collected from wild birds, among which 46 H4 subtypes of avian influenza viruses were identified, accounting for 7.40% of the total positive samples. The H4 subtype viruses have a wide range of hosts, including the spot-billed duck, common teal, and other wild birds in Anseriformes. Among all H4 subtypes, the most abundant are the H4N2 viruses. To clarify the genetic characteristics of H4N2 viruses, the whole genome sequences of 20 H4N2 viruses were analyzed. Phylogenetical analysis showed that all 8 genes of these viruses belonged to the Eurasian lineage and closely clustered with low pathogenic avian influenza viruses from countries along the East Asia-Australia migratory route. However, the PB1 gene of 1 H4N2 virus (NH21920) might provide its internal gene for highly pathogenic avian influenza H5N8 viruses in Korea and Japan. At least 10 genotypes were identified in these viruses, indicating that they underwent multiple complex recombination events. Our study has provided a better epidemiological understanding of the H4N2 viruses in wild birds. Considering the mutational potential, comprehensive surveillance of the H4N2 virus in both poultry and wild birds is imperative.

The digitized chronic disease management model: scalable strategies for implementing standardized healthcare and big data analytics in Shanghai

Background

Chronic disease management (CDM) falls under production relations, and digital technology belongs to the realm of productivity. Production relations must adapt to the development of productivity. Simultaneously, the prevalence and burden of chronic diseases are becoming increasingly severe, leveraging digital technology to innovate chronic disease management model is essential.

Methods

The model was built to cover experts in a number of fields, including administrative officials, public health experts, information technology staff, clinical experts, general practitioners, nurses, metrologists. Integration of multiple big data platforms such as General Practitioner Contract Platform, Integrated Community Multimorbidity Management System and Municipal and District-Level Health Information Comprehensive Platform. This study fully analyzes the organizational structure, participants, service objects, facilities and equipment, digital technology, operation process, etc., required for new model in the era of big data.

Results

Based on information technology, we build Integrated Community Multimorbidity Care Model (ICMCM). This model is based on big data, is driven by "technology + mechanism," and uses digital technology as a tool to achieve the integration of services, technology integration, and data integration, thereby providing patients with comprehensive people-centered services. In order to promote the implementation of the ICMCM, Shanghai has established an integrated chronic disease management information system, clarified the role of each module and institution, and achieved horizontal and vertical integration of data and services. Moreover, we adopt standardized service processes and accurate blood pressure and blood glucose measurement equipment to provide services for patients and upload data in real time. On the basis of Integrated Community Multimorbidity Care Model, a platform and index system have been established, and the platform's multidimensional cross-evaluation and indicators are used for management and visual display.

Conclusions

The Integrated Community Multimorbidity Care Model guides chronic disease management in other countries and regions. We have utilized models to achieve a combination of services and management that provide a grip on chronic disease management.

Association Between Sleep Duration and Stroke in Different Status of Metabolic Syndrome: A Cross-Sectional Study in Shanghai Adult Residents

Purpose

This study aimed to investigate the relationship between sleep duration (SD) and stroke, and examine the effects of SD on stroke with or without metabolic syndrome (Mets) and its components among the adult residents in Shanghai, China.

Participants and Methods

A total of 20,245 participants (51.72% male, mean age 44.66 years) were included from Shanghai Chronic Disease and Risk Factors Surveillance (SCDRFS) in 2017. The weighted logistic regressions were performed to examine the associations between SD and stroke in different status of Mets and its components.

Results

The mean SD was 7.51±0.03 h/d. After adjusting for all the potential factors, SD<6 h/d (OR=1.73, 95% CI: 1.35-2.20) or ≥10 h/d (OR=1.66, 95% CI: 1.08-2.57) was significantly positively associated with stoke in the total participants; moreover, in the non-Mets group, only SD<6 h/d (OR=1.77, 95% CI: 1.19, 2.64) significantly increased the risk of stroke; while, in the Mets group, SD<6 h/d (OR=1.80, 95% CI:1.17-2.76) and ≥10 h/d (OR=1.97, 95% CI: 1.00-3.88) both had a positive significantly association with stoke. In addition, the effects of SD<6 h/d on stroke were more pronounced among those with high WC (OR=2.24, 95% CI: 1.40-3.58) and high TG (OR=2.60, 95% CI: 1.86-3.62), and the effects of SD≥10 h/d on stroke were more evident among those with high TG (OR=2.28, 95% CI: 1.02-5.08) and high FBG (OR=2.58, 95% CI: 1.30-5.10).

Conclusion

Both short and long SD were significantly positively associated with stroke in the total participants, and the associations were stronger in the Mets group; conversely, in the non-Mets group, only short SD was significantly positively associated with stroke, and no significant association was observed between long SD and stroke. Therefore, more precise sleep measures may be needed to prevent stroke according to the different status of Mets.

Differences in the evolution of urban and rural surface thermal environment and their responses to urban renewal in Shanghai, China

The rapid and extensive urbanization has profound impacts on urban thermal environment. It is of great significance to comprehensively understand how urbanization affects the evolution of urban thermal environment for urban ecological safety, environmental quality, and residents' health. Based on daily land surface temperature (LST) products of MODIS Aqua satellite in the summer of 2002-2020, we investigated the evolution of urban-rural differences in surface summer thermal environment in Shanghai during 2002-2020 and its response to urban spatial renewal. We used normalized land surface temperature (NLST) and urban heat island ratio index (URI) as the surface thermal environment measurement indicators, by combining vegetation index and impervious surface cove-rage, and used M-K trend analysis and interpretation analysis. The results showed that the linear growth rate of LST in Shanghai was 0.09 ℃·a-1 (2002-2020), and that URI showed a trend of first increasing (2002-2010) and then decreasing (2010-2020). The mean summer LST was generally in the order of urban core>suburban>rural. 1.6% of the areas showed a significant cooling trend, of which 54.0% were distributed in the urban core. 39.5% of the regions showed a significant warming trend, of which 77.6% were distributed in the suburban. In general, there were concentrated significant cooling areas in the highly urbanized urban areas, while there was a significant warming trend in the suburban. The transformation from urban expansion to urban renewal was the main reason for the emergence of concentrated and significant cooling areas in the urban. Nearly 20% of the urban area showed a signi-ficant increase of vegetation coverage. Urban renewal projects such as gathering vegetation or dispersing impervious surfaces in highly urbanized areas are important ways to effectively improve the urban residential thermal environment.

Comprehensive Assessment of Pollution Sources and Health Impacts in Suburban Area of Shanghai

Shanghai, one of China's largest metropolises, faces significant environmental pollution challenges due to rapid economic development. Suburban areas of Shanghai are affected by both long-distance transport and local sources of pollutants. This study conducted an integrated analysis that links health-risk assessment of heavy metals and source apportionment of atmospheric constituents to distinguish the contributions of emission sources and the major sources of health risks. Source-apportionment analysis revealed that secondary sources had the greatest contribution to the local pollutants, indicating the significant influence of peripheral and long-distance transport. Health-risk assessment of Cr, Ni, As, and Cd revealed that local residents were exposed to respiratory health risks, in which Cr is the major contributor. This health risk was primarily associated with emissions from nearby industry-related sources. Our study highlights the significant effects of both long-distance transport and local source emissions on atmospheric composition and human health in large urban agglomerations. The findings can inform future efforts to develop more precise emission-reduction strategies and policy improvements to mitigate environmental pollution and protect public health.

Description of the medical services provided to children in Shanghai: a cross-sectional study of the characteristics and disparities of hospitals of different levels and types

Background

The development of the pediatric care system is uneven in China. Limited research has been conducted on pediatric care in Shanghai, which is a well-developed region in China, in which the National Children's Medical Centers are located.

Methods

In November 2021, under the commission of the Shanghai Center for Medical Quality Control, a city-wide questionnaire designed to examine the provision of medical services to children in Shanghai in 2020 was conducted at 86 hospitals providing pediatric care. The overall characteristics and disparities between the general hospitals and children's hospitals and suggestions for future developments were explored.

Results

In 2020, there were 86 hospitals providing pediatric care, covering all 16 municipal districts of Shanghai, with an average distribution of 1.4 hospitals per 100 km2. The hospitals were mainly public (94.2%) and general (96.5%) hospitals. With a response rate of 90.7%, the questionnaire results revealed that there were 2,683 in-service pediatricians in Shanghai, with an average of 1.1 pediatrician per 1,000 children aged 0-14 years in Shanghai. The pediatricians were mainly women (71.8%), aged 40 years or younger (60.6%), who held a bachelor's degree or higher (99.5%). The total number of pediatric outpatient and emergency visits was approximately 8 million, with an average of 2,973 visits per pediatrician in 2020. There were >370,000 visits to fever clinics. The number of pediatric inpatient visits exceeded 160,000, with an average hospital stay length of 5.8 days. The uneven development between the children's hospitals and general hospitals represents a major challenge facing Shanghai's pediatric care system, and the close links between the 2 types of hospitals need to be further strengthened.

Conclusions

Shanghai provides an overall superior medical service to children in China. The close link between the children's hospitals and general hospitals should be further strengthened to optimize the distribution of high-quality resources and greatly improve the overall provision of pediatric medical services.

Resilience assessment and obstacle factor analysis of urban areas facing waterlogging disasters: a case study of Shanghai, China

In recent years, accelerated global warming, rainstorms, typhoons, and other natural disasters have been frequently observed, bringing immeasurable direct and indirect economic losses to urban areas. Determining how to further enhance the resilience of urban areas has become an important topic in economic and social development. Therefore, based on waterlogging scenarios, this study uses a more accurate research method combining the subjective evaluation AHP (analytic hierarchy process) method and objective evaluation TOPSIS (Technique for Order of Preference by Similarity to Ideal Solution) method to evaluate the urban resilience of 16 districts of the Shanghai megacity as the research objects and divides the resilience grade results using the ArcGIS natural breakpoint method. The results show that (1) the overall resilience of all districts in Shanghai needs to be further improved. Among the 16 districts in Shanghai, Pudong New Area has the highest urban resilience level. There are more areas with moderate and above-moderate resilience levels, while some areas with low and moderate resilience levels are distributed mainly in the downtown area of Shanghai. (2) Through the analysis of obstacles to the development of urban resilience in the districts of Shanghai, such obstacles tend to be the same under the waterlogging disaster scenarios. Compared to ecological and social policy resilience indices, economic resilience indices and infrastructure resilience indices significantly impact the resilience of urban districts under waterlogging scenarios. The above conclusions can not only help improve the direction of urban resilience governance in various districts of Shanghai but also provide empirical theoretical experience for the resilient construction of urban areas in the future.

Dynamic zero-COVID strategy in controlling COVID-19 in Shanghai, China: A cost-effectiveness analysis

BACKGROUND

The sustainability and generalizability of China's dynamic zero-COVID strategy on eliminating SARS-CoV-2 transmission has casted doubt globally, mainly because it has exacted high social and economic cost. This study aimed to estimate the disease burden during the first wave of Omicron in China and compared the cost-effectiveness of implementing a Real-world strategy (adjusted dynamic zero-COVID strategy) with two simulated strategies (routine and stricter dynamic zero-COVID strategy) to inform appropriate strategies for COVID-19 pandemic control.

METHODS

A dynamic state-transition simulation model was developed to compare the health and cost outcomes between different dynamic zero-COVID strategies. Omicron-related healthcare costs were estimated from the societal perspective. Epidemiological parameter values were derived from data of real-world or generated by model calibration; costs and effectiveness parameter values were informed either by local data or published literature. The primary outcomes were total social cost, disability adjusted life-years (DALYs) and net monetary benefit (NMB). Deterministic sensitivity analyses (DSA) and scenario analyses were performed to assess the model robustness.

RESULTS

The first wave of Omicron in Shanghai resulted in 47,646 DALYs lost and 415 billion RMB losses. At a willingness-to-pay threshold of 173,630 RMB (the GDP per capita of Shanghai in 2021) per DALY saved, the Real-world strategy was considered as the most cost-effective strategy due to its highest NMB (-407 billion). Results from DSA confirmed the robustness of our findings.

CONCLUSION

Our finding supported the Real-world strategy taken by the Shanghai Municipal Government between March 1 and May 21, 2022 to control the first wave of Omicron outbreak. Moreover, our results indicated that whether the Stricter dynamic zero-COVID strategy is worth implementing at the beginning of the COVID-19 outbreak mainly depended on the infection rate of COVID-19 among primary contacts. Our analysis provides important evidence to inform policy makers to make appropriate decisions regarding COVID-19 pandemic management.

Impact of Newborn Screening Programme for Congenital Heart Disease in Shanghai: a five-year observational study in 801,831 newborns

Background

Newborn Screening Programme for Congenital Heart Disease (CHD) in Shanghai has been in operation for over 5 years, and its feasibility and effectiveness still lack a systematic and comprehensive evaluation. This study aimed to detail the implementation of the programme and evaluate its results, benefits, and reliability in clinical practice.

Methods

This study was an observational study involving all newborns received CHD screening in Shanghai from 2017 to 2021. Pulse oximetry (POX) plus cardiac murmur auscultation (namely the dual-index method) was used for CHD screening in newborns aged 6-72 h. Newborns who screened positive was recommended for echocardiography, and those diagnosed with CHD would be planned for further evaluation and intervention. Data were aggregated by birth year and district of birth. Results of neonatal CHD screening, diagnosis and treatment, and temporal trends of infant mortality rate (IMR) and the proportion of under-five mortality (U5M) attributed to CHD were analysed. A retrospective cohort study was also conducted to assess the reliability of the dual-index method in clinical practice.

Findings

In total, 801,831 (99.48%) newborns were screened for CHD, 16,489 (2.06%) were screened positive, and 3541 (21.47%) of the screened-positive newborns were identified with CHD. Seven hundred and fifty-two patients with CHD received surgical or interventional treatment with a successful rate of 94.81%. The period from 2015 to 2021 witnessed an approximately twofold decrease in IMR from 4.58‰ to 2.30‰, and a downtrend in the proportion of U5M attributed to CHD from 25.93% to 16.61%. High sensitivity and specificity of the dual-index method in clinical practice were observed for both critical (100.00% and 97.72%) and major CHD (98.47% and 97.76%).

Interpretation

Newborn screening programme for CHD has been well implemented in Shanghai, and this programme is a successful public health intervention to reduce infant death. Our study provides encouraging evidence and experience for implementing newborn screening programme for CHD nationwide in China.

Funding

This study was supported by the National Key Research and Development Programme of China (2021YFC2701004 and 2016YFC1000506), CAMS Innovation Fund for Medical Sciences (2019-I2M-5-002), and Three-Year Planning for Strengthening the Construction of Public Health System in Shanghai (No. GWIV-24).

A cross-sectional study on the need for and utilization of assistive walking devices by people age 55 and older in Shanghai

We conducted a study to analyze the unmet needs of and risk factors for use of assistive walking devices by the elderly based on sample survey data from Shanghai, China from July to October 2019. Among a total sample size of 11,193 people age 55 and older, 1,947 people (17.39%) needed assistive walking devices, 829 (42.58%) of whom needed but did not use those devices. Multivariate analysis indicated that residence, living alone or cohabitating, indoor handrails, the number of diseases, and IADL were factors influencing the unmet need for assistive walking devices (p < 0.05, respectively). People who lived in community health centers (p = 0.0104, OR = 1.956, 95% CI: 1.171-3.267) and those who lived only with their spouse (p = 0.0002, OR = 2.901, 95% CI: 1.641-5.126) were more likely to have an unmet need for assistive walking devices. People without indoor handrails (p = 0.0481, OR = 0.718, 95% CI: 0.517-0.997), those with 3 or more diseases (p = 0.0008, OR = 0.577, 95% CI: 0.418-0.796), and those with severely impaired IADL (p = 0.0002, OR = 0.139, 95% CI: 0.05-0.386) were less likely to have an unmet need for assistive walking devices. Self-perceived needs of the elderly, the diversity and performance of assistive devices, and the accessibility and affordability of assistive walking devices may lead to unmet needs.

Evaluation of the household solid waste mandatory sorting policy in Shanghai: A 1-year public opinion survey

Sustainable management of household solid waste (HSW) is an essential step in realizing the development of a circular economy (CE). However, for many developing countries, HSW sorting is evolving incrementally, and focusing on the intervention role of policy and the sorting behaviour of residents can help achieve sustainable waste management. This study aims to investigate the main determinants of residents' HSW sorting behaviour and how policy particularly contributes to it. Drawing upon the theory of planned behaviour (TPB) and incorporating experiences, a conceptual framework is tested on a sample of Chinese residents in Shanghai (n = 560, from November to December 2020) using structural equation modelling analysis. The empirical results show that experience and behavioural intention greatly influence HSW sorting behaviour. Moreover, the positive attitude of residents promotes the success of HSW sorting. Subjective norms and perceived behaviour control indirectly affect behavioural intention and behaviour via attitude. The findings of this study provide policymakers with critical factors for the successful implementation of HSW sorting. We also propose policy implications to maintain and improve sorting efficiency from the perspective of residents (education, communication and publicity), neighbourhood committees (degree and efficiency of supervision) and property management companies (good infrastructure, services and processes).

Effects of the spatial patterns of urban parks on public satisfaction: evidence from Shanghai, China

CONTEXT

Urban parks need to meet the growing demand for activities vital to residents' well-being and urban development. A holistic understanding of public satisfaction with urban parks is a prerequisite for improving management.

OBJECTIVE

The spatial patterns and composition of urban parks vary greatly, and the objective of this study is to comprehensively investigate public satisfaction with urban parks and the impact of their structure.

METHODS

With the metropolis of Shanghai, China, as an example, we employed 111,814 social media data sets for 50 urban park sites to quantify public satisfaction via the long short-term memory model. We analyzed the internal, boundary and external dimensions of spatial patterns and described the internal landscape patterns from the perspectives of size, heterogeneity, aggregation, shape, diversity and landscape elements. Moreover, we used all-subset regression and hierarchical partitioning to quantify the relationship and mechanism of action between spatial patterns and public satisfaction.

RESULTS

The results indicate that the mean value of public satisfaction with urban parks was 0.716 (ranging from 0 to 1), which is generally positive or neutral. Satisfaction was influenced by the internal, boundary, and external spatial patterns of urban parks. The independent contribution rates of external transportation facility density (51.49%) and internal edge density (48.51%) to satisfaction.

CONCLUSIONS

We highlight the roles of spatial patterns, especially the degree of external transportation convenience and the edge density of urban parks at the landscape level. The findings provide guidance and recommendations for the planning and design of public satisfaction-oriented urban parks.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10980-023-01615-z.

Prevalence of depression, anxiety, and suicidal ideation during the Shanghai 2022 Lockdown: A cross-sectional study

BACKGROUND

Common mental disorders and suicidal ideation are associated with exposures to COVID-19 pandemic stressors, including lockdown. Limited data is available on the effect of city-wide lockdowns on population mental health. In April 2022, Shanghai entered a city-wide lockdown that sealed 24 million residents in their homes or residential compounds. The rapid initiation of the lockdown disrupted food systems, spurred economic losses, and widespread fear. The associated mental health effects of a lockdown of this magnitude are largely unknown. The purpose of this study is to estimate the prevalence of depression, anxiety, and suicidal ideation during this unprecedented lockdown.

METHODS

In this cross-sectional study, data were obtained via purposive sampling across 16 districts in Shanghai. Online surveys were distributed between April 29 and June 1, 2022. All participants were physically present and residents of Shanghai during the lockdown. Logistic regression was used to estimate the associations between lockdown-related stressors and study outcomes, adjusting for covariates.

FINDINGS

A total of 3230 Shanghai residents who personally experienced the lockdown participated the survey, with 1657 (55.5 %) men, 1563 (44.3 %) women, and 10 (0.02 %) other, and a median age of 32 (IQR 26-39), who were predominately 3242 (96.9 %) Han Chinese. The overall prevalence of depression based on PHQ-9 was 26.1 % (95 % CI, 24.8 %-27.4 %), 20.1 % (18.3 %-22.0 %) for anxiety based on GAD-7, and 3.8 % (2.9 %-4.8 %) for suicidal ideation based on ASQ. The prevalence of all outcomes was higher among younger adults, single people, lower income earners, migrants, those in poor health, and with a previous psychiatric diagnosis or suicide attempt. The odds of depression and anxiety were associated with job loss, income loss, and lockdown-related fear. Higher odds of anxiety and suicidal ideation were associated with being in close contact with a COVID-19 case. Moderate food insecurity was reported by 1731 (51.8 %), and 498 (14.6 %) reported severe food insecurity. Moderate food insecurity was associated with a >3-fold increase in the odds of screening for depression and anxiety and reporting suicidal ideation (aOR from 3.15 to 3.84); severe food insecurity was associated with >5-fold increased odds for depression, anxiety, and suicidal ideation (aOR from 5.21 to 10.87), compared to being food secure.

INTERPRETATION

Lockdown stressors, including food insecurity, job and income loss, and lockdown-related fears, were associated with increased odds of mental health outcomes. COVID-19 elimination strategies including lockdowns should be balanced against the effects on population wellbeing. Strategies to avoid unneeded lockdown, and policies that can strengthen food systems and protect against economic shocks are needed.

FUNDING

Funding was provided by the NYU Shanghai Center for Global Health Equity.

How Does Spatial Injustice Affect Residents' Policy Acceptance of the Economic-Social-Ecological Objectives of Construction Land Reduction?

Construction land reduction (CLR) is a policy innovation for Shanghai to explore high-quality economic development, but it will also lead to spatial injustice in the implementation process. Although the literature on spatial injustice and CLR is increasing, very little is known about the influence of spatial injustice in CLR on residents' policy acceptance of the economic-social-ecological objectives of CLR. To fill the knowledge gap, this study uses micro-survey data to identify the factors that influence residents' policy acceptance of the economic-social-ecological objectives of CLR. Results show that: (1) Spatial injustice in CLR significantly reduces residents' policy acceptance of the social and ecological objectives of CLR. (2) The locational disadvantage of villages significantly reduces residents' policy acceptance of the ecological objectives of CLR. (3) The more educated the residents are, the more they recognize the social and ecological objectives of CLR. (4) The higher the percentage of household workers, the more residents endorse the economic and social objectives of CLR. (5) Compared with ordinary residents, cadres are more accepting of the economic objectives of CLR. (6) Robustness tests support the findings of this study. The findings of this study provide insights for sustainable CLR policy reform.

Penicillin and Cefotaxime Resistance of Quinolone-Resistant Neisseria meningitidis Clonal Complex 4821, Shanghai, China, 1965-2020

Clonal complex 4821 (CC4821) Neisseria meningitidis, usually resistant to quinolones but susceptible to penicillin and third-generation cephalosporins, is increasing worldwide. To characterize the penicillin-nonsusceptible (PenNS) meningococci, we analyzed 491 meningococci and 724 commensal Neisseria isolates in Shanghai, China, during 1965-2020. The PenNS proportion increased from 0.3% in 1965-1985 to 7.0% in 2005-2014 and to 33.3% in 2015-2020. Of the 26 PenNS meningococci, 11 (42.3%) belonged to the CC4821 cluster; all possessed mutations in penicillin-binding protein 2, mostly from commensal Neisseria. Genetic analyses and transformation identified potential donors of 6 penA alleles. Three PenNS meningococci were resistant to cefotaxime, 2 within the CC4821 cluster. With 96% of the PenNS meningococci beyond the coverage of scheduled vaccination and the cefotaxime-resistant isolates all from toddlers, quinolone-resistant CC4821 has acquired penicillin and cefotaxime resistance closely related to the internationally disseminated ceftriaxone-resistant gonococcal FC428 clone, posing a greater threat especially to young children.

Observation-based sources evolution of non-methane hydrocarbons (NMHCs) in a megacity of China

Both concentrations and emissions of many air pollutants have been decreasing due to implement of control measures in China, in contrast to the fact that an increase in emissions of non-methane hydrocarbons (NMHCs) has been reported. This study employed seven years continuous NMHCs measurements and the related activities data of Shanghai, a megacity in China, to explore evolution of emissions and effectiveness of air pollution control measures. The mixing ratio of NMHCs showed no statistical interannual changes, of which their compositions exhibited marked changes. This resulted in a decreasing trend of ozone formation potential by 3.8%/year (p < 0.05, the same below), which should be beneficial to ozone pollution mitigation as its production in Shanghai is in the NMHCs-limited regime. Observed alkanes, aromatics and acetylene changed by +3.7%/year, -5.9%/year and -7.4%/year, respectively, and alkenes showed no apparent trend. NMHCs sources were apportioned by a positive matrix factorization model. Accordingly, vehicular emissions (-5.9%/year) and petrochemical industry emissions (-7.1%/year) decreased significantly, but the decrease slowed down; significant reduction in solvent usage (-9.0%/year) appeared after 2010; however, emissions of natural gas (+12.6%/year) and fuel evaporation (with an increasing fraction) became more important. The inconsistency between observations and inventories was found in interannual trend and speciation as well as source contributions, emphasizing the need for further validation in NMHCs emission inventory. Our study confirms the effectiveness of measures targeting mobile and centralized emissions from industrial sources and reveals a need focusing on fugitive emissions, which provided new insights into future air policies in polluted region.

'And I thought having a cancer diagnosis was hard': A descriptive phenomenological study of family caregiver experiences navigating the pre-hospital system during COVID-19

PURPOSE

Cancer patients usually need frequent hospitalization for diagnosis and treatment. However, the unprecedented outbreak of the Omicron wave in Shanghai pressured local communities and hospitals to enforce strict control measures. This qualitative study aimed to investigate cancer family caregivers' experiences of navigating the pre-hospital system during the lockdown in Shanghai.

METHOD

This is a substudy of a larger study investigating the experience of 20 caregivers of hospitalized cancer patients during the lockdown in Shanghai. This study was based on findings from a subset of 14 semi-structured face-to-face interviews with cancer family caregivers. Inductive thematic analysis was used to analyze the data.

RESULTS

The outbreak of the epidemic and lockdown measures created additional challenges for caregivers, which extended beyond their daily concerns. Uncertainties of the situation, risks of infection, and income loss, along with the strict restrictions in their community and hospitals, added to their burden and compromised their abilities to seek help for their significant others. Yet, in an attempt to reduce undue concern and worry, caregivers were eventually allowed to accompany their family member to the hospital using reliable information, and telemedicine techniques based on an updated governmental policy governing access to care and support for cancer patients.

CONCLUSIONS

The lockdown in Shanghai significantly affected cancer family caregivers' experience navigating the pre-hospital system. Policy support for cancer care, reliable information, and telemedicine techniques have been identified as essential facilitators of improved access to cancer care.

Effect of atropine 0.01% on myopia control in children aged 6-13 years during the 2022 lockdown in Shanghai

Purpose

To compare the myopic progression in children treated with 0. 01% atropine and those who discontinued atropine during the 2022-home quarantine in Shanghai.

Methods

In this retrospective study, children aged 6-13 years with follow-up visits before (between January 2022 and February 2022) and after the lockdown (between July 2022 and August 2022) were included. Cycloplegic refraction and axial length (AL) were measured at both visits. The atropine group had continuous medication during the lockdown while the control group discontinued. The 0.01% atropine eyedrops were administered daily before bedtime. The types of spectacle lens were recorded: single vision (SV) spectacles or defocus incorporated multiple segments lenses (DIMS).

Results

In total, 41 children (81 eyes) in the atropine group and 32 children (64 eyes) in the control group were enrolled. No significant difference was found in the demographic characteristics, spherical diopter, spherical equivalent (SE), AL, and follow-up time between the two groups before the lockdown in 2022 (all p > 0.1). After the home confinement, a greater myopia progression was observed in the control group (-0.46 ± 0.42 D) compared to atropine group (-0.26 ± 0.37 D; p = 0.0023). Axial elongation was also longer in the control group than that in children sustained with atropine (0.21 ± 0.17 vs. 0.13 ± 0.15 mm, p = 0.0035). Moreover, there was no significant change of spherical diopter and SE during lockdown in the atropine + DIMS combined subgroup (0.03 ± 0.033 D for spherical diopter, p = 0.7261 and 0.08 ± 0.27 D for SE, p = 0.2042, respectively). However, significant myopic shift was observed in the atropine + SV subgroup during the quarantine time (-0.31 ± 0.39 D for SE and 0.15 ± 0.16 mm for AL, both p < 0.001).

Conclusion

Children treated with 0.01% atropine had slower myopia progression during the lockdown period in Shanghai compared with children discontinued. Moreover, the effect of atropine on myopic prevention can be strengthened with DIMS lenses.

Exploration of the Dynamic Evolution of Online Public Opinion towards Waste Classification in Shanghai

Shanghai is one of the fastest-growing metropolises and the first city in China to implement mandatory waste classification. Waste classification policy of Shanghai has attracted widespread attention since its implementation in July 2019. However, previous papers have not focused on online public attitudes surrounding the implementation of a waste classification policy in Shanghai. In order to fill this gap, this paper explored the dynamic evolution of online public attitudes towards waste classification in Shanghai by using sentiment analysis technology and topic modeling technology. It was found that the proportion of negative posts each month was about 20%; therefore, online public sentiment towards waste classification in Shanghai was generally positive. Compared with the first three months of policy implementation, the public sentiment towards Shanghai's waste classification became more positive, with the exception of two special periods. Negative posts in July 2019 mainly discussed waste's environmental hazards and policy provisions. New topics in negative posts in later months focused on some specific problems, including the process of throwing away wet waste, the allocated throwing times, the number of waste cans, takeaway meal disposal, and gathering activities. Improving the factors causing the negative sentiments in the posts will help the government better implement the policy. The paper will help the government to receive higher public support for the waste classification policy in Shanghai. The present findings also have great reference significance for other cities.

Molecular Evolution and Increasing Macrolide Resistance of Bordetella pertussis, Shanghai, China, 2016-2022

Resurgence and spread of macrolide-resistant Bordetella pertussis (MRBP) threaten global public health. We collected 283 B. pertussis isolates during 2016-2022 in Shanghai, China, and conducted 23S rRNA gene A2047G mutation detection, multilocus variable-number tandem-repeat analysis, and virulence genotyping analysis. We performed whole-genome sequencing on representative strains. We detected pertussis primarily in infants (0-1 years of age) before 2020 and older children (>5-10 years of age) after 2020. The major genotypes were ptxP1/prn1/fhaB3/ptxA1/ptxC1/fim2-1/fim3-1 (48.7%) and ptxP3/prn2/fhaB1/ptxA1/ptxC2/fim2-1/fim3-1 (47.7%). MRBP increased remarkably from 2016 (36.4%) to 2022 (97.2%). All MRBPs before 2020 harbored ptxP1, and 51.4% belonged to multilocus variable-number tandem-repeat analysis type (MT) 195, whereas ptxP3-MRBP increased from 0% before 2020 to 66.7% after 2020, and all belonged to MT28. MT28 ptxP3-MRBP emerged only after 2020 and replaced the resident MT195 ptxP1-MRBP, revealing that 2020 was a watershed in the transformation of MRBP.

Healthcare Provider Knowledge, Attitudes, and Practices in Hospice Care and Their Influencing Factors: A Cross-sectional Study in Shanghai

BACKGROUND

In 2017, the Chinese government launched a pilot project in hospice care (HC), in which Shanghai was a pioneer. Healthcare provider knowledge, attitudes, and practices in hospice care (KAPHC) may facilitate or hinder HC development. To determine how to design targeted training for healthcare providers and policies to improve their KAPHC, we conducted an original study based on an indigenized KAPHC scale to (a) comprehensively measure the KAPHC baseline of healthcare providers in Shanghai and (b) explore its influencing factors.

METHODS

A cross-sectional study was designed to evaluate healthcare providers' KAPHC with the indigenized KAPHC scale. Descriptive analysis, linear regression, and Pearson's (r) correlation analysis were performed to uncover providers' KAPHC, its influencing factors, and their correlations.

RESULTS

The KAPHC scale proved applicable to the knowledge, attitudes, and practices of the large sample of providers we surveyed. The 7027 KAPHC scaling results revealed that 42.44% of participants had HC experience and 57.49% were willing to provide HC. The mean accuracy of the responses related to knowledge was 59.30%. Scoring rates for attitudes, confidence, and self-reported practices were 74.20%, 73.96%, and 75.55%, respectively. The linear regression revealed that higher KAPHC scores were associated with experience and willingness and varied with professional specializations. The Pearson's (r) correlation evidenced that HC practices were strongly correlated with confidence (r = 0.648, P<.001) and moderately correlated with attitudes (r = 0.463, P<.001).

CONCLUSION

We uncovered that targeted training for enhancing healthcare provider KAPHC in Shanghai should focus on psychological and spiritual care, the management of pain and other symptoms, and traditional Chinese medicine (TCM). Additionally, training should be scaled up for providers with different characteristics. Meanwhile, policy should encourage providers to work enthusiastically in HC-universal high-quality HC requires well-trained, supported, and motivated providers.

A diagnostic model for serious COVID-19 infection among older adults in Shanghai during the Omicron wave

Background

The Omicron variant is characterized by striking infectivity and antibody evasion. The analysis of Omicron variant BA.2 infection risk factors is limited among geriatric individuals and understanding these risk factors would promote improvement in the public health system and reduction in mortality. Therefore, our research investigated BA.2 infection risk factors for discriminating severe/critical from mild/moderate geriatric patients.

Methods

Baseline characteristics of enrolled geriatric patients (aged over 60 years) with Omicron infections were analyzed. A logistic regression analysis was conducted to evaluate factors correlated with severe/critical patients. A receiver operating characteristic (ROC) curve was constructed for predicting variables to discriminate mild/moderate patients from severe/critical patients.

Results

A total of 595 geriatric patients older than 60 years were enrolled in this study. Lymphocyte subset levels were significantly decreased, and white blood cells (WBCs) and D-dimer levels were significantly increased with disease progression from a mild/moderate state to a severe/critical state. Univariate and multivariate logistic regression analyses identified a panel of WBCs, CD4⁺ T cell, and D-dimer values that were correlated with good diagnostic accuracy for discriminating mild/moderate patients from severe/critical patients with an area under the curve of 0.962.

Conclusion

Some key baseline laboratory indicators change with disease development. A panel was identified for discriminating mild/moderate patients from severe/critical patients, suggesting that the panel could serve as a potential biomarker to enable physicians to provide timely medical services in clinical practice.

Zoning Optimization Method of a Riverfront Greenspace Service Function Oriented to the Cooling Effect: A Case Study in Shanghai

Blue-green space commonly provides multiple ecological service functions, especially thermal environment comfort for citizens. The greenspace of the riparian buffers along 22 river channels in Shanghai was selected as the study object, and remote sensing and GIS technologies were used to obtain the quantitative composition and morphological indices of riverfront greenspace and the spatial distribution data of the land surface temperature in the study area. Through BRT modelling and statistical analyses, the interactive correlations among the three aspects, namely, the spatial patterns of riverfront greenspace, their specific functional zoning, and cooling island differentiation characteristics, were explored. The results showed that different river types served for different functional zones of the city, namely, high-density built-up zoning, new urban-growth zoning in built-up areas, suburban areas, and rural areas, and had specific regular patterns of morphosis and service function of riverfront greenspace. These also led to a significant spatial differentiation pattern of cooling intensity levels, which generally appeared in the approximate circle differentiation structure of the cooling island in the city riverfront area. The study further proposed the key factors and corresponding strategies for optimizing the greenspace pattern to strengthen the cooling intensity levels of different river types. This study summarizes the landscape composition paradigm of riverfront greenspaces at the urban mesoscale and provides adaptive planning methods for better local microclimate conditions.

[Identification and restoration strategy of key areas for territorial space ecological restoration in Shanghai, China based on ecological security pattern]

In the new era, ecological restoration of territorial space is the important task of maintaining regional ecological security, improving regional ecological quality and providing high-quality ecological products. From the perspective of ecological security, accurately determination of key areas to be restored in the territorial space is the primary work, and it is also a key and difficult problem to scientifically carry out ecological restoration. Based on the mainstream ecological security pattern theory, taking Shanghai as the research area, we integrated morphological spatial pattern analysis method and InVEST model to identify ecological sources, extracted ecological corridors, ecological "pinch points" and obstacle points with circuit theory, comprehensively determined the key areas to be restored, and proposed targeted restoration strategies. The results showed that the ecological sources of Shanghai were mainly distributed in the Yangtze River estuary, Chongming Island, Hangzhou Bay coast, and Dianshan Lake, accounting for about 17.9% of the study area. There were 103 key ecological corridors. The key areas to be repaired included 12 ecological "pinch points" and 54 ecological obstacle points, which were mainly distributed at the border of ecological source and ecological corridor, as well asthe intersection or turning point of ecological corridor and ecological corridor. According to the typical problems of key areas to be restored and land use conditions, three types of restoration strategy zones were proposed: ecological landscape reshaping, important corridor penetration, and ecological shoreline protection and restoration. The results could provide reference for compiling a territorial space ecological restoration plan in Shanghai and building a medium-scale ecological security pattern and carrying out systemic ecological restoration work in other regions of China.

Response of PM2.5-bound elemental species to emission variations and associated health risk assessment during the COVID-19 pandemic in a coastal megacity

The coronavirus (COVID-19) pandemic is disrupting the world from many aspects. In this study, the impact of emission variations on PM_2.5-bound elemental species and health risks associated to inhalation exposure has been analyzed based on real-time measurements at a remote coastal site in Shanghai during the pandemic. Most trace elemental species decreased significantly and displayed almost no diel peaks during the lockdown. After the lockdown, they rebounded rapidly, of which V and Ni even exceeded the levels before the lockdown, suggesting the recovery of both inland and shipping activities. Five sources were identified based on receptor modeling. Coal combustion accounted for more than 70% of the measured elemental concentrations before and during the lockdown. Shipping emissions, fugitive/mineral dust, and waste incineration all showed elevated contributions after the lockdown. The total non-carcinogenic risk (HQ) for the target elements exceeded the risk threshold for both children and adults with chloride as the predominant species contributing to HQ. Whereas, the total carcinogenic risk (TR) for adults was above the acceptable level and much higher than that for children. Waste incineration was the largest contributor to HQ, while manufacture processing and coal combustion were the main sources of TR. Lockdown control measures were beneficial for lowering the carcinogenic risk while unexpectedly increased the non-carcinogenic risk. From the perspective of health effects, priorities of control measures should be given to waste incineration, manufacture processing, and coal combustion. A balanced way should be reached between both lowering the levels of air pollutants and their health risks.

Unmet supportive care needs and associated factors: Evidence from 4195 cancer survivors in Shanghai, China

BACKGROUND

Cancer survivors at different stages of life often have different needs that make it challenging for services to provide satisfactory care. Few studies have considered whether services are truly meeting the needs of cancer patients by exploring and identifying their perspectives on unmet needs.

OBJECTIVE

The aim of this study was to identify the unmet needs of cancer survivors and to further determine the potential impact of socio-demographic factors.

METHODS

A cross-sectional study that included 4195 cancer patients was conducted in Shanghai, China. Using Maslow's hierarchy of needs theory as a conceptual framework, the questionnaire included five dimensions: information, life and finances, continuing care, emotions, and self-actualization. Correlation analysis and ordered logistic regression analysis was used to explore the relationship between demographic sociological factors and unmet needs for supportive care.

RESULTS

The most common unmet supportive care needs include information needs (2.91 ± 1.32), self-actualization needs (2.69 ± 1.32) and continuing care needs (2.59 ± 1.30). Unmet needs for life and finances were more pronounced among cancer participants in the 45-69 age group. After adjusting for confounders, we found that each 6-month increase in the time since diagnosis was associated with a 0.8% (OR: 0.992, 95% CI: 0.985-0.998) reduction in high need for continuing care and a 0.9% (OR:0.991, 95% CI: 0.983-0.999) reduction in high need for self-actualization, respectively.

CONCLUSIONS

Information needs are the most important concern among the diverse unmet needs of cancer survivors. Time since diagnosis is associated with unmet supportive care needs of cancer survivors. The findings highlight the large gap between actual health services and patients' unmet need for supportive care, which will provide the basis for a patient-centered supportive care system for cancer survivors.

Prevalence of antibiotic resistance of Helicobacter pylori isolates in Shanghai, China

OBJECTIVE

This study aimed to evaluate the resistance of Helicobacter pylori (H. pylori) to common antibiotics in Shanghai.

METHODS

A total of 1171 eligible subjects participated in the study. Antibiotic susceptibility to six common antibiotics was examined with the disk diffusion method. Mutations in resistant-related genes were identified via Sanger sequencing analysis.

RESULTS

Overall, the resistance rates of strains to amoxicillin, clarithromycin, levofloxacin, metronidazole, tetracycline, and furazolidone were 0.1%, 27.8%, 31.1%, 79.9%, 0.1%, and 0.5%, respectively. Compared with untreated patients, resistance rates of clarithromycin (P < 0.01), levofloxacin (P < 0.01), and metronidazole were significantly higher in re-treated patients (P < 0.05). The total multiple resistance rate was 40.5%. Age (levofloxacin), gender (clarithromycin, levofloxacin, and metronidazole) and endoscopic findings (clarithromycin and levofloxacin) were independent factors influencing antibiotic resistance. High correlation was observed between the drug susceptibility test and molecular test for the resistance to clarithromycin and levofloxacin.

CONCLUSIONS

The resistance rates of H. pylori to amoxicillin, tetracycline, and furazolidone were low, whereas the resistance rates of H. pylori to clarithromycin, levofloxacin, and metronidazole were high, especially in re-treated patients. Our results indicate that the clinical resistance patterns of clarithromycin and levofloxacin could be guided by relevant gene mutations.

How Do the Young Perceive Urban Parks? A Study on Young Adults' Landscape Preferences and Health Benefits in Urban Parks Based on the Landscape Perception Model

(1) Background: Youth's physical and mental health is of increasing concern today. However, gaining a more comprehensive knowledge of young people's landscape preferences for urban parks is challenging. Additionally, young adults' voices (aged from 20 to 24) are often neglected. (2) Methods: This study collected 349 interview questionnaires from 2014 to 2020 and recorded them into Nvivo10. Firstly, the study did a thematic analysis using the preliminary coding framework based on the landscape perception model to code the interview data and statistics on the frequencies of each theme and code. Then, we used diffractive analysis to interpret original materials to comprehend the underlying significance. (3) Results: Our research showed that young adults' landscape perceptions are richer in diversity and express more subjective feelings. Their landscape preferences are also related to behavioral activities in addition to environmental features, which have some differences from teenagers. (4) Conclusions: It is helpful to attract more young adults by creating sound and smell landscapes, accommodating more dynamic sports and recreation facilities, and controlling unhygienic and noise problems, which can offer better design, planning, and management for creating inclusive urban parks. The landscape perception model developed in this paper can also provide a reference for related studies in the future.

Estimation of disease burden and clinical severity of COVID-19 caused by Omicron BA.2 in Shanghai, February-June 2022

An outbreak of COVID-19 caused by the SARS-CoV-2 Omicron BA.2 sublineage occurred in Shanghai, China from February 26 to June 30, 2022. We use official reported data retrieved from Shanghai municipal Health Commissions to estimate the incidence of infections, severe/critical infections, and deaths to assess the disease burden. By adjusting for right censoring and RT PCR sensitivity, we provide estimates of clinical severity, including the infection fatality ratio, symptomatic case fatality ratio, and risk of developing severe/critical disease upon infection. The overall infection rate, severe/critical infection rate, and mortality rate were 2.74 (95% CI: 2.73-2.74) per 100 individuals, 6.34 (95% CI: 6.02-6.66) per 100,000 individuals and 2.42 (95% CI: 2.23-2.62) per 100,000 individuals, respectively. The severe/critical infection rate and mortality rate increased with age, noted in individuals aged 80 years or older. The overall fatality ratio and risk of developing severe/critical disease upon infection were 0.09% (95% CI: 0.09-0.10%) and 0.27% (95% CI: 0.24-0.29%), respectively. Having received at least one vaccine dose led to a 10-fold reduction in the risk of death for infected individuals aged 80 years or older. Under the repeated population-based screenings and strict intervention policies implemented in Shanghai, our results found a lower disease burden and mortality of the outbreak compared to other settings and countries, showing the impact of the successful outbreak containment in Shanghai. The estimated low clinical severity of this Omicron BA.2 epidemic in Shanghai highlight the key contribution of vaccination and availability of hospital beds to reduce the risk of death.

Changes in Public Sentiment under the Background of Major Emergencies-Taking the Shanghai Epidemic as an Example

The occurrence of major health events can have a significant impact on public mood and mental health. In this study, we selected Shanghai during the 2019 novel coronavirus pandemic as a case study and Weibo texts as the data source. The ERNIE pre-training model was used to classify the text data into five emotional categories: gratitude, confidence, sadness, anger, and no emotion. The changes in public sentiment and potential influencing factors were analyzed with the emotional sequence diagram method. We also examined the causal relationship between the epidemic and public sentiment, as well as positive and negative emotions. The study found: (1) public sentiment during the epidemic was primarily affected by public behavior, government behavior, and the severity of the epidemic. (2) From the perspective of time series changes, the changes in public emotions during the epidemic were divided into emotional fermentation, emotional climax, and emotional chaos periods. (3) There was a clear causal relationship between the epidemic and the changes in public emotions, and the impact on negative emotions was greater than that of positive emotions. Additionally, positive emotions had a certain inhibitory effect on negative emotions.

Spatial and seasonal variation and sources of deposition fluxes of polycyclic aromatic hydrocarbons (PAHs) in Shanghai

Spatial and temporal variations of polycyclic aromatic hydrocarbons (PAHs) deposition fluxes and sources may significantly facilitate risk evaluation and pollution control of super megacity in China. A study on PAHs of wet and dry deposition in Shanghai was conducted from January to December of 2019. Seventeen sampling sites located in four functional areas were set, including the Baoshan iron and steel industry area (BS), Jinshan petrochemical industry area (JS), city center (CC), and Chongming agricultural area (CM). A total of 15 PAHs were determined by gas chromatography-mass spectrometry (GC-MS, Agilent 7890A/5975C). PAHs atmospheric deposition flux in winter was highest (3.12 ± 1.98 μg/(m²·day), mostly attributed to local emissions accumulation under adverse meteorological diffusion conditions, as well as pollutants transport from northern China during heating season. PAHs deposition fluxes in industrial area (BS and JS) were 3.75 ± 4.08 μg/(m²·day) and 3.18 ± 3.62 μg/(m²·day) respectively, which were greater than those in CC and CM, accounting for 1.91 ± 1.06 μg/(m²·day) and 1.41 ± 0.61 μg/(m²·day) respectively. Proportional composition and isomer ratios of PAHs indicated that the PAHs deposition in winter and spring samples were more homogeneous, whereas those of summer and autumn seemed to be more variable and dispersed. Positive matrix factorization model were employed to identify the potential sources of PAHs in specific functional areas. A dominance of contribution was attributed to coal combustion (46%) at BS, petroleum volatilization (48%) at JS, biomass burning (55%) at CM, and vehicle emission (49%) at CC. This study highlighted that local urbanization and industrialization have a significant contribution to PAHs deposition to specific functional regions in Shanghai.

Environmental and Resource Impacts from an Aggressive Regionalized Carbon Peak Policy

When and how to achieve a carbon peak is a concern for provincial regions within China under the context of achieving carbon neutrality in 2060. This study investigates the overall carbon peak environmental and resource impacts under current national targets and Shanghai's latest more aggressive carbon peak policy by using a dynamic multiple-region computable general equilibrium (CGE) model for the year 2030. Results show that (1) the national carbon peak and the more aggressive regional policy in Shanghai will result in energy consumption and carbon emissions decreases when compared to the business-as-usual scenario in most provinces; (2) although some cobenefits in water use reduction may occur in most provinces under the carbon policy scenarios, the results show positive and negative variations; (3) provincial level environmental and resources in transport, electricity, metal smelting and pressing, and agricultural production sectors are most influenced by Shanghai's aggressive carbon peak policy; and (4) the outsourced environmental and resource impacts from Shanghai to other provinces are very significant under Shanghai's aggressive carbon policy. These relevant results provide insights to facilitate broader governance decision-making for environmental resource nexuses while seeking an improved understanding of global sustainable development and climate governance.

An epidemiological analysis of imported malaria in Shanghai during a COVID-19 outbreak

Background

The goal of this study was to understand the epidemiological characteristics of imported malaria in Shanghai specifically during the epidemic period of novel corona-virus pneumonia (COVID-19), to provide a reference for preventing the transmission of imported malaria after this disease had been previously eliminated.

Methods

The data of malaria cases reported in Shanghai from 2020 to 2021 were obtained from the China Information System for Disease Control and Prevention (CISDCP) and the Information System for Parasitic Disease Control and Prevention (ISPDCP). The characteristics of demographic and epidemiological distribution, travel-related information, diagnosis information, regions of infection acquisition and disposal information of epidemic situation were analysed with descriptive statistics.

Results

A total of 112 cases of malaria were reported in Shanghai from January 2020 to December 2021. There were 18 cases and 94 cases in 2020 and 2021, respectively, reaching the lowest and highest levels in the past 10 years. The incidence of malaria associated with seasons had an increasing trend (χ² = 81.143, P < 0.05). These cases included Plasmodium falciparum (97, 86.61%), Plasmodium vivax (4, 3.57%), Plasmodium ovale (8, 7.14%) and Plasmodium malariae (3, 2.68%). The median age of patients with malaria was 38.0 years, the majority of these individuals were males (109, 97.32%), and most of them were labour personnel (93, 83.04%). Of the reported cases, 8 of these individuals (7.14%) reported experiencing malaria symptoms before their arrival in China after their stay overseas; 97 of these individuals (86.61%) reported experiencing symptoms within 14 days after their initial arrival from overseas; 15 of these individuals (13.39%) were diagnosed with ‘severe malaria’; and 4 of these individuals (3.57%) were also diagnosed with COVID-19. All cases were imported from Africa, and there were no indigenous cases and deaths.

Conclusion

Due to the impact of COVID-19, the number of imported malaria cases in Shanghai had greatly increased; however, prevention and control measures for imported malaria could be implemented to prevent re-transmission of this condition. Considering that the number of individuals returning from overseas labour is likely to increase in the next few years, it is necessary to strengthen the surveillance of imported malaria and to review the protocol for potential epidemic situations. Together, these measures could support the maintation of free-malaria status in Shanghai.

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.