Association between Ambient Air Pollution and Outpatient Visits for Acute Bronchitis in a Chinese City

Objective To investigate the short-term association between outdoor air pollution and outpatient visits for acute bronchitis,which is a rare subject of research in the mainland of China.Methods A time-series analysis was conducted to examine the association of outdoor air pollutants with hospital outpatient visits in Shanghai by using two-year daily data(2010-2011).Results Outdoor air pollution was found to be associated with an increased risk of outpatient visits for acute bronchitis in Shanghai.The effect estimates of air pollutants varied with the lag structures of the concentrations of the pollutants.For lag06,a 10 μg/m3 increase in the concentrations of PM10,SO2,and NO2 corresponded to 0.94%(95% CI:0.83%,1.05%),11.12%(95% CI:10.76%,11.48%),and 4.84%(95% CI:4.49%,5.18%) increases in hospital visits for acute bronchitis,respectively.These associations appeared to be stronger in females(P0.05).Between-age differences were significant for SO2(P0.05),and between-season differences were also significant for SO2(P0.05).Conclusion Our analyses have provided the first evidence that the current air pollution level in China has an effect on acute bronchitis and that the rationale for further limiting air pollution levels in Shanghai should be strengthened.     

Statistical distributions of ambient air pollutants in Shanghai, China

Objective To determine the best statistical distribution of concentration data of major air pollutants in Shanghai. Methods Four types of theoretic distributions (lognormal, gamma, Pearson V and extreme value) were chosen to fit daily average concentration data of PMt0, SO2 and NO2 from June 1,2000 to May 31, 2003 in Shanghai by using the maximum likelihood method. The fit results were evaluated by Chi-square test. Results The best-fit distributions for PM10, SO2 and NO2 concentrations in Shanghai were lognormal, Pearson V, and extreme value distributions, respectively. Conclusion The results can be further applied to local air pollution prediction and control, e.g., the probabilities exceeding the air quality standard and emission source reduction of air pollutant concentration to meet the standard.     

Relationship between ambient air pollution and daily mortality of SARS in Beijing

Objective To study the relationship between ambient air pollution and daily mortality of SARS in Beijing. Methods The approach of time-series Poisson regression was used to assess the relationship between daily SARS mortality, ambient air pollution, and other factors from April 25 to May 31, 2003 in Beijing. Results An increase of each 10 μg/m3 over a 5-day moving average of PM10, SO2 and NO2 corresponded to 1.06 (1.00-1.12), 0.74 (0.48-1.13) and 1.22 (1.01-1.48) relative risks(RRs) of daily SARS mortality, respectively, The relative risks (RRs) values depended largely on the selection of lag days.Conclusion The daily mortality of SARS might be associated with certain air pollutants in Beijing.     

Diurnal temperature range as a novel risk factor for sudden infant death

Objective To assess the relationship between diurnal temperature range (DTR) and sudden infant death (SID) between 2001 and 2004 in Shanghai,China.Methods We conducted a time‐stratified case‐crossover analysis to estimate the percent increase of SID associated with changes in DTR after adjustment for daily weather conditions (temperature and relative humidity) and outdoor air pollution.Results DTR was significantly associated with daily SID.An increase of 1 °C in the current‐day (L0) and in the 2‐day moving...     

院前心肺复苏中加压素与肾上腺素的比较

Background Vasopressin is an alternative to epinephrine for vasopressor therapy during cardiopulmonary resuscitation, but clinical experience with this treatment has been limited. Methods We randomly assigned adults who had had an out - of- hospital cardiac arrest to receive two injections of either 40 IU of vasopressin or 1 mg of epinephrine, followed by additional treatment with epinephrine if needed. The primary end point was survival to hospital admission, and the secondary end point was survival to hospital discharge. Results A total of 1219 patients underwent randomization; 33 were excluded because of missing study-drug codes. Among the remaining 1186 patients, 589 were assigned to receive vasopressin and 597 to receive epinephrine. The two treatment groups had similar clinical profiles. There were no significant differences in the rates of hospital admission between the vasopressin group and the epinephrine group either among patients with ventrieular fibrillation (46.2 percent vs. 43.0 percent, P=0.48) or among those with pulseless electrical activity (33.7 percent vs. 30.5 percent, P=0.65). Among patients with asystole, however, vasopressin use was associated with significantly higher rates of hospital admission (29.0 percent, vs. 20.3 percent in the epinephrine group; P = 0.02) and hospital discharge (4.7 percent vs. 1.5 percent, P=0.04). Among 732 patients in whom spontaneous circutationwas not restored with the two injections of the study drug, additional treatment with epinephrine resulted in significant improvement in the rates of survival to hospital admission and hospital discharge in the vasopressin group, but not in the epinephrine group (hospital admission rate, 25.7 percent vs. 16.4 percent; P = 0.002; hospital discharge rate, 6.2 percent vs. 1.7 percent; P=0.002). Cerebral performance was similar in the two groups. Conclusions The effects of vasopressin were similar to those of epinephrine in the management of ventricular fibrillation and pulseless electrical activity, but vasopressin was superior to epinephrine in patients with asystole. Vasopressin followed by epinephrine may be more effective than epinephrine alone in the treatment of refractory cardiac arrest.     

Why H7N9 bird flu may cause scare in China?

The first identified case of human infection with a novel influenza A （H7N9） virus occurred in eastern China during February and March,2013.According to the Center for Disease Control and Prevention （CDC）,Chinese mainland has recorded a total of 134 laboratory-confirmed cases of H7N9,among whom 45 died by August.It has spread to eight provinces including Beijing and Shanghai in mainland and,on April 29,it was confirmed to have spread to Taiwan,1 and might be slowly gaining pace daily,about 31% have died,55% have recovered,and the rest are still sick and the fatality risk on admission to hospital was 36% （95% CI26%-45%） for H7N9.     

Impact ofTemperature onMortality inThree Major Chinese Cities

Objective To study the relation between temperature and mortality by estimating the temperature-related mortality in Beijing, Shanghai, and Guangzhou. Methods Data of daily mortality, weather and air pollution in the three cities were collected. A distributed lag nonlinear model was established and used in analyzing the effects of temperature on mortality. Current and future net temperature-related mortality was estimated. Results The association between temperature and mortality was J-shaped, with an increased death risk of both hot and cold temperature in these cities. The effects of cold temperature on health lasted longer than those of hot temperature. The projected temperature-related mortality increased with the decreased cold-related mortality. The mortality was higher in Guangzhou than in Beijing and Shanghai. Conclusion The impact of temperature on health varies in the 3 cities of China, which may have implications for climate policy making in China.     

Impact of Long—term Exposure to Air Particulate Matter on Life Expectancy and Survival Rate of Shanghai Residents

Objective To evaluate the impact of long-term air particulate matter exposure on the life expectancy and survival rate of Shanghai residents. Methods Epidemiology - based exposureresponse function was used for the calculation of attributable deaths to air particulate matter in Shanghai, and the effect of long-term exposure to particulate matter on life expectancy and survival rate was estimated using the life table of Shanghai residents in 1999. Results It was shown that in 1999, the long-term air particulate matter exposure caused 1.34-1.69 years reduction of life expectancy and a decrease of survival rate for each age group of Shanghai residents. Conclusion The effect of long-term exposure to air particulate matter on life expectancy is substantial in Shanghai.     

ACTIVITIF,S OF T.HE BUREAU OF PUBLIC HEALTH, CITY GOVERNMENT OF GREATER SHANGHAI.

Clty Government of Greater Shanghai. Greater Shanghai whicb meamres aprrroximately 17 x I2 miIes is located on the banks of the Whampo。 River at the mouth of the Yangtze River. It is sub-divided into two urban districts, Nantao and Chapei an.d fifteen suburban districts. The population according to the June, 1934 census was 2,015,966. The City Govemment is directIy under the control of the Executive Yuan of the National Government and is administered by a Mayor, while the activities of the govemment are carried out by eight bureaus: namely, Bureau of Public Safety, Bureau of Education, Bureau of Public Utility, Bureau of PubIic Works, Bureau of Land, Bureau of Finance, Bureau of Social Welfare and Bureau of Puhlic Health. The Government budget for the current year is approximately ten million dollars, about six per ccnt of which is being spent for public health work.     

To determine the frequency of subtelomeric abnormalities in children with idiopathic mental retardation

Background

Cross-sectional study was carried out to determine the frequency of subtelomeric abnormalities in children with idiopathic mental retardation (MR).

Method

Multiplex ligation-dependant probe amplification technique was used to detect subtelomeric abnormalities.

Results

Out of 35 children, 21 (60%) were males. Family history of MR was present in 23%. Main clinical features included speech delay in all motor delay cases (83%) and non-specific dysmorphic features (77%).

Conclusion

Associated clinical features were more in children with intelligence quotient (IQ) < 50 (P < 0.05). Subtelomeric deletion (4q35) was observed in one child.     

Using Empiric Semantic Correlation to Interpret Temporal Assertions in Clinical Texts

Objective

To measure the uncertainty of temporal assertions like “3 weeks ago” in clinical texts.

Design

Temporal assertions extracted from narrative clinical reports were compared to facts extracted from a structured clinical database for the same patients.

Measurements

The authors correlated the assertions and the facts to determine the dependence of the uncertainty of the assertions on the semantic and lexical properties of the assertions.

Results

The observed deviation between the stated duration and actual duration averaged about 20% of the stated deviation. Linear regression revealed that assertions about events further in the past tend to be more uncertain, smaller numeric values tend to be more uncertain (1 mo v. 30 d), and round numbers tend to be more uncertain (10 versus 11 yrs).

Conclusions

The authors empirically derived semantics behind statements of duration using “ago,” and verified intuitions about how numbers are used.     

Use of Electronic Information Systems in Nursing Homes: United States, 2004

Objectives

This study sought to define the extent of utilization of 12 types of electronic information system (EIS) function in U.S. nursing homes (NH), to relate EIS utilization to selected facility characteristics and to contrast these findings to previous estimates of EIS use in NH.

Design

This study used data from the National Nursing Home Survey (NNHS), a nationally representative, cross-sectional sample of U.S. NH.

Measurements

Data on current use of EIS in 12 functional areas, including administrative and resident care activities, were collected. Information was also collected on facility characteristics including ownership, bed size, and whether the facility was a member of a chain.

Results

Essentially all (99.6%) U.S. NH had ≥1 EIS, a figure that was driven by the nearly universal use of EIS for Minimum Data Set (MDS) reporting (96.4%) and for billing (95.4%). Nearly 43% of U.S. NH had EIS for medical records, including nurse's notes, physician notes, and MDS forms. EIS use ranged from a high of 79.6% for admission, transfer, and discharge to a low of 17.6% for daily care by certified nursing assistants (CNAs). Ownership, membership in a chain, and bed size were associated with use of selected EIS. Larger facilities and those that were part of a chain used more EIS than smaller standalone facilities.

Conclusion

In 2004, NH use of EIS for functions other than MDS and billing was highly variable, but considerably higher than previous estimates.     

ENPP1/PC-1 gene K121Q polymorphism is associated with obesity in European adult populations: evidence from a meta-analysis involving 24,324 subjects

Objective Findings from the previous studies have suggested a relationship between ectonucleotide pyrophosphatase /phosphodiesterase 1 (ENPP‐1) or plasma cell membrane glycoprotein 1 (PC‐1) gene single nucleotide polymorphism (K121Q, rs1044498) and genetic susceptibility to obesity. However, such relationship is not reproduced by some currently available studies. In this context, the present study is aimed to quantitatively analyze the association of K121Q variant with obesity in all published case‐control ...     

BHMT gene polymorphisms as risk factors for cleft lip and cleft palate in a Chinese population

Objective Convincing evidence suggests a link between increased risk of nonsyndromic cleft lip with or without cleft palate (NSCL/P) and low intake of folic acid by the mother during pregnancy. The present study was designed to explore if genetic variation in the betaine‐homocysteine methyltransferase (BHMT) gene contributes to NSCL/P. Methods DNA was obtained from 166 individuals with NSCL/P and 285 healthy subjects. Three known single nucleotide polymorphisms (SNPs) present in the BHMT gene (rs651852, rs3...     

The Influence that Electronic Prescribing Has on Medication Errors and Preventable Adverse Drug Events: an Interrupted Time-series Study

Objective

This study evaluated the effect of a Computerized Physician Order Entry system with basic Clinical Decision Support (CPOE/CDSS) on the incidence of medication errors (MEs) and preventable adverse drug events (pADEs).

Design

Interrupted time-series design.

Measurements

The primary outcome measurements comprised the percentage of medication orders with one or more MEs and the percentage of patients with one or more pADEs.

Results

Pre-implementation, the mean percentage of medication orders containing at least one ME was 55%, whereas this became 17% post-implementation. The introduction of CPOE/CDSS has led to a significant immediate absolute reduction of 40.3% (95% CI: −45.13%; −35.48%) in medication orders with one or more errors.Pre-implementation, the mean percentage of admitted patients experiencing at least one pADE was 15.5%, as opposed to 7.3% post-implementation. However, this decrease could not be attributed to the introduction of CPOE/CDSS: taking into consideration the interrupted time-series design, the immediate change was not significant (−0.42%, 95% CI: −15.52%; 14.68%) because of the observed underlying negative trend during the pre-CPOE period of −4.04% [95% CI: −7.70%; −0.38%] per month.

Conclusions

This study has shown that CPOE/CDSS reduces the incidence of medication errors. However, a direct effect on actual patient harm (pADEs) was not demonstrated.     

A System for Classifying Disease Comorbidity Status from Medical Discharge Summaries Using Automated Hotspot and Negated Concept Detection

Objective

Free-text clinical reports serve as an important part of patient care management and clinical documentation of patient disease and treatment status. Free-text notes are commonplace in medical practice, but remain an under-used source of information for clinical and epidemiological research, as well as personalized medicine. The authors explore the challenges associated with automatically extracting information from clinical reports using their submission to the Integrating Informatics with Biology and the Bedside (i2b2) 2008 Natural Language Processing Obesity Challenge Task.

Design

A text mining system for classifying patient comorbidity status, based on the information contained in clinical reports. The approach of the authors incorporates a variety of automated techniques, including hot-spot filtering, negated concept identification, zero-vector filtering, weighting by inverse class-frequency, and error-correcting of output codes with linear support vector machines.

Measurements

Performance was evaluated in terms of the macroaveraged F1 measure.

Results

The automated system performed well against manual expert rule-based systems, finishing fifth in the Challenge's intuitive task, and 13^th in the textual task.

Conclusions

The system demonstrates that effective comorbidity status classification by an automated system is possible.     

Disparities in Use of a Personal Health Record in a Managed Care Organization

Objective

Personal health records (PHRs) can increase patient access to health care information. However, use of PHRs may be unequal by race/ethnicity.

Design

The authors conducted a 2-year cohort study (2005-2007) assessing differences in rates of registration with KP.org, a component of the Kaiser Permanente electronic health record (EHR).

Measurements

At baseline, 1,777 25-59 year old Kaiser Permanente Georgia enrollees, who had not registered with KP.org, responded to a mixed mode (written or Internet) survey. Baseline, EHR, and KP.org data were linked. Time to KP.org registration by race from 10/1/05 (with censoring for disenrollment from Kaiser Permanente) was adjusted for baseline education, comorbidity, patient activation, and completion of the baseline survey online vs. by paper using Cox proportional hazards.

Results

Of 1,777, 34.7% (616) registered with KP.org between Oct 2005 and Nov 2007. Median time to registering a KP.org account was 409 days. Among African Americans, 30.1% registered, compared with 41.7% of whites (p < 0.01). In the hazards model, African Americans were again less likely to register than whites (hazard ratio [HR] = 0.652, 95% CI: 0.549-0.776) despite adjustment. Those with baseline Internet access were more likely to register (HR = 1.629, 95% CI: 1.294-2.050), and a significant educational gradient was also observed (more likely registration with higher educational levels).

Conclusions

Differences in education, income, and Internet access did not account for the disparities in PHR registration by race. In the short-term, attempts to improve patient access to health care with PHRs may not ameliorate prevailing disparities between African Americans and whites.     

Power to Detect Spatial Disturbances under Different Levels of Geographic Aggregation

Objective

Spatio and/or temporal surveillance systems are designed to monitor the ongoing appearance of disease cases in space and time, and to detect potential disturbances in either dimension. Patient addresses are sometimes reported at some level of geographic aggregation, for example by ZIP code or census tract. While this aggregation has the advantage of protecting patient privacy, it also risks compromising statistical efficiency. This paper investigated the variation in power to detect a change in the spatial distribution in the presence of spatial aggregation.

Methods

The authors generated 400,000 spatial datasets with varying location and spread of simulated spatial disturbances, both on a purely synthetic uniform population, and on a heterogeneous population, representing hospital admissions to three community hospitals in Cape Cod, Massachusetts. The authors evaluated the power of the M-statistic to detect spatial disturbances, comparing the use of exact spatial locations versus twelve different levels of aggregation, where the M-statistic is a comparison of two distributions of interpoint distances between locations.

Results

When the spread of simulated spatial disturbances was contained to a small portion of the study region or affects a large proportion of the population at risk, power was highest when exact locations were reported. If the spatial disturbance was a more modest signal, the best power was attained at an aggregated level.

Conclusions

The precision at which patients' locations are reported has the potential to affect the power of detection significantly.