BACKGROUND: There are few multi-city studies on the association between temperature and mortality in basin climates. This study was based on the Sichuan Basin in southwest China to assess the association of basin temperature with non-accidental mortality in the population and with the temperature-related mortality burden. METHODS: Daily mortality data, meteorological and air pollution data were collected for four cities in the Sichuan Basin of southwest China. We used a two-stage time-series analysis to quantify the association between temperature and non-accidental mortality in each city, and a multivariate meta-analysis was performed to obtain the overall cumulative risk. The attributable fractions (AFs) were calculated to access the mortality burden attributable to non-optimal temperature. Additionally, we performed a stratified analyses by gender, age group, education level, and marital status. RESULTS: A total of 751,930 non-accidental deaths were collected in our study. Overall, 10.16% of non-accidental deaths could be attributed to non-optimal temperatures. A majority of temperature-related non-accidental deaths were caused by low temperature, accounting for 9.10% (95% eCI: 5.50%, 12.19%), and heat effects accounted for only 1.06% (95% eCI: 0.76%, 1.33%). The mortality burden attributable to non-optimal temperatures was higher among those under 65 years old, females, those with a low education level, and those with an alternative marriage status. CONCLUSIONS Our study suggested that a significant association between non-optimal temperature and non-accidental mortality. Those under 65 years old, females, and those with a low educational level or alternative marriage status had the highest attributable burden.
Female ; Humans ; China/epidemiology* ; Cities ; Cold Temperature ; Hot Temperature ; Mortality ; Temperature ; Time Factors ; Middle Aged ; Male

Objective To evaluate the molluscicidal effect of spraying different formulations of niclosamide ethanolamine salt with drones against Oncomelania hupensis in ditches. Methods A semi-dry and semi-wet ditch with O. hupensis snails was selected in the second branch field of Jiangbei Farm, Jiangling County, Hubei Province in May 2023, and divided into 4 experimental areas, named groups A1, A2, B1 and B2. Environmental cleaning was performed in groups A1 and B2, and was not conducted in groups A2 or B2. Then, 50% wettable powder of niclosamide ethanolamine salt was sprayed with drones at an effective dose of 2 g/m² in groups A1 and A2, and 5% niclosamide ethanolamine salt granule was sprayed with drones at an effective dose of 2 g/m² in groups B1 and B2. O. hupensis snails were surveyed using the systematic sampling method 1, 3, 5, 7, 14 days after spraying, and the natural mortality and corrected mortality of O. hupensis snails were calculated. Results The occurrence of frames with living snails, mean density of living snails and natural mortality of snails were 97.50% (117/120), 6.30 snails/0.1 m² and 1.18% (9/765) in the test ditch before spraying, respectively. There were significant differences in the mortality of snails among four groups 1, 3, 5, 7 and 14 days after spraying niclosamide formulations with drones (χ² = 17.230, 51.707, 65.184, 204.050 and 34.435, all P values < 0.01). The overall mortality rates of snails were 94.51% (1 051/1 112), 79.44% (908/1 143), 96.54% (977/1 012) and 88.55% (1 021/1 153) in groups A1, A2, B1 and B2 (χ² = 207.773, P < 0.05), respectively. In addition, there was no significant difference in the overall snail mortality between groups A1 and B1 (P > 0.05), and the snail mortality in groups A1 and B1 were both statistically different from that in groups A2 and B2 (all P values < 0.05). Conclusion Both 50% wettlable powder of niclosamide ethanolamine salt and 5% niclosamide ethanolamine salt granule sprayed with drones are active against O. hupensis snails in ditches, and environmental cleaning may improve the molluscicidal effect.

Objective To understand the application value of spacial clusters detection of human schistosomiasis epidemic,based on small scale level in heavy mountainous and hilly endemic areas, Songzi County,Hubei Province,China. Methods Positive results of human serological detection antibody titer equal or above 80,and positive schistosomiasis cases of fecal examination from 2016 to 2018 as research object in Songzi County.The flexible irregular space scan statistics was used to analyse the spatial clustering analysis of human schistosomiasis epidemic in the heavy mountainous and hilly endemic areas, setting parameter K=2 ,K=6 or K=10, respectively,based on small scale of village level in Songzi County. Results There was none positive schistosomiasis cases of fecal examination in Songzi County from 2016 to 2018.The number of human serological detection antibody titer equal or above 80 were  74, 206, 83, from 2016 to 2018，respectively.There was spatial clusters of positive of human serological detection antibody titer equal or above 80 for schistosomiasis cases in the county from 2016-2018. Areas of flexible irregular space scan statistic in cluster detection changing with the change of different K values. Under different parameters of flexible irregular space scan statistic results show that the most likely cluster of 40 endemic villages in three towns,inculding Laocheng town,Chendian town and Wangjiaqiao town were the prominent. Conclusion There are spatial clusters of human schistosomiasis based on small scale of village level by flexible irregular space scan statistic in mountainous and hilly endemic areas, Songzi County,Hubei Province.Therefore,the monitoring and control of schistosomiasis should be consolidated in the future,in order to achieve schistosomiasis elimination in Hubei Province at an early date.

Objective:To explore the effects of an integrated clinical pathway model on the gastrointestinal function and complications in patients after pancreaticoduodenectomy (PD) .Methods:Totally 95 patients after PD admitted to the First Affiliated Hospital of Zhengzhou University from March 2018 to March 2020 were selected and divided into a control group (41 cases) and an observation group (54 cases) . Patients in the control group received routine clinical care pathway, while patients in the observation group received integrated clinical pathway. The indicators for postoperative gastrointestinal function recovery (postoperative bowel sound recovery, time of anal exhaust time, first time of defecation) , pancreatic fistula and other complications were compared between the two groups.Results:The postoperative bowel sound recovery time, time of anal exhaust, and first time of defecation in the observation group were shorter than those in the control group, and the differences were statistically significant ( P< 0.05) ; 10 patients in the observation group developed postoperative complications, accounting for an incidence rate of 18.52%, which was lower than 70.73% (29/41) in the control group, with statistically significant difference ( P< 0.05) . Conclusions:The postoperative gastrointestinal function of patients after PD who receive the integrated clinical pathway model recovers better and postoperative complications are reduced.

Objective:To investigate the status quo of patient privacy protection behavior of clinical nurses and analyze its influencing factors.Methods:Using the convenient sampling method, clinical nurses from tertiary hospitals in China were selected to conduct a questionnaire survey on from March to April 2018. The Chinese version of Patient Privacy Scale (PPS) were used to conduct an investigation through Questionnaire Star electronic questionnaire. A total of 1, 043 valid questionnaires were collected, and the effective response rate was 100%.Results:The PPS total score of 1 043 clinical nurses was (124.86±12.16) . The item with the highest score was "You would use screens, curtains and sheets to protect patients' privacy when necessary" (4.89±0.39) , while the item with the lowest score was "You would knock on the door before entering the patient's room and enter after asking for the patient's consent" (4.11±1.14) . The results of multiple regression analysis showed that education level and department had effects on patients' privacy protection behavior ( P<0.05) . Conclusions:The patient privacy protection behavior of clinical nurses is generally at a good level, but there is still room for improvement in individual behaviors. Teaching hospitals should strengthen education related to patient privacy protection for nurses with higher education degree who undertake teaching tasks and nurses in surgical monitoring departments and formulate specific relevant teaching procedures and detailed rules.

Objective:To evaluate the effect of airway driving pressure (ΔP) guided sedation strategy on the prognosis of patients with mechanical ventilation.Methods:Patients who needed invasive mechanical ventilation and admitted to the department of intensive care unit (ICU) of Jiangxi Provincial People's Hospital from January 2017 to December 2018 were enrolled. The patients were divided into study group and control group according to the random number table. After informed consent of patients or their families, both groups received routine treatment in ICU. The control group was treated with light sedation strategy, the Richmond agitation sedation score (RASS) was performed every 4 hours, and the target was RASS > -3. ΔP in the study group was measured once a day, and the sedative target of patients with low driving pressure (ΔP ≤ 14 cmH 2O, 1 cmH 2O = 0.098 kPa) was RASS > -3, while the patients with high driving pressure (ΔP > 14 cmH 2O) was RASS ≤ -3. The evaluation was conducted at 28 days after admission to ICU, and the patients were followed up to 60 days. The main outcome was days without mechanical ventilation in 28 days. The secondary outcomes were the rate of extubation, discharge outcome, incidence of ventilator associated pneumonia (VAP) and delirium, and 60-day survival rate. Results:A total of 60 patients with respiratory failure due to various reasons were recruited, 30 in each group. There was no significant difference in gender, age, primary disease, severity of disease or ΔP between the two groups. The days without mechanical ventilation within 28 days in the study group were significantly more than that in the control group [days: 20 (0, 23) vs. 12 (0, 16), P = 0.018], and the incidences of VAP (3.3% vs. 16.7%, P = 0.045) and delirium (0% vs. 10.0%, P = 0.038) were significantly lower than that in the control group. There were no significant differences in the rate of extubation (73.3% vs. 66.7%, P = 0.273), discharge outcome [improvement (cases): 24 vs. 21, unhealed (cases): 2 vs. 5, deaths (cases): 4 vs. 4, P = 0.506] and 60-day survival rate (83.3% vs. 76.7%, P = 0.519) between the study group and control group. Conclusion:Compared with light sedation strategy, ΔP directed sedation strategy can effectively shorten the duration of mechanical ventilation and reduce the incidence of VAP and delirium in the ICU patients.

Objective To analyze the main characteristics of air pollution in Nanchang City, and discuss the correlation between air pollution exposure (especially PM2.5) and the development of pneumonia related intensive care unit (ICU) patients and their lag effect.Methods 2454 patients who lived in Nanchang City admitted to ICU of Jiangxi Provincial People's Hospital from January 1st, 2014 to December 31st, 2016 were enrolled. According to the diagnosis, the patients were divided into pneumonia group (156 cases) and non-pneumonia group (2298 cases). The general clinical characteristics of patients and air pollution concentration in Nanchang in the year between 2014-2016 were collected. Multiple regression model was used to analyze the influence of meteorological factors on the condition of ICU patients associated with pneumonia. Using odds ratio (OR), the correlation intensity of air pollution exposure and pneumonia related ICU patients' development was reflected, and the confidence level of association intensity was reflected by the 95％ confidence interval (95％CI). The distribution lag nonlinear model (DLNM) was established to evaluate the effect of air mass parameters on the time lag effect.Results The results of air pollution analysis in Nanchang City in the year between 2014-2016 showed that the annual average concentration of carbon monoxide (CO), sulfur dioxide (SO2) and nitrogen dioxide (NO2) was low and maintained at the same level in the year between 2014-2016. The annual average concentration of CO and NO2 increased in the year between 2014-2016, but the average annual concentration of SO2 decreased rapidly in the year between 2014-2016, and the average annual concentration of PM2.5 tended to slow down after the year between 2014-2016. The annual average concentration of PM10 decreased in the year between 2014-2016, but continued to rise in the year between 2014-2016. The annual mean concentration of O3 showed a trend of continuous increase from the year between 2014-2016. The age of pneumonia group was generally higher than that of non-pneumonia group, most of them were male, and had higher expected mortality and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score. The average air temperature in the pneumonia group was lower than that in the non-pneumonia group on the day of entering the group, and the air pollutants such as PM2.5 and PM10 were significantly higher than those in the non-pneumonia group. The analysis of multiple regression models showed that PM2.5 and air temperature were significantly related to patients with ICU pneumonia on the day of entry (PM2.5:OR = 1.02, 95％CI =1.00-1.03,P < 0.05; air temperature:OR = 0.96, 95％CI = 0.92-0.98,P < 0.05), and the effect of PM2.5 on patients with ICU pneumonia could last for at least 5 days (OR = 1.04, 95％CI = 1.00-1.09,P < 0.05), and the effect disappeared until the 7th day. According to the analysis of the influence of different concentrations of PM2.5 on ICU pneumonia patients, when the PM2.5 concentration reached 200μg/m3, its effect on ICU pneumonia patients would last for 5 days (OR = 1.45, 95％CI = 1.07-1.76,P < 0.01).Conclusion PM2.5 and air temperature are significantly related to the condition of ICU patients with pneumonia, and the influence of high concentration of PM2.5 on ICU patients with pneumonia has a lag effect.

Objective To understand the spatial distribution characteristics of wild feces in schistosomiasis endemic areas of Jiangling County,Hubei Province and further explore the source of infection efficiently,so as to provide the evidence for the development of corresponding monitoring and response technology. Methods In 2011,the fresh wild feces were investigated every two months in the selected 15 villages by the severity of historical endemic in Jiangling County. The schistosome miracidi-um hatching method was used to test the schistosome infection of the wild feces. The descriptive analysis and spatial analysis were used for the description of the spatial distribution of the wild feces. Results Totally 701 wild feces samples were collected with the average density of 0.0556/100 m2,and the positive rate of the wild feces was 11.70%(82/701). The results of the re-gression analysis showed a positive spatial correlation between the positive rate of wild feces and the rate of human infection,the area with infected Oncomelania hupensis and the number of fenced cattle,and the corrected R2 of the model was 0.58. Conclu-sion The infection rate of wild feces is positively correlated with the rate of human infection,area with infected O. hupensis and number of fenced cattle in space in Jiangling County,so the prevention and control measures could be conducted according to the spatial distribution of the positive wild feces.

Objective To implement a two?level community?based health education pattern of schistosomiasis in residents of endemic areas in marshland and lake regions,so as to explore the suitable pattern of health education under hypo?endemic situa?tion. Methods Two schistosomiasis endemic villages in Jiangling County,Hubei Province were collected as study areas,and among which,one village was treated as an intervention group,where the two?level community?based health education pattern as well as regular control measures was implemented;the other village was a control group,where only regular control measures were implemented. The awareness rates on schistosomiasis control,the rates of correct behavior and the compliance rates of ex?amination,treatment and chemotherapy of the two groups before and after the intervention were compared. Results According to the results of the baseline survey in 2014,the awareness rates of schistosomiasis control of the intervention and control groups were 84.00%and 77.45%,respectively,the correct rates of behavior of the two groups were 72.00%and 63.73%,respectively, and the compliance rates of the treatment were 80.36%and 82.28%,respectively,there were no statistically significant differ? ences between all the above rates of the two groups(all P>0.05). After the intervention of the two?level community?based health education,the correct rates of behavior,and the compliance rates of examination and chemotherapy of the two groups were 92.31%and 80.37%,95.11%and 82.55%,84.13%and 63.64%,respectively,and the differences between all the rates above of the two groups were statistically significant(all P<0.05). When compared to those before intervention,the growing rates of the compliance rates of examination,treatment and chemotherapy of the intervention group were 20.97%,15.33%and 23.29%, respectively,while those of control group were 14.27%,4.17%,-3.77%,respectively,the growing rates of the intervention groups were higher than those of the control groups. Conclusions Through the two?level community?based pattern of health edu?cation,the compliance rates of examination and treatment of the residents have improved,and therefore,the pattern is suitable for popularization and application in marshland and lake regions.

Objective To evaluate the cost-effectiveness of the comprehensive control measures carrying out in schistosomia-sis endemic inner embankment of marshland and lake regions from 2006 to 2010,so as to provide the reference for further rational allocation of limited health resources and ultimately speeding up the procedure of schistosomiasis elimination. Methods With ref-erence to the requirements of the national schistosomiasis transmission control and phase goals for schistosomiasis control in Hubei Province,Jiangling County,one schistosomiasis control pilot of Hubei Province combined with the National Health and Family Planning Commission and Ministry of Agriculture,was selected for the study. A definition of the infection rates of human and do- mestic animals was used for endemic villages stratified by different layers(i.e.,the village with the infection rates of human and domestic animals ≥3% belonged to the first layer,≥ 1% belonged to the second layer;<1% belonged to the third layer). By us- ing the stratification method and cost-effectiveness analysis,the endemic villages stratified with the different layers were investi- gated and all the data of schistosomiasis endemic situation,cost and effectiveness of schistosomiasis control were collected and comprehensively analyzed from 2006 to 2010. Results In the effectiveness of schistosomiasis control,by the end of 2010, there were no first layer villages,there were 114 second layer villages,and there were 18 third layer villages in Jiangling Coun- ty. In the former first layer villages,the schistosomiasis patients decreased year by year ultimately to 0;but in the second and third layer villages,the schistosomiasis patients increased. In the fecal treatment and management,the coverage rates of harm- less sanitary latrines were 27.45% in 2009 and 48.74% in 2010 respectively in the second layer villages,whereas there were no harmless sanitary latrines in the first and third layer villages. In the 5 years,the input of comprehensive control measures was 10 266 3900 Yuan,much higher than the human and buffalo examinations and treatments,Oncomelania hupensis snail investi- gation and elimination(4 183 000 Yuan)and other labor inputs(2 239 500Yuan). In the ratio of cost-effectiveness,the annual ratio of unit cost(1% reduction of human and buffalo infection and 1 hm2 reduction of snail areas)increased yearly. In addition, the semi-logarithmic stability trend analysis of health inputs and cost showed that there was a stable balance between inputs and cost in the different layers(logarithmic values of any two layers of pair-wise comparison were <1,and in the third layer villages, the annual average logarithmic values of 5 years were <1). Whereas,in the first and second layer villages,the annual average cost was fluctuated(the costs was higher than the inputs). Conclusion The schistosomiasis situation is reduced year by year in Jiangling County from 2006 to 2010. Whereas,the main infection source(buffaloes)still exists and the present control mea- sures including fecal management should be further strengthened. In the resource allocation,in the field of health,the annual distribution of key inputs and unit-cost control also has a further space of adjustment.