Spatial and temporal analysis of tuberculosis in Zhejiang Province, China, 2009-2012

Abstract Background Tuberculosis (TB) is an infectious disease of major public health concern. The disease has demonstrated large space-time variations. This study aims to explore the space-time dynamics of TB cases in an economically and geographically dynamic province in China with specific references of TB control for policy makers. Methods Data on all reported TB cases from 2009 to 2012 were collected from the TB program at the Zhejiang Provincial Center for Disease Control and Prevention. We employed time series and exploratory spatial data analyses, including Moran’s I, Local Getis’s G i * , and Kulldorff’s space-time scan statistics, to identify the temporal trends and spatial patterns of TB at a county level. Results A total of 147,941 TB cases were reported during 2009–2012 in Zhejiang. A higher proportion of TB cases were younger, male, and registered permanent residents among all TB cases notified in the province. TB cases were reported most frequently in April with small peaks in June, July, and October. This disease was spatially clustering with Moran’s I values ranged from 0.29 to 0.32 (p < 0.001). A most likely cluster and ten secondary clusters were identified, mainly concentrated in the southeast and west counties of the province. Conclusions This study identified seasonal patterns and significant space-time clusters of TB cases in Zhejiang, China. Poverty, migration, and seasonal effects may play important roles in potential clusters

Additional file 1: of Spatial and temporal analysis of tuberculosis in Zhejiang Province, China, 2009-2012

Multilingual abstracts in the six official working languages of the United Nations. (PDF 548 kb

Season-dependent heatwave mechanisms: A study of southern China

Heatwaves are among the deadliest weather-related disasters. They are not only seen in summer but also may appear in spring and autumn, especially under climate warming. Although the mechanisms of summertime heatwaves have been extensively studied, how they differ from spring and autumn seasons and possibly season-dependent mechanisms of heatwaves are poorly understood. Here we examine the specific processes associated with spring, summer, and autumn heatwaves in southern China during 1961–2020. We show that heatwaves in all three seasons are intensifying in frequency, duration, and intensity, and they exhibit distinctly season-dependent circulation changes. Summer heatwaves are characterized by a warm-core high-pressure structure, while spring and autumn heatwaves exhibit a warm low pattern. Summer heatwaves are mainly triggered by the westward (eastward) extension of the western North Pacific subtropical high (South Asian high), and are accompanied by anomalous lower-level anticyclone and positive pressure anomalies. In contrast, spring and autumn heatwaves coincide with lower-than-normal pressure and anomalous southwesterly over East Asia, indicative of a weakening of the East Asian winter monsoon circulation and the Siberian high. Their developments are linked to the eastward movement of an upper-tropospheric wave-like pattern over the mid-latitudes. It is also found that autumn heatwaves are largely contributed by local preceding soil moisture deficit, in comparison to spring and summer heatwaves. Our findings contribute to a better understanding of the heatwave characteristics in different seasons and provide insights into their mitigation strategies

Different characteristics of independent and compound extreme heat and ozone pollution events in the Greater Bay Area of China

Under global warming and rapid urbanization, heat extremes, ozone pollution, and their co-occurrences are emerging and posing severe risks to human health. However, possibly different characteristics of independent heat days (IHD), independent ozone pollution (IOP) and compound heat-ozone pollution (CHOP) events are unclear. In this study, we present an investigation of the spatial distribution and mechanisms associated with IHD, IOP and CHOP events during May–October in 2014–2022 by taking the Guangdong-Hong Kong-Macao Greater Bay Area (GBA) of China as an example. The results show that central GBA faces higher compound risk than northwestern and southeastern regions. IHD events are primarily driven by extremely high temperatures and accompanied by anomalous anticyclone and high pressure at both lower and upper troposphere levels, under the joint effects of the South Asian high and western North Pacific subtropical high. IOP events are predominantly accompanied by decreased cloud cover, air humidity and enhanced downward solar radiation. CHOP events are influenced by increases in both temperature and downward solar radiation. The circulation patterns of CHOP events are somewhat similar to IOP but with much stronger magnitude and faster developing process, and both are likely related to tropical cyclone activities. Our findings can strengthen the early forecasting of these extreme events and mitigate their negative impacts

A systematic literature review and critical appraisal of epidemiological studies on outdoor air pollution and tuberculosis outcomes

Ambient air pollution is the leading environmental risk factor for disease globally. Air pollutants can increase the risk of some respiratory infections, but their effects on tuberculosis (TB) are unclear. In this systematic literature review, we aimed to assess epidemiological studies on the association between outdoor air pollutants and TB incidence, hospital admissions and death (collectively referred to here as 'TB outcomes'). We sought to consolidate available evidence on this topic and propose recommendations for future studies. Following PRISMA guidelines, we searched PubMed, Web of Science, Google Scholar, and Scopus with no restrictions imposed on year of publication. A total of 11 epidemiological studies, performed in Asia, Europe and North America, met our inclusion criteria (combined sample size: 215,337 people). We extracted key study characteristics from each eligible publication, including design, exposure assessment, analytical approaches and effect estimates. The studies were assessed for overall quality and risk of bias using standard criteria. The pollutant most frequently associated with statistically significant effects on TB outcomes was fine particulate matter ( < 2.5 µm; PM); 6/11 studies assessed PM, of which 4/6 demonstrated a significant association). There was some evidence of significant associations between PM ( < 10 µm), nitrogen dioxide (NO) and sulfur dioxide (SO) and TB outcomes, but these associations were inconsistent. The existing epidemiological evidence is limited and shows mixed results. However, it is plausible that exposure to air pollutants, particularly PM, may suppress important immune defence mechanisms, increasing an individual's susceptibility to development of active TB and TB-related mortality. Considering the small number of studies relative to the demonstrably large global health burdens of air pollution and TB, further research is required to corroborate the findings in the current literature. Based on a critical assessment of existing evidence, we conclude with methodological suggestions for future studies

A daily high-resolution (1 km) human thermal index collection over the North China Plain from 2003 to 2020

Abstract Human-perceived temperature (HPT) describes the joint effects of multiple climatic factors such as temperature and humidity. Extreme HPT events may reduce labor capacity and cause thermal discomfort and even mortality. These events are becoming more frequent and more intense under global warming, posing severe threats to human and natural systems worldwide, particularly in populated areas with intensive human activities, e.g., the North China Plain (NCP). Therefore, a fine-scale HPT dataset in both spatial and temporal dimensions is urgently needed. Here we construct a daily high-resolution (~1 km) human thermal index collection over NCP from 2003 to 2020 (HiTIC-NCP). This dataset contains 12 HPT indices and has high accuracy with averaged determination coefficient, mean absolute error, and root mean squared error of 0.987, 0.970 °C, and 1.292 °C, respectively. Moreover, it exhibits high spatiotemporal consistency with ground-level observations. The dataset provides a reference for human thermal environment and could facilitate studies such as natural hazards, regional climate change, and urban planning

Ambient carbon monoxide associated with reduced risk of hospital admissions for respiratory tract infections

Rationale: Recent experimental and clinical studies suggest that exogenous carbon monoxide (CO) at lower concentrations may have beneficial effects under certain circumstances, whereas populationbased epidemiologic studies of environmentally relevant CO exposure generated mixed findings. Objectives: To examine the acute effects of ambient CO on respiratory tract infection (RTI) hospitalizations. Methods: A time series study was conducted. Daily emergency hospital admission and air pollution data in Hong Kong were collected from January 2001 to December 2007. Log-linear Poisson models wereused to estimate the associations between daily hospital admissions for RTI and daily average concentrations of CO across three background air monitoring stations and three roadside stations, respectively, controlling for other traffic-related copollutants. Measurements and Main Results: CO concentrations were low during the study period with a daily average of 0.6 ppm in background stations and 1.0 ppm in roadside stations. Negative associations were found between ambient CO concentrations and daily hospital admissions for RTI. One ppm increase in background CO at lag 0-2 days was associated with 25.7% (95% confidence interval, 29.2 to 22.1) change in RTI admissions from the whole population according to single-pollutant model; the negative association became stronger when nitrogen dioxide or particulate matter with aerodynamic diameter less than 10 mm was adjusted for in two-pollutant models.Thenegative associationseemedtobestronger in the adults than in the children and elderly. Conclusions: Short-termexposure to ambientCOwas associated with decreased risk of hospital admissions for RTI, suggesting some acute protective effectsof lowambientCOexposureonrespiratory infection. Copyright © 2013 by the American Thoracic Society.link_to_subscribed_fulltex

Protocol for a pragmatic cluster randomised controlled trial to evaluate the effectiveness of digital health interventions in improving non-communicable disease management during the pandemic in rural Pakistan.

BackgroundThe COVID-19 pandemic has revealed gaps in global health systems, especially in the low- and middle-income countries (LMICs). Evidence shows that patients with non-communicable diseases (NCDs) are at higher risk of contracting COVID-19 and suffering direct and indirect health consequences. Considering the future challenges such as environmental disasters and pandemics to the LMICs health systems, digital health interventions (DHI) are well poised to strengthen health care resilience. This study aims to implement and evaluate a comprehensive package of DHIs of integrated COVID-NCD care to manage NCDs in primary care facilities in rural Pakistan.MethodsThe study is designed as a pragmatic, parallel two-arm, multi-centre, mix-methods cluster randomised controlled trial. We will randomise 30 primary care facilities in three districts of Punjab, where basic hypertension and diabetes diagnosis and treatment are provided, with a ratio of 1:1 between intervention and control. In each facility, we will recruit 50 patients who have uncontrolled hypertension. The intervention arm will receive training on an integrated COVID-NCD guideline, and will use a smartphone app-based telemedicine platform where patients can communicate with health providers and peer-supporters, along with a remote training and supervision system. Usual care will be provided in the control arm. Patients will be followed up for 10 months. Our primary indicator is systolic blood pressure measured at 10 months. A process evaluation guided by implementation science frameworks will be conducted to explore implementation questions. A cost-effectiveness evaluation will be conducted to inform future scale up in Pakistan and other LMICs.DiscussionOur study is one of the first randomised controlled trials to evaluate the effectiveness of DHIs to manage NCDs to strengthen health system resilience in LMICs. We will also evaluate the implementation process and cost-effectiveness to inform future scale-up in similar resource constrained settings.Trial registrationClinicalTrials.gov Identifier-NCT05699369