Table of Content

  

10 August 2018
Volume 56 Issue 8

Concerning climate change and protecting human health

QIN Dahe

Journal of Shandong University (Health Sciences). 2018, 56(8):  1-2.  doi:10.6040/j.issn.1671-7554.0.2018.676

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Protecting human health by mitigation and adaptation to climate change

LIU Qiyong

Journal of Shandong University (Health Sciences). 2018, 56(8):  3-6.  doi:10.6040/j.issn.1671-7554.0.2018.690

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Climate change is so far one of the biggest, broadest and most far-reaching challenges to human being. Without effective measures, climate change will pose a great threat to over 7 billion people, and erode the results of health development achieved over the past 50 years. Currently, climate change has attracted the attention of governments and scientists all over the world, including China. China has attached strategic significance to climate change and proposed a series of key tasks and safeguards to deal with this issue. China will increase the investments in scientific research, develop interdisciplinary integration, deepen international exchange and cooperation, and ultimately achieve mutual benefits and win-win results.

Leading researches on meteorological factors and human health

KAN Haidong, JIANG Yixuan, CHEN Renjie

Journal of Shandong University (Health Sciences). 2018, 56(8):  7-13.  doi:10.6040/j.issn.1671-7554.0.2018.513

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Meteorological factors are closely related to human life. In recent years, the relationship between meteorological factors and human health has been paid more and more attentions. The existing researches mainly focus on temperature, and the conclusions are inconsistent. We have reviewed domestic and international researches to introduce the effects of meteorological factors on chronic non-communicable diseases, infectious diseases, mental health and pregnancy outcomes, as well as their possible mechanisms. Meteorological factors such as temperature, humidity and air pressure all have a suitable range for human health and non-optimum ranges of meteorological conditions may result in adverse effects. In the future, China should investigate more comprehensively the health effects and the potential pathophysiologic mechanisms of meteorological factors and design targeted early-warning system to protect susceptible population.

Health effects of heatwave: from impact assessment to coping strategy

HUANG Cunrui, HE Yiling, MA Rui, SU Yanan

Journal of Shandong University (Health Sciences). 2018, 56(8):  14-20.  doi:10.6040/j.issn.1671-7554.0.2018.160

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Climate change poses multiple threats to human health. The most primary and direct threat of climate change on human health is expected to be exposure to heatwaves. It is projected that the frequency and intensity of heatwaves will increase under the scenario of climate change. Thus, coping with heatwaves and mitigating health impacts have increasingly 山 东 大 学 学 报 (医 学 版)56卷8期 -黄存瑞,等.高温热浪的健康效应:从影响评估到应对策略 \=-become a priority issue in public health. This article reviews the current epidemiological information on the impacts of heatwaves, and points out that sensitive health outcomes and efficient research designs are needed to evaluate extreme temperature related health losses precisely, thus well-designed coping strategies and public health interventions to climate change can be made with a solid foundation.

Research progress on the relationship between floods and human health

JIANG Baofa, DING Guoyong, LIU Xuena

Journal of Shandong University (Health Sciences). 2018, 56(8):  21-28.  doi:10.6040/j.issn.1671-7554.0.2018.514

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Floods has become one of the most frequent natural disasters in the world. Increasing evidences show that an increase in frequency and intensity of various natural disasters was observed since the 20th century due to the changing climate, including floods. The deteriorated living condition and the lacking of clean water and health service facilities would assist the transmission of many diseases. Studies have shown that floods may cause adverse impact on human health, and this effect will persist for a long time. Based on the previous literature, we reviewed studies on relationship between floods and human health, methodology and research direction, to provide theoretical basis for responding to the health risks after floods.

Impacts of tropical cyclone on human health: latest research progress

MA Wei, ZHANG Anran

Journal of Shandong University (Health Sciences). 2018, 56(8):  29-36.  doi:10.6040/j.issn.1671-7554.0.2018.519

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Tropical cyclone, a natural disaster which may cause huge damages to human beings, has direct and indirect impacts on human health in various ways. It can cause direct casualties through gales, heavy rains and storm tides, and can also indirectly increase mortality and disability rate, incidence of infectious and chronic diseases, through house and health facility damage, movement of population, water pollution, and grain yield reduction. In addition, it can cause psychological and mental damage. Adaptive measures need to be taken both before and after landing of tropical cyclone in order to reduce its impacts on human health.

Lag effect and vulnerable areas of floods on bacillary dysentery in Hunan Province

LIU Zhidong, LAO Jiahui, LIU Yanyu, ZHANG Jing, JIANG Baofa

Journal of Shandong University (Health Sciences). 2018, 56(8):  37-42.  doi:10.6040/j.issn.1671-7554.0.2017.1200

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Objective To study the lag effect and vulnerable areas of floods on bacillary dysentery in Hunan Province. Methods The meteorological data and weekly data of bacillary dysentery in 2004-2011 were obtained. The two-stage model was conducted. Firstly, a distributed lag non-linear model was developed to assess the relationship between floods and bacillary dysentery. Secondly, a hierarchical linear model was used to find the vulnerable areas. Results A total of 53 439 cases of bacillary dysentery were notified over the study period. At the province level, the cumulative effect of floods on bacillary dysentery at lag 0-1 week was statistically significant(RR=1.19, 95%CI: 1.05-1.36), and the effect reached maximum at lag 1 week(RR=1.12, 95%CI: 1.05-1.20). Western Hunan(RR=1.66, 95%CI: 1.09-2.55)and regions with low level of economic development(RR=1.43, 95%CI: 1.02-2.02)were more vulnerable than other areas. Conclusion Floods have significantly increased the risk of bacillary dysentery in study area. The intervention measures should be last at least two weeks. Disaster relief work must be intensified especially in regions with low level of economic development to control a potential risk of bacillary dysentery after floods.

A case-crossover study on the tropical cyclones and daily outpatient numbers of respiratory diseases

LI Jiawei, WEI Ran, ZHANG Anran, HU Wenqi, LIN Junfen, MA Wei

Journal of Shandong University (Health Sciences). 2018, 56(8):  43-49.  doi:10.6040/j.issn.1671-7554.0.2018.055

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Objective To explore the impacts of tropical cyclones on the daily outpatient numbers of respiratory diseases in the coastal area of Zhejiang Province in 2012 and 2013. Methods Time-stratified case-crossover study was used to explore the relationship between tropical cyclones and the daily outpatient numbers of respiratory diseases from July to October in 2012 and 2013 in Cangnan County, Zhejiang Province. Poisson regression model was used to control meteorological factors and conduct the statistical analysis. Stratified analysis by gender and age was conducted. Results In the tropical cyclone period, the risk of respiratory diseases increased to a maximum on the 3rd, 4th, and 6th lag days among all population, males, and females, respectively. The risk of respiratory diseases increased to a maximum on the 6th lag day among population aged <15 years old(RR=1.298, 95%CI:1.016~1.658). There was no statistically significant relationship between tropical cyclones and respiratory diseases among population aged from 15 to 65 years old and population aged >65 years old(P>0.05). Conclusion The tropical cyclone may increase the risk of respiratory diseases and there are lagged effects. The population aged <15 years old is more vulnerable.

Impacts of tropical cyclones on the incidence of hand-foot-mouth disease in Guangdong Province, 2009-2013

XUN Huanmiao, HU Wenqi, LIU Yicong, MA Wei

Journal of Shandong University (Health Sciences). 2018, 56(8):  50-55.  doi:10.6040/j.issn.1671-7554.0.2018.128

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Objective To explore the effects of tropical cyclones on the incidence of hand-foot-mouth disease(HFMD)in Guangdong Province during 2009 and 2013. Methods The effects of tropical cyclones of different grades on the incidence of HFMD in people aged 0-14 years were quantitatively analyzed with time stratified case-cross design. The lag effect was also explored. Subgroup analyses were conducted according to age, sex and educational style. Results Tropical storms could increase the risk of HFMD in population aged 0-14 years in 4-6 lag days. The RR value reached its maximum of 1.59(95%CI: 1.20-2.11)on the 5^th lag day. Typhoon had no significant effect on the incidence of HFMD. Male, children aged 0-4 years and scattered children were sensitive to tropical storms. The RR value of male and scattered children reached the maximum on the 5^th lag day, which was 1.75(95%CI: 1.29-2.37)and 1.60(95%CI: 1.18-2.16), respectively. The RR value of children aged 0-4 years reached the maximum on the 4^th lag day, which was 山 东 大 学 学 报 (医 学 版)56卷8期 -荀换苗,等.2009~2013年广东省热带气旋对手足口病的影响 \=-1.58(95%CI: 1.18-2.10). Conclusion Tropical cyclones can increase the risk of HFMD in people aged 0-14 years and have lag effect. Measures should be taken to prevent the occurrence of HFMD among children and young people after tropical storms attack, especially among boys, children aged 0-4 years and scattered children.

Impact of heatwaves on daily death from cardiovascular diseases: a case-crossover study

ZHANG Anran, HU Wenqi, LI Jiawei, WEI Ran, MA Wei

Journal of Shandong University (Health Sciences). 2018, 56(8):  56-62.  doi:10.6040/j.issn.1671-7554.0.2018.052

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Objective To estimate the impact of heatwave on daily death from cardiovascular diseases(CVD)in Jiaxing City, Zhejiang Province, China. Methods The definition of heatwave was a period at least 3 consecutive days with maximum temperature exceeding 35 ℃ in this study. Multivariate conditional Poisson regression models were applied to examine the heatwave-death association using the relative risk(RR)while adjusting for meteorological and air pollution factors including daily average temperature, average rainfall, average wind speed, average pressure and air pollution index. The impacts were analyzed by using time-stratified case-crossover design based on relevant data from 2008 to 2011 in Jiaxing City. The RR of different risk period was calculated to definite lag effects. Results Six heatwaves happened during the study period. The largest effect of the heatwave-CVD association was 1.342(95%CI: 1.081-1.667)at the 2 lag day. The risk of deaths from CVD among people ≥65 years old(RR=1.296, 95%CI: 1.027-1.636)and female(RR=1.407, 95%CI: 1.021-1.937)increased at the 2 lag day. Conclusion Heatwave has impacts on the daily deaths caused by CVD and there are lagged effects. People at risk are female and people ≥65.

Impacts of heatwaves on the number of hypertensive outpatient visits in Cangnan County during 2011 and 2013

XUE Li, HU Wenqi, WEI Ran, ZHANG Anran, LIN Junfen, MA Wei

Journal of Shandong University (Health Sciences). 2018, 56(8):  63-69.  doi:10.6040/j.issn.1671-7554.0.2018.122

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Objective To investigate the impacts of heatwaves on the number of hypertensive outpatient visits in Cangnan County, Zhejing province during 2011 and 2013. Methods Data of hypertensive outpatients visits in the Third Peoples Hospital of Cangnan County and the daily meteorological data from July to September in 2011-2013 were collected and analyzed with generalized additive models(GAM)to evaluate their effects on different gender and age groups(elder group: ≥65 years, non-elder group: <65 years). Results From 2011 to 2013, a total of 7 heatwaves occurred in Cangnan County. The total number of hypertensive outpatient visits significantly increased on lag day 1(RR=1.20, 95%CI: 1.06-1.37). The heatwaves imposed the greatest effects on female patients on lag day 1(RR=1.40, 95%CI: 1.14-1.72). The number of visits increased on lag day 1 for the non-elder group(RR=1.22, 95%CI: 1.03-1.44), and on lag day 3 for the elder group(RR=1.25, 95%CI: 1.06-1.48). Conclusion Heatwaves are associated with an increase of hypertensive outpatient visits in Cangnan County. Females are vulnerable to heatwaves, and heatwaves can increase the number of outpatient visits in both elder group and non-elder group.

Application of panel data model in screening of drought-sensitive infectious diseases in Hunan Province

WANG Ning, HUANG Jinming, DING Guoyong, LI Xuewen

Journal of Shandong University (Health Sciences). 2018, 56(8):  70-75.  doi:10.6040/j.issn.1671-7554.0.2018.051

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Objective To identify drought-sensitive infectious diseases in Hunan Province, and provide scientific basis for the prevention and control of the infectious diseases during the drought period. Methods The morbidity of infectious diseases in Hunan Province during the drought period was calculated, and Spearman rank correlation analysis was done to investigate the effects of drought on infectious diseases, in addition, a panel data model was used to screen the drought-sensitive infectious diseases. Results Spearman rank correlation analysis showed that incident number of hepatitis B, hepatitis C, bacillary dysentery, mumps, rubella, varicella and pulmonary tuberculosis were closely correlated 山 东 大 学 学 报 (医 学 版)56卷8期 -王宁,等.面板数据模型在湖南省干旱敏感传染病筛选中的应用 \=-with drought(all P<0.05), and the corresponding lag periods were 0, 0, 1, 5, 5, 3 and 4 weeks, respectively. The panel data model results showed that drought can increase the risk of hepatitis B, hepatitis C, bacillary dysentery, mumps, rubella and varicella, and the corresponding incidence rate ratios(IRRs)and 95%CI were 1.35(1.29-1.40), 1.40(1.22-1.60), 1.42(1.31-1.54), 1.31(1.18-1.45), 1.70(1.45-2.00)and 2.86(2.55-3.21), respectively. However, drought could reduce the risk of tuberculosis, and IRR(95%CI)was 0.72(0.70-0.74). Conclusion Hepatitis B, hepatitis C, bacillary dysentery, mumps, rubella and varicella are the drought-sensitive infectious diseases in Hunan Province.

Impacts of ambient temperature on chronic non-communicable disease mortality in Jinan City, China during 2007-2013: an attributable risk study

LI Jing, WANG Chuangxin, XU Xin, YANG Jun, WANG Chunping, XUE Fuzhong, LIU Qiyong

Journal of Shandong University (Health Sciences). 2018, 56(8):  76-87.  doi:10.6040/j.issn.1671-7554.0.2017.1275

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Objective To supplement the public health evidence by assessing the relationship between temperature and health adopting attributable risk assessment. Methods Daily data on temperature and non-accidental/cardiovascular/respiratory mortality outcomes were obtained from 2007 to 2013. Attributable risk assessment by distributed lag non-linear model was used to estimate the relationship of different disease mortality with temperature, and further to explore the risks of temperature on susceptible population. Results The overall cumulative exposure-response curve of temperature-mortality relationship was U-shaped. In total, ambient temperature was attributable 13.2%(95%CI: 9.6-16.8)/17.0%(95%CI: 12.6-20.8)/27.8%(95%CI: -2.5-50.5)to death risks for non-accidental/cardiovascular/respiratory disease, respectively. Females, people ≥65 years and people with low educated level were more vulnerable. Conclusion Both heat and cold are associated with an increased risk of daily mortality, but most mortality burdens are caused by cold.

Effect of temperature on the incidence of mumps in Heze City and Weihai City

ZHANG Dandan, WANG Xu, XU Qinqin, ZHENG Zhaolei, WANG Peizhu, LI Jiqing, LIU Jing, XU Qing, LI Xiujun

Journal of Shandong University (Health Sciences). 2018, 56(8):  88-94.  doi:10.6040/j.issn.1671-7554.0.2018.307

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Objective To provide a reference for the prevention and control of mumps by exploring the impact of daily mean temperature on its incidence during 2012 and 2014 in Heze City and Weihai City of Shandong Province. Methods The daily monitoring data of mumps and meteorological data of Heze City and Weihai City from Jan. 1, 2012 to Dec. 31, 2014 were collected. The distribution lag nonlinear model was constructed to investigate the effects of daily mean temperature on the incidence of mumps when the long-term trends, seasonal trends, day-of-week effects and other meteorological factors were controlled. Results During this period, a total of 2 669 and 1 838 mumps cases were reported in Heze City and Weihai City, respectively, with a higher annual incidence in Heze City. There were more male cases than female cases in both cities, especially among students, infants and scattered children. In Heze City, with the median daily temperature of 16.10 ℃ as a reference, when the lowest daily temperature was -7.10 ℃, the risk of mumps reached the highest on the 8^th lag day, RR=1.06(95%CI: 1.00-1.13). In Weihai City, with 12.55 ℃ as a reference, when the lowest daily temperature 山 东 大 学 学 报 (医 学 版)56卷8期 -张丹丹,等.菏泽市与威海市气温对流行性腮腺炎发病的影响 \=-was -9.20 ℃, the risk of mumps was the highest on lag day 0, RR=1.29(95%CI: 1.00-1.66). Conclusion The daily mean temperature has a nonlinear effect on the incidence of mumps, and it has different lag time in Heze City and Weihai City. The meteorological factors should be closely monitored for effective prevention and control of mumps.

Effect of meteorological factors and their interaction on hand-foot-mouth disease in Nanning City, China during 2008 to 2011

LIU Yanyu, LIU Zhidong, LAO Jiahui, ZHANG Jing, JIANG Baofa

Journal of Shandong University (Health Sciences). 2018, 56(8):  95-100.  doi:10.6040/j.issn.1671-7554.0.2018.165

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Objective To analyze the influence of meteorological factors and their interaction on hand-foot-mouth disease(HFMD)in Nanning City, China. Methods Weekly data of HFMD cases in Nanning City during 2008 to 2011 were collected. Generalized additive model was used to evaluate the influence of meteorological factors on the incidence of HFMD, and the interaction among meteorological factors was explored. Results The meteorological factors had nonlinear effect on HFMD. The number of cases of the disease increased continuously with the increase of the average temperature, and reached the peak at around 24 ℃, then decreased gradually as the temperature increased. However, the number of HFMD cases gradually decreased with the increase of rainfall after the peak at 40 mm. The average temperature had a certain interaction with relative humidity and average wind speed. The number of HFMD cases increased under the condition of high temperature and low humidity, and high wind speeds under the suitable temperature. Conclusion The average temperature, rainfall and other meteorological factors have nonlinear effects on the incidence of HFMD, and there is certain interaction among the meteorological factors.

Effect of diurnal temperature range on incidence of measles in Jinan City

WANG Peizhu, ZHENG Zhaolei, LI Runzi, XU Qinqin, KANG Fengling, XU Qing, LI Xiujun

Journal of Shandong University (Health Sciences). 2018, 56(8):  101-106.  doi:10.6040/j.issn.1671-7554.0.2018.126

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Objective To investigate the effects of diurnal temperature range(DTR)on measles in Jinan City, Shandong Province. Methods With data of daily measles cases and meteorological data from 1 January, 2005 to 31 December, 2011, we used a distribution lag non-linear model(DLNM)to analyze the effects of DTR on the incidence of measles adjusted for seasonal, long-term trends and other confounding factors. Results A total of 2 198 measles cases were reported in Jinan City from 2005 to 2011, with a sex ratio of 1.28∶1. Children aged <8 months accounted for 20.70% of all cases, children aged ≥8 months and <5 years accounted for 28.43%, patients aged ≥5 and <18 years accounted for 10.92%, and those aged ≥18 accounted for 39.95%. Taking 9.1 ℃ as reference, the risk was the highest when weekly average DTR was the maximum, 13.2 ℃ on lag 2 weeks, as the relative risk(RR)was 1.92(95% CI: 1.47-2.50), when the significant lag range was the maximum. For a 2 ℃ increase in DTR, the risk was the highest in both male and female at 2 weeks lag, with RR values of 1.19(95%CI: 1.08-1.32)and 1.24(95%CI:1.12-1.38)respectively. DTR had the strongest effect on children aged ≥5 and <18 years at 2 weeks lag, with an RR of 1.41(95% CI: 1.15-1.74)and no significant effect on infants aged 8 months and younger. Conclusion The significant impact and lag effect are found between DTR and the incidence of measles in Jinan City. Female and people aged ≥5 and <18 years are more sensitive to DTR. Attention should be paid to DTR, and timely prevention measures should be taken against susceptible population to mitigate the hazard.

Relationship between diurnal temperature range and outpatient visits of respiratory diseases in summer

WEI Ran, ZHANG Anran, LI Jiawei, HU Wenqi, XUE Li, LIN Junfen, MA Wei

Journal of Shandong University (Health Sciences). 2018, 56(8):  107-113.  doi:10.6040/j.issn.1671-7554.0.2018.050

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Objective To quantitatively analyze the influence of the diurnal temperature range(DTR)on outpatient visit of respiratory diseases in summer. Methods The outpatient visit data were collected from the electronic medical record(EMR)of respiratory diseases in the Third Peoples Hospital of Cangnan County, Zhejiang Province, China between July to September in 2010-2013. The daily meteorological data at the same period were collected. Generalized additive model(GAM)was used to explore the exposure-response relationship between DTR and risk of respiratory diseases, lag effects, cumulative lag effects, and impacts on different populations. Results A total of 27 770 cases of outpatients with respiratory diseases were collected and the DTR varied from 1.4 ℃ to 11.3 ℃. Increasing DTR significantly increased the number of outpatient with respiratory diseases with the maximum lag effect at lag 4 days and cumulative lag 13 days. The RRs for outpatient visit were 1.033(95%CI: 1.022-1.045)and 1.349(95%CI: 1.318-1.381)at lag 4 days and cumulative 13 days, respectively. Children(<15 years old)were more likely to be affected. Conclusion In Cangnan County, the increasing DTR in summer may significantly increase the incidence of respiratory diseases and lag effects exists. Special attention should be paid to the onset of childhood respiratory disease, and more positive measures 山 东 大 学 学 报 (医 学 版)56卷8期 -魏然,等.夏季日温差与医院门诊呼吸系统疾病就诊量的关系 \=-should be taken to minimize the effect of DTR.

Relationship between severe fever with thrombocytopenia syndrome and meteorological factors in Weihai City

WANG Xu, ZHANG Dandan, Zheng Zhaolei, WANG Peizhu, XU Qinqin, WANG Xianjun, DING Shujun, LI Xiujun

Journal of Shandong University (Health Sciences). 2018, 56(8):  114-120.  doi:10.6040/j.issn.1671-7554.0.2018.459

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Objective To explore the relationship between severe fever with thrombocytopenia syndrome(SFTS)and meteorological factors in Weihai City. Methods The incidence of SFTS and the meteorological factors in Weihai City from 2011 to 2015 were statistically interpreted. The months in which SFTS occurred were defined as the case months, and the months without SFTS occurrence were the non-case months. The case months and non-cases months were compared to analyze the differences in meteorological factors. Decision tree was established to classify the meteorological factors, which were then fit into negative binomial regression. The variables were diagnosed to select the optimal model. After that, the impacts of meteorological factors on SFTS were analyzed. Results There was a clear seasonal trend in the incidence of SFTS in Weihai City, and May to October was the peak of onset of the disease. The comparative analysis showed that there were differences in meteorological factors between the case months and non-case months except for average monthly sunshine duration. When the average monthly temperature was higher than 14 ℃, the incidence of SFTS increased(RR=3.41, 95%CI: 1.12-10.89). When the average monthly wind speed was faster than 5.8 m/s, 山 东 大 学 学 报 (医 学 版)56卷8期 -王旭,等.威海市发热伴血小板减少综合征与气象因素关系 \=-the incidence of SFTS decreased(RR=0.62, 95%CI: 0.39-0.96). Conclusion The average monthly temperature above 14 ℃ may be a risk factor for SFTS, while the average monthly wind speed above 5.8 m/s may be a protective factor for the disease.