With the increasing frequency of extreme weather events due to global climate change, the impact of air temperature on stroke deaths is gaining increasing attention.

This study aimed to evaluate the impact of average daily temperature on stroke mortality in Pudong New Area.

Data were collected from Pudong New Area from January 1, 2005 to December 31, 2019, including deaths due to stroke (hemorrhagic stroke and ischemic stroke) , meteorological information (air temperature, relative humidity, atmospheric pressure) , atmospheric pollutants 〔particulate matter 10 (PM₁₀) , sulfur dioxide (SO₂) and nitrogen dioxide (NO₂) 〕. We used a distributed lag non-linear model (DLNM) to evaluate the impact of average daily air temperature on stroke mortality, and assess the lagged and cumulative effects. Age- and education attainment-specific analyses were performed to identify the susceptible groups.

During the period, a total number of 30 337 deaths from stroke were reported in Pudong New Area of Shanghai, and the deaths due to hemorrhagic stroke and ischemic stroke numbered 11 221 (36.99%) and 15 308 (50.46%) , respectively. The average daily deaths from stroke, hemorrhagic stroke and ischemic stroke were 5.54, 2.05 and 2.79, respectively. The average daily temperature, relative humidity and air pressure in Pudong New Area were 17.25 ℃, 73.75%, and 1 015.83 hPa, respectively. The average daily concentrations of PM₁₀, SO₂ and NO₂ were 68.87 μg/m³, 28.82 μg/m³, and 44.68 μg/m³, respectively. Using the average median daily temperature (P₅₀=18.2 ℃) as a reference, the strongest cumulative effects of low temperature (P₅=3.0℃) were observed within 0-14 days lagged (Lag 0-14) for stroke mortality〔RR=1.34, 95%CI (1.15, 1.56) 〕 and hemorrhagic stroke mortality〔RR=1.61, 95%CI (1.25, 2.08) 〕. The impact of low temperature on stroke mortality and hemorrhagic stroke mortality was significantly lagged and cumulated, but its impact on ischemic stroke mortality was not significant. The strongest cumulative effects of high temperature (P₉₅=30.1 ℃) on stroke mortality 〔RR=1.26, 95%CI (1.12, 1.41) 〕 and ischemic stroke 〔RR=1.64, 95%CI (1.39, 1.93) 〕 were observed within 0-1 day lagged (Lag 0-1) . High temperature imposed an acute effect on stroke mortality and ischemic stroke mortality, but produced insignificant effect on hemorrhagic stroke mortality. No significant impact of low temperature was observed on stroke mortality in population < 75 years old, but the impact on stroke mortality in population≥ 75 years old was strongest within Lag 0-14 d. The strongest impacts of low temperature on stroke mortality in population with primary education or below, and in population with secondary education or above were observed within Lag 0-21 d and Lag 0-14 d, respectively. No significant impact of high temperature was observed on stroke mortality in population < 75 years old and population with secondary education and above, but the impact was the strongest on stroke mortality in population ≥ 75 years old and the population with primary education or below within Lag 0-1 d. The impact of high temperature on stroke mortality in population with primary education or below was significantly higher than that in population with secondary education and above within Lag 0-3 d (P<0.05) .

Both low and high temperatures were associated with the stroke mortality risk in Pudong New Area. Low temperature increased the risk of death from hemorrhagic stroke, while high temperature increased the risk of death from ischemic stroke. People with primary education or below were more likely to die from strokes in hot environments.

Patients with ischemic heart disease (IHD) are prone to gastrointestinal bleeding (GIB) under stress and other stimuli, and in turn severe GIB can induce IHD. IHD patients complicated with GIB are facinga higher mortality risk than those with IHD or GIB alone. Season and temperature may increasethe morbidity and mortality risk of patients with IHD and GIB, but further research is stillneeded.

To investigate the seasonal distribution characteristics of IHD complicated with GIB and its correlation with temperature.

A total of 730 IHD patients complicated with GIB treated at West China Hospital, Sichuan University, from January 2014 to December 2018 were enrolled as the research objectsbased on inclusion and exclusion criteria. The following baseline data of the patients were collected through the electronic medical record system, including age, sex, history of smoking, drinking, percutaneous coronary intervention (PCI) , use of antiplatelet agents and use of anticoagulants; presence or absence of hypertension, diabetes mellitus, chronic kidney disease (CKD) and chronic obstructive pulmonary disease (COPD) ; time of admission, IHD type (stable angina pectoris and acute coronary syndrome) , GIB site (nonvariceal upper GIB, variceal upper GIB, lower GIB and unexplained GIB) and mode of discharge (death outcome) . The meteorological dataincluding monthly average high temperature, monthly average low temperature, monthly average temperature and monthly temperature difference from January 2014 to December 2018 in Chengdu were obtained from the Chengdu Meteorological Office. Based on the commonly adopted seasonal division method in climatology and meteorological characteristics of the Chengdu area, the seasons were divided into spring (March, April and May) , summer (June, July and August) , autumn (September, October and November) and winter (December, January and February) . The seasonal hospitalization rate, seasonal incidence of acute coronary syndrome, seasonal incidence of bleeding sites and seasonal mortality of IHD patients complicated with GIB were analyzed.

The participants included 493 males and 237 females (male-to-female ratio: 2.08∶1) with an average age of (72.8±11.3) years. The proportions of males and females aged 70-79 were higher, which were 35.29% (174/493) and 39.66% (94/237) , respectively. The temperature was highest in July and August and lowest in December and January. The greatest temperature difference occurred in spring. The hospitalization rate was higher in winter and spring than in summer and autumn (58.8% vs 41.2%, χ²=3.907, P=0.003) . Compared with summer and autumn, the hospitalization rate for IHD patients complicated with GIB increased in spring (χ²=2.912, P=0.020; χ²=2.567, P=0.033) . In addition, the hospitalization rate for IHD patients complicated with GIB increased in winter compared with that in summer (χ²=2.191, P=0.035) . The Spearman correlation analysis results indicated that the number of hospitalized IHD patients complicated with GIB was negatively correlated with the monthly average temperature (r_s=-0.280, P<0.05) and positively correlated with the monthly temperature difference (r_s=0.260, P<0.05) . Compared with summer and autumn, the incidence of acute coronary syndrome in patients with IHD combined with GIB was higher in winter (χ²=3.755, P=0.006; χ² =3.167, P=0.013) ; the incidence of acute coronary syndrome in patients with IHD combined with GIB in spring was higher than that in summer and autumn (χ²=3.108, P=0.015; χ²=2.520, P=0.036) . Compared with summer and autumn, the incidence of non-variceal upper gastrointestinal bleeding increased in winter (χ²=2.963, P=0.018; χ² =2.528, P=0.035) ; the incidence of non-variceal upper gastrointestinal bleeding in spring was higher than that in summer and autumn (χ²=3.056, P=0.016; χ²=2.620, P=0.031) . Compared with summer and autumn, the incidence of lower gastrointestinal bleeding in winter was higher (χ²=2.773, P=0.024; χ²=2.973, P=0.018) ; the incidence of lower gastrointestinal bleeding in spring was higher than that in summer and autumn (χ²=2.757, P=0.025; χ²=2.957, P=0.018) ; the incidence of unexplained GIB in winter was higher than that in summer (χ²=2.449, P=0.040) . Compared with that in spring, summer and autumn, the mortality rate for IHD patients complicated with GIB was higher in winter (P<0.05) .

The morbidity of IHD patients complicated with GIB shows obvious seasonality and is influenced by the monthly average temperature and temperature difference, among seasonal and meteorological factors. A decrease in the monthly average temperature or an increase in the temperature difference increases the risks of acute coronary syndrome, nonvariceal upper GIB, lower GIB, unexplained GIB and mortality in IHD patients complicated with GIB.

The measurement of exhaled gas nitric oxide (FeNO) has safe, non-invasive, simple, repetitive characteristics which is widely used in the assessment of airway inflammation in asthmatic patients, but the determination of FeNO is affected by a variety of factors, among which living environment factors exposure may have a close relationship to FeNO level, whereas there are few studies on the impact of exposure of living environment factors on the level of FeNO.

To analyze the effect of exposure to living environment factors on the level of exhaled nitric oxide (FeNO) in patients with bronchial asthma in non acute attack period, so as to improve the efficacy of clinicians in using FeNO to manage asthma.

A total of 109 patients with bronchial asthma in non acute attack period who visited the Respiratory Department Outpatient of the Second Affiliated Hospital of Guangzhou Medical University from July 2018 to June 2020 were included as the study subjects, the data were collected through a questionnaire survey, and the questionnaire information mainly included general information (gender, age, height, body mass) , living environment factors (including smoking history, whether family members smoked at home, allergy history, location of residence, the distance between the residence and the main road with large traffic volume, whether there were factories around the residence, floors of residential buildings, length of residence building, frequency of washing and drying bed sheets, quilt covers/pillow cases, curtain materials at home, potted plants at home, whether the trash can in the home was cleaned regularly, whether kept pets at home, whether there were cockroaches at home and whether kitchen waste was disposed of the same day, whether there were plush toys at home) and the inspection data of FeNO collected. Patients with bronchial asthma were divided into 3 groups according to FeNO level: there were 47 cases in the FeNO low level group (FeNO<25 ppb) , 35 cases in the FeNO medium level group (25 ppb≤FeNO≤50 ppb) and 27 cases in the FeNO high level group (FeNO>50 ppb) . Ordinal multiple classification logistic regression analysis was used to explore the environmental factors affecting the FeNO value level measurement.

There was no significant difference in gender, age, height and body mass among the three groups (P>0.05) . There was no significant difference among the three groups in floors of residential buildings, length of residence, frequency of washing and drying bed sheets, quilt covers/pillow cases, curtain materials at home, potted plants at home, whether the trash can in the home was cleaned regularly, whether there were cockroaches at home and whether kitchen waste was disposed of the same day, whether there were plush toys at home (P>0.05) ; There were statistically significant differences in smoking history, whether family members smoked at home, allergy history, location of residence, the distance between the residence and the main road with large traffic volume, whether there were factories around the residence, and whether there were pets at home (P<0.05) . Those with a history of smoking were 0.332 (P=0.022) times more likely to have one grade higher FeNO levels compared to those without; Family member smoking at home was 0.345 (P=0.014) times more likely to have one grade higher FeNO level compared to those not smoking at home; Compared with those without pets at home, those who kept pets at home were 0.327 (P=0.014) times more likely to have one grade higher FeNO level; Those with a history of allergy were 4.076 (P=0.003) times more likely to have one grade higher FeNO levels compared to those without; Those whose place of residence was the center of the city were 3. 908 (P = 0.006) times more likely to have one grade higher FeNO level compared with those whose place of residence was suburban; The probability of having one grade higher FeNO level were 2.689 (P=0.018) times higher in those whose place of residence was near the main tract versus those whose place of residence was far from the main tract; Those with a factory around their place of residence were 2.740 (P=0.032) times more likely to have one grade higher FeNO level compared with those without a factory around their place of residence.

The determination of FeNO value level used in daily management of asthma is obviously affected by exposure factors of living environment, especially tobacco exposure, allergies, keeping pets and place of residence, and needs to be differentiated clinically for relevant patients.

The prevalence of hypertension in population is still increasing by year, and the significant increase in the prevalence of chronic diseases caused by aging of the population results in a serious medical burden. There are still about 450 million people in China who use solid fuels for cooking or heating, causing indoor air pollution as an important public health problem in China. At present, the relationship between solid fuels use and the risk of hypertension in Chinese older adults still remains unclear.

To analyze the association between solid fuels use and the risk of hypertension in older adults in urban and rural areas of China through a prospective cohort study, so as to provide a theoretical basis for the prevention and treatment of hypertension in the elderly.

This study is a prospective cohort study. Data were obtained from 2011 to 2018 China Longitudinal Healthy Longevity Survey (CLHLS) by using baseline questionnaire and physical examination. A total of 1 453 non-hypertensive older adults aged 65 years and above from 2011 to 2012 cohort were included in the study, and the occurrence of hypertension during follow-up was considered as the outcome indicator, follow-up as of 2018-12-31. The included subjects were divided into the clean fuel (electrical appliances such as induction cooker, pipeline natural gas, solar energy) group (n=654) and solid fuel (charcoal, kerosene, coal, firewood) group (n=799). Multivariate Cox proportional hazard regression model was used to analyze the association between cooking with solid fuels and the risk of hypertension.

A total of 1 453 non-hypertensive older adults at baseline with an average age of (77.6±8.8) years and a median follow-up of 7 years, and a total of 838 people developed hypertension at the outcome. The results of this study showed that the proportion of cooking with solid fuels in rural areas was significantly higher than that in urban areas (70.3% vs. 1.1%, P<0.05). Multivariate Cox proportional hazard regression model showed that cooking with solid fuels significantly increased the risk of hypertension〔HR=1.20, 95%CI (1.05, 1.38), P=0.01〕, and the adjustment for covariates still indicated that it increased the risk of hypertension〔HR=1.21, 95%CI (1.04, 1.41), P=0.01〕. In addition, cooking with solid fuels was positively associated with abnormal mean arterial pressure (MAP) 〔HR=1.26, 95%CI (1.02, 1.55), P=0.03〕; and the adjustment for covariates still showed positive association of it with abnormal MAP〔HR=1.28, 95%CI (1.02, 1.60), P=0.03〕.

Cooking with solid fuels in urban and rural areas of China significantly increases the risk of hypertension in the elderly, as well as affects MAP. Reducing the use of solid fuels for cooking and promoting the use of clean fuels is a simple and effective measure in the prevention and control of hypertension.

Dyslipidemia has become one of the global public health issues. However, the relationship between air pollution and dyslipidemia has been rarely reported.

To explore the relationship between air pollutant exposure and dyslipidemia in middle-aged and elderly people in mining areas.

A total of 1 965 residents over 45 years old were sampled using cluster random sampling from mining areas in western Hunan from 2018 to 2019. The general data and lipid indices were obtained by using an interviewer-administered questionnaire survey, a physical examination and a laboratory test. The level of air pollution of the mining area was calculated by inverse distance weighted interpolation, and the average daily dose (ADD_total) of air pollutants of each resident was calculated, and used to divide them into Q1 group (0.5-0.7 m³·kg^-1·d^-1, n=172), Q2 group (>0.7-0.9 m³·kg^-1·d^-1, n=870), Q3 group (>0.9-1.1 m³·kg^-1·d^-1, n=717), and Q4 group (>1.1 m³·kg^-1·d^-1, n=172). Unconditional Logistic regression was used to analyze the relationship between ADD_total and dyslipidemia.

The annual average concentration of PM_2.5 in the two mining areas exceeded the National Air Quality Standard (Ⅱ). The prevalence rate of dyslipidemia was 25.3% (498/1 965). There were statistically significant differences in mean age and body mass index (BMI), prevalence of smoking and hypertension between patients with normal and dyslipidemia (P<0.05). The detection ratios of abnormal triglyceride (TG) and high density lipoprotein cholesterol in Q1 to Q4 groups were statistically significant different (P<0.05). After adjusting for age, sex, hypertension, BMI, smoking, diabetes, drinking and other factors, unconditional Logistic regression analysis found that Q2, Q3 and Q4 groups had a greater risk of abnormal TG (P<0.05), and Q4 group also had a greater risk of abnormal total cholesterol (TC) (P<0.05), compared with group Q1 (with the lowest concentration of ADD_total) .

The air pollutants in the two mining areas were mainly PM_2.5, the ADD_total of air pollutants was positively correlated with TC and TG anomalies, which provides a reference for further research on the relationship between air pollutant exposure and dyslipidemia.

Exposure to indoor air particles pollution increases the incidence and mortality of respiratory and cardiovascular diseases, especially in the elderly population.

To explore the effect of indoor air particles on cardiopulmonary-related physiological indexes of the elderly and short-term use of air purifiers on the improvement of cardiopulmonary health of the elderly.

A randomized, double-blind, crossover trial was conducted in January 2020 on 24 healthy older adults selected from a senior apartment in Jiangbei District of Chongqing. These included older adults equally divided into two groups alternately using real and sham air purifiers for 48 h with a 12-days washout interval by complete randomization. 14 health indexes including biomarkers of circulatory system inflammation, coagulation, oxidative stress and pulmonary function, blood pressure, heart rate, exhaled fractional nitric oxide (FeNO) were measured. Linear mixed-effect model was used to evaluate the effect of the air purifiers on health indexes.

The results of the linear mixed-effect model showed that compared with the sham purifiers, fibrinogen, MCP-1 and MPO in the blood inflammatory indicators were changed by -15.1%〔95%CI (-23.1%, -6.3%) , P<0.05〕, -17.7%〔95%CI (-22.9%, -12.3%) , P<0.05〕 and -17.2%〔95%CI (-23.9%, -9.8%) , P<0.05〕, PAI-1 and t-PA in the coagulation factors changed by -14.9%〔95%CI (-21.1%, -8.2%) , P<0.05〕 and -13.5%〔95%CI (-18.7%, -8.0%) , P<0.05〕, heart rate changed by -5.8%〔95%CI (-10.6%, -0.8%) , P<0.05〕in the real purifiers, respectively. For every 1 μg/m³ increase in PM_2.5 concentration, fibrinogen, MCP-1, MPO, PAI-1, t-PA, D-dimer and heart rate in the elderly increased by 0.51%, 0.48%, 0.56%, 0.49%, 0.43%, 0.31% and 0.20%, respectively (P<0.05) .

Indoor air purifiers are associated with decreased concentrations of systemic and local inflammation and coagulation biomarkers. Reducing air particles may be a public health measure to improve circulatory and cardiopulmonary health in the elderly.

The number of depression patients has exceeded 300 million worldwide, and its high disability rate has attracted global attention. However, the relationship between temperature-humidity index (Humidex) and depression remains to be explored.

To explore the relationship between Humidex of the twenty-four solar terms and depression.

Outpatient data of depression patients (n=18 289) admitted to the Psychology Department, Mental Health Center of Jiading District from 2016-10-08 to 2019-10-07 were collected, including gender, age, time of treatment, number of outpatient visits and specialist visits. The data of daily mean temperature, relative humidity, rainfall, air pressure and mean wind speed in Jiading District from 2016-10-08 to 2019-10-07 published by Shanghai Meteorological Bureau were collected to calculate Humidex. The included patients were divided into the groups of ≤18 years (n=157) , 19-44 years (n=3 099) , 45-59 years (n=4 848) , 60-74 years (n=6 270) and≥75 years (n=3 915) according to different ages. The relationship between Humidex of twenty-four solar terms and depression was estimated by using the combination of nonhomogeneous Poisson distribution and distributed-lag nonlinear model. Correlation between Humidex and meteorological variables was calculated using Pearson correlation analysis. Relative risk rates (RR) of Humidex and depression were calculated of twenty-four solar terms using median Humidex as control.

A total of 18 289 patients with depression were included from 2016-10-08 to 2019-10-07, including 6 900 males and 11 389 females. The Lesser Cold solar term corresponded to the lowest average Humidex and highest number of depression patients, the Great Heat solar term corresponded corresponded to the highest average Humidex and lowest number of depression patients from 2016-10-08 to 2017-10-07. The Great Cold solar term corresponded to the lowest average Humidex and highest number of depression patients, the Great Heat solar term corresponded to the highest average Humidex and lowest number of depression patients from 2017-10-08 to 2018-10-07. The Great Cold solar term corresponded to the lowest average Humidex and highest number of depression patients, the Great Heat corresponded to the highest average Humidex and lowest number of depression patients from 2018-10-08 to 2019-10-07. Humidex in 24 solar terms showed a nonlinear relationship with the overall population risk of depression. The top two solar terms corresponding to Humidex of depression risk distribution for total population, male, female, ≤18 years, 19-44 years, 45-59 years, 60-74 years, and ≥75 years were the Great Cold and Beginning of Spring solar terms, Great Heat solar term corresponded to the lowest depression risk distribution. The maximum lag effect was observed on the 10th day of the Great Cold and Beginning of Spring solar terms (RR=1.020, 95%CI=1.001-1.040) , and the lag effect was observed on the 8th day of Great Heat solar term and lasted to the 9th day. The lag effect was observed on the 7th day after the Great Cold and Beginning of Spring and the maximum lag effect was observed on the 9th day (RR=1.054, 95%CI=1.007-1.104) , which lasted until the 11th day in the 60-74 years group. The lag effect was observed on the 1st day and 8th day after the Great Heat, and lasted to the 2nd day and 10th day, respectively, with the maximum lag effect on the 10th day (RR=0.952, 95%CI=0.911-0.994) in male depression patients. The lag effect was observed on the 8th day after the Great Heat solar term and lasted to the 9th day in the 60-74 years group.

Humidex in the Great Cold and Beginning of Spring solar terms are risk factors for depression. Clinically, accurate diagnosis and treatment should be provided for different depression patients according to Humidex in different solar terms, and individualized intervention programs should be formulated.

Stroke is a chronic condition that seriously impairs human health. The correlation between rainfall and onset of stroke remains unclear.

To analyze the correlation between rainfall and stroke admissions in Nanchang City, and to provide scientific references for developing a comprehensive prevention and treatment strategy for stroke.

Stroke admission data from Nanchang City (2015-2019) from the digital-related group (DRG) system of the Jiangxi Provincial Health Commission Information Center were collected. In addition, atmospheric pollutant data from the national urban air quality real-time release platform and meteorological data from the Nanchang meteorological base station were collected. Basic characteristics of stroke admission patients, air pollutants, and meteorological factors were analyzed. Spearman rank correlation analysis was performed to identify the correlation of case number of stroke admissions with air pollutants and atmospheric factors. Distributional lag nonlinear model was used to explore the linkage between rainfall and stroke admissions. Stratified analysis was conducted based on gender and age (<65 years old and ≥65 years old), and lag represented the lagging days.

From 2015 to 2019, there were 79 523 hospitalized patients with stroke in Nanchang City, of which 49 072 (61.71%) were males and 48 092 (60.48%) were ≥65 years old, accounting for a large proportion. The number of stroke admissions in winter (December to February) and spring (March to May) were 20 065 (25.23%) and 20 358 (25.60%), respectively. There was a nonlinear relationship between rainfall and stroke admission, and there was a certain lag effect. The RR values of lag1 and lag2 for the effect of rainfall on stroke admission was both 1.009, and 95%CI were 1.000-1.019 and 1.001-1.016, respectively. Stratified analysis showed that the main effect of higher rainfall on the number of male stroke admissions was lag6, RR value was 1.003; the main effect on the number of hospital admissions for female stroke was lag1 and lag2, with RR values of 1.018 (95%CI=1.004-1.031) and 1.020 (95%CI=1.009-1.031), respectively. The main effects on the number of hospitalizations for ischemic stroke under 65 years of age were lag1 (RR=1.016, 95%CI=1.003-1.030), and lag2 (RR=1.018, 95%CI=1.007-1.029) .

Short-term exposure to higher rainfall can increase the risk of stroke hospitalization, and women and people under 65 years of age are more sensitive to rainfall exposure, and protection should be strengthened for this group of people.