Publications by authors named "Weilin Zeng"

96 Publications

Ambient Temperature and Years of Life Lost: A National Study in China.

Innovation (N Y) 2021 Feb 16;2(1):100072. Epub 2020 Dec 16.

School of Medicine, Griffith University, Gold Coast, 4214, Australia.

Although numerous studies have investigated premature deaths attributable to temperature, effects of temperature on years of life lost (YLL) remain unclear. We estimated the relationship between temperatures and YLL, and quantified the YLL per death caused by temperature in China. We collected daily meteorological and mortality data, and calculated the daily YLL values for 364 locations (2013-2017 in Yunnan, Guangdong, Hunan, Zhejiang, and Jilin provinces, and 2006-2011 in other locations) in China. A time-series design with a distributed lag nonlinear model was first employed to estimate the location-specific associations between temperature and YLL rates (YLL/100,000 population), and a multivariate meta-analysis model was used to pool location-specific associations. Then, YLL per death caused by temperatures was calculated. The temperature and YLL rates consistently showed U-shaped associations. A mean of 1.02 (95% confidence interval: 0.67, 1.37) YLL per death was attributable to temperature. Cold temperature caused 0.98 YLL per death with most from moderate cold (0.84). The mean YLL per death was higher in those with cardiovascular diseases (1.14), males (1.15), younger age categories (1.31 in people aged 65-74 years), and in central China (1.34) than in those with respiratory diseases (0.47), females (0.87), older people (0.85 in people ≥75 years old), and northern China (0.64) or southern China (1.19). The mortality burden was modified by annual temperature and temperature variability, relative humidity, latitude, longitude, altitude, education attainment, and central heating use. Temperatures caused substantial YLL per death in China, which was modified by demographic and regional characteristics.
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http://dx.doi.org/10.1016/j.xinn.2020.100072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8454660PMC
February 2021

The relationship between ambient temperature and fasting plasma glucose, temperature-adjusted type 2 diabetes prevalence and control rate: a series of cross-sectional studies in Guangdong Province, China.

BMC Public Health 2021 08 11;21(1):1534. Epub 2021 Aug 11.

Guangdong Provincial Center for Disease Control and Prevention, Guangdong Provincial Institute of Public Health, No. 160, Qunxian Road, Panyu District, Guangzhou, 511430, Guangdong, China.

Background: There existed evidence that type 2 diabetes mellitus (T2DM) prevalence and control rate have seasonal variation. Our study aimed to examine the ambient temperature and fasting plasma glucose (FPG) association and estimate temperature-adjusted T2DM prevalence and control rate.

Methods: Four cross-sectional health surveys with 26,350 respondents were conducted in Guangdong Province from 2007 to 2015. Multistage cluster sampling was used to recruit study participants. The data of demographic characteristics, lifestyle factors, diet and use of hypoglycemic medicine, height, weight, FPG and meteorological information were collected. And an inverse distance-weighted method was employed to estimate daily temperature exposures at the individual' s residential district/county. Base on World Health Organization 2006 criteria, participants were divided into normal fasting glucose (NFG) participants (n = 23,877), known T2DM patients (n = 916) and newly detected T2DM patients (n = 1557). Generalized additive mixed model was employed to evaluate the nonlinear associations between temperature and FPG among different T2DM subgroups. The T2DM prevalence and control rate were estimated based on temperature-FPG association.

Results: The curves of temperature and FPG were downward parabola for total, NFG and known T2DM groups, while it was "U"-shaped for newly detected T2DM patients. When temperature decreased from 30 °C to 4 °C, the FPG significantly increased 0.24 (95%CI: 0.15, 0.33) mmol/L, 0.10 (95%CI: 0.06, 0.14) mmol/L and 1.34 (95%CI: 0.56, 2.12) mmol/L in total, NFG and known T2DM groups, respectively. Compared to 19 °C, newly detected T2DM patients' FPGs were increased 0.73 (95%CI: 0.13, 1.30) mmol/L at 4 °C and 0.53 (0.00, 1.07) mmol/L at 30 °C. The model-estimated temperature-adjusted T2DM prevalence had a down and up trend, with 9.7% at 5 °C, 8.9% at 20 °C and 9.4% at 30 °C, respectively. At 5, 10, 15, 20, 25 and 30 °C, the model-estimated temperature-adjusted T2DM control rates were 33.2, 35.4, 38.2, 43.6, 49.1 and 55.2%.

Conclusion: Temperature was negatively associated with FPG for NFG and known T2DM subgroups, while their association was U-shape for newly detected T2DM patients. Hence, the temperature-adjusted T2DM prevalence show a dip/peak pattern and T2DM control rate display a rising trend when temperature increase. Our findings suggest temperature should be considered in T2DM clinic management and epidemiological survey.
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http://dx.doi.org/10.1186/s12889-021-11563-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8356456PMC
August 2021

Age-specific disparity in life loss per death attributable to ambient temperature: A nationwide time-series study in China.

Environ Res 2021 Aug 4;203:111834. Epub 2021 Aug 4.

School of Public Health, Southern Medical University, Guangzhou, China. Electronic address:

Age-specific discrepancy of mortality burden attributed to temperature, measured as years of life lost (YLL), has been rarely investigated. We investigated age-specific temperature-YLL rates (per 100,000) relationships and quantified YLL per death caused by non-optimal temperature in China. We collected daily meteorological data, population data and daily death counts from 364 locations in China during 2006-2017. YLL was divided into three age groups (0-64 years, 65-74 years, and ≥75 years). A distributed lag non-linear model was first employed to estimate the associations of temperature with age-specific YLL rates in each location. Then we pooled the associations using a multivariate meta-analysis. Finally, we calculated age-specific average YLL per death caused by temperature by cause of death and region. We observed greater effects of cold and hot temperature on YLL rates for the elderly compared with the young population by region or cause of death. However, YLL per death due to non-optimal temperature for different regions or causes of death decreased with age, with 2.0 (95 % CI:1.5, 2.5), 1.2 (1.1, 1.4) and 1.0 years (0.9, 1.2) life loss per death for populations aged 0-64 years, 65-74 years and over 75 years, respectively. Most life loss per death results from moderate temperature, especially moderate cold for all age groups. The effect of non-optimal temperature on YLL rates is smaller for younger populations than older ones, while the temperature-related life loss per death was more prominent for younger populations.
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http://dx.doi.org/10.1016/j.envres.2021.111834DOI Listing
August 2021

The Mediating Role of Placental Weight Change in the Association Between Prenatal Exposure to Thallium and Birth Weight: A Prospective Birth Cohort Study.

Front Public Health 2021 2;9:679406. Epub 2021 Jul 2.

School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China.

Previous studies have demonstrated the embryotoxicity and fetotoxicity of thallium (Tl). However, the effects of prenatal exposure to Tl on birth weight and placental weight and the mediating role of placental weight in the association of Tl with birth weight remain unclear. We recruited 2,748 participants from the ongoing Prenatal Environment and Offspring Health Cohort (PEOH Cohort) study, which was initiated in 2016 in Guangzhou, China. The Tl concentrations in maternal urine samples collected during the first and third trimester were determined by inductively coupled plasma mass spectrometry. Birth weight and placental weight were extracted from maternal medical records. Pregnant women exposed to the highest tertile of Tl in the first trimester (β = -42.7 g, 95% CI: -82.3, -3.1 g) and third trimester (β = -50.6 g, 95% CI: -99.0, -2.3 g) had babies with lower birth weights than those exposed to the lowest tertile. We also found significant negative associations of exposure to Tl concentrations in the first and third trimester with placental weight. Mediation analyses showed that 50.3% (95% CI: 15.9, 79.2%) and 33.5% (95% CI: 1.3, 80.3%) of the effects of Tl exposure in the first and third trimester on birth weight were mediated by decreased placental weight. Our results suggest that prenatal exposure to Tl is negatively associated with birth weight and that this association may be mediated by decreased placental weight.
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http://dx.doi.org/10.3389/fpubh.2021.679406DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283527PMC
August 2021

Polymorphism of Antifolate Drug Resistance in From Local Residents and Migrant Workers Returned From the China-Myanmar Border.

Front Cell Infect Microbiol 2021 24;11:683423. Epub 2021 Jun 24.

Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China.

Drug-resistant  malaria impedes efforts to control, eliminate, and ultimately eradicate malaria in Southeast Asia. resistance to antifolate drugs derives from point mutations in specific parasite genes, including the dihydropteroate synthase (), dihydrofolate reductase (), and GTP cyclohydrolase I () genes. This study aims to investigate the prevalence and spread of drug resistance markers in populating the China-Myanmar border. Blood samples were collected from symptomatic patients with acute infection. Samples with single-clone infections were sequenced for and genesand genotyped for 6 flanking microsatellite markers. Copy number variation in the gene was also examined. Polymorphisms were observed in six different codons of the  gene (382, 383, 512, 549, 553, and 571) and six different codons of the  gene (13, 57, 58, 61, 99, 117) in two study sites. The quadruple mutant haplotypes 57I/L/58R/61M/117T of gene were the most common (comprising 76% of cases in Myitsone and 43.7% of case in Laiza). The double mutant haplotype 383G/553G of  gene was also prevalent at each site (40.8% and 31%). Microsatellites flanking the gene differentiated clinical samples from wild type and quadruple mutant genotypes ( = 0.259-0.3036), as would be expected for a locus undergoing positive selection. The lack of copy number variation of suggests that SP-resistant may harbor alternative mechanisms to secure sufficient folate.
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http://dx.doi.org/10.3389/fcimb.2021.683423DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8265503PMC
July 2021

Increasing proportions of relapsing parasite species among imported malaria in China's Guangxi Province from Western and Central Africa.

Travel Med Infect Dis 2021 Sep-Oct;43:102130. Epub 2021 Jun 21.

Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, 650500, China. Electronic address:

Background: Travel-related malaria in non-endemic areas returning from endemic areas presents important challenges to diagnosis and treatment. Imported malaria to newly malaria-free countries poses further threats of malaria re-introduction and potential resurgence. For those traveling to places with high Plasmodium falciparum prevalence, prophylaxis against this parasite is recommended, whereas causal prophylaxis against relapsing malaria is often overlooked.

Methods: We analyzed a cluster of imported malaria among febrile patients in Shanglin County, Guangxi Province, China, who had recent travel histories to Western and Central Africa. Malaria was diagnosed by microscopy and subsequently confirmed by species- and subspecies-specific PCR. Plasmodium vivax was genotyped using a barcode consisting of 42 single nucleotide polymorphisms.

Results: Investigations of 344 PCR-confirmed malaria cases revealed that in addition to Plasmodium falciparum being the major parasite species, the relapsing parasites Plasmodium ovale and P. vivax accounted for ~40% of these imported cases. Of the 114 P. ovale infections, 65.8% and 34.2% were P. ovale curtisi and P. ovale wallikeri, respectively, with the two subspecies having a ~2:1 ratio in both Western and Central Africa. Phylogenetic analysis of 14 P. vivax isolates using a genetic barcode demonstrated that 11 formed a distinct clade from P. vivax populations from Eastern Africa.

Conclusion: This study provides support for active P. vivax transmission in areas with the predominant Duffy-negative blood group. With relapsing malaria making a substantial proportion of the imported malaria, causal prophylaxis should be advocated to travelers with a travel destination to Western and Central Africa.
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http://dx.doi.org/10.1016/j.tmaid.2021.102130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8429216PMC
June 2021

The association of cooking fuels with cataract among adults aged 50 years and older in low- and middle-income countries: Results from the WHO Study on global AGEing and adult health (SAGE).

Sci Total Environ 2021 Oct 29;790:148093. Epub 2021 May 29.

Shanghai Medical College, Fudan University, Shanghai, China. Electronic address:

Reducing household air pollution and protecting eye health are essential to achieve the Sustainable Development Goals (SDGs). There is contradictory evidence about the association between cooking fuels and cataract among adults aged 50 years and older. WHO Study on global AGEing and adult health (SAGE) was conducted in six low- and middle-income countries (LMICs). We used propensity-score method (inverse probability of weighting) and logistic regression to examine the association between cooking fuels and self-reported cataract. Odds ratio (OR) estimates and 95% confidence intervals (CIs) were calculated. Overall, use of unclean fuels was associated with an adjusted OR of cataract of 1.42 (95%CIs, 1.29-1.56). In subgroup analysis, unclean cooking fuels increased 1.71 (95%CI, 1.46-2.01) and 1.53 (95%CI, 1.30-1.79) times the risk of cataract in India and China, respectively, whereas no association was found in other countries. In gender-stratified analyses, unclean fuel use was associated with a 1.27 (95%CI, 1.13-1.44) times risk for males and 1.67 (95%CI, 1.44-1.94) times risk for females. Higher cataract risk attributed to unclean fuels was observed among those aged over 60 (1.45; 95%CI, 1.28-1.64) than people aged under 60 (1.39; 95%CI, 1.20-1.62). OR was higher in rural area (1.74; 95%CI, 1.51-2.00) than urban area (1.24; 95%CI, 1.09-1.41). Our results indicate that unclean fuels may be associated with self-reported cataract, but it varied among different LMICs. Higher risk was found in females, people older than 60 years old and those who live in rural areas. The result of this study provides useful information to support transition to clean household energy and eye health promotion in LMICs. Greater efforts should be taken to protect vulnerable populations.
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http://dx.doi.org/10.1016/j.scitotenv.2021.148093DOI Listing
October 2021

Reduction of air pollutants and associated mortality during and after the COVID-19 lockdown in China: Impacts and implications.

Environ Res 2021 09 2;200:111457. Epub 2021 Jun 2.

Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China; Department of Public Health, School of Medicine, Jinan University, Guangzhou, China. Electronic address:

Although strict lockdown measurements implemented during the COVID-19 pandemic have dramatically reduced the anthropogenic-based emissions, changes in air quality and its health impacts remain unclear in China. We comprehensively described air pollution during and after the lockdown periods in 2020 compared with 2018-2019, and estimated the mortality burden indicated by the number of deaths and years of life lost (YLL) related to the air pollution changes. The mean air quality index (AQI), PM, PM, NO, SO and CO concentrations during the lockdown across China declined by 18.2 (21.2%), 27.0 μg/m (28.9%), 10.5 μg/m (18.3%), 8.4 μg/m (44.2%), 13.1 μg/m (38.8%), and 0.3 mg/m (27.3%) respectively, when compared to the same periods during 2018-2019. We observed an increase in O concentration during the lockdown by 5.5 μg/m (10.4%), and a slight decrease after the lockdown by 3.4 μg/m (4.4%). As a result, there were 51.3 (95%CI: 32.2, 70.1) thousand fewer premature deaths (16.2 thousand during and 35.1 thousand after the lockdown), and 1066.8 (95%CI: 668.7, 1456.8) thousand fewer YLLs (343.3 thousand during and 723.5 thousand after the lockdown) than these in 2018-2019. Our findings suggest that the COVID-19 lockdown has caused substantial decreases in air pollutants except for O, and that substantial human health benefits can be achieved when strict control measures for air pollution are taken to reduce emissions from vehicles and industries. Stricter tailored policy solutions of air pollution are urgently needed in China and other countries, especially in well-developed industrial regions, such as upgrading industry structure and promoting green transportation.
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http://dx.doi.org/10.1016/j.envres.2021.111457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8170876PMC
September 2021

Loop-mediated isothermal amplification (LAMP) assays targeting 18S ribosomal RNA genes for identifying P. vivax and P. ovale species and mitochondrial DNA for detecting the genus Plasmodium.

Parasit Vectors 2021 May 24;14(1):278. Epub 2021 May 24.

Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, 650500, Yunnan, People's Republic of China.

Background: Loop-mediated isothermal amplification (LAMP) has been widely used to diagnose various infectious diseases. Malaria is a globally distributed infectious disease attributed to parasites in the genus Plasmodium. It is known that persons infected with Plasmodium vivax and P. ovale are prone to clinical relapse of symptomatic blood-stage infections. LAMP has not previously been specifically evaluated for its diagnostic performance in detecting P. ovale in an epidemiological study, and no commercial LAMP or rapid diagnostic test (RDT) kits are available for specifically diagnosing infections with P. ovale.

Methods: An assay was designed to target a portion of mitochondrial DNA (mtDNA) among Plasmodium spp., the five human Plasmodium species and two other assays were designed to target the nuclear 18S ribosomal DNA gene (18S rDNA) of either P. vivax or P. ovale for differentiating the two species. The sensitivity of the assays was compared to that of nested PCR using defined concentrations of plasmids containing the target sequences and using limiting dilutions prepared from clinical isolates derived from Chinese workers who had become infected in Africa or near the Chinese border with Myanmar.

Results: The results showed that 10 copies of the mitochondrial target or 10 and 10 copies of 18S rDNA could be detected from Plasmodium spp., P. vivax and P. ovale, respectively. In 279 clinical samples, the malaria Pan mtDNA LAMP test performed well when compared with a nested PCR assay (95% confidence interval [CI] sensitivity 98.48-100%; specificity 90.75-100%). When diagnosing clinical cases of infection with P. vivax, the 18S rDNA assay demonstrated an even great sensitivity (95.85-100%) and specificity (98.1-100%). The same was true for clinical infections with P. ovale (sensitivity 90.76-99.96%; specificity 98.34-100%). Using plasmid-positive controls, the limits of detection of Malaria Pan, 18S rDNA P. vivax and 18S rDNA P. ovale LAMP were 100-, 100- and tenfold lower than those of PCR, respectively.

Conclusion: The novel LAMP assays can greatly aid the rapid, reliable and highly sensitive diagnosis of infections of Plasmodium spp. transmitted among people, including P. vivax and P. ovale, cases of which are most prone to clinical relapse.
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http://dx.doi.org/10.1186/s13071-021-04764-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8147439PMC
May 2021

The association of compound hot extreme with mortality risk and vulnerability assessment at fine-spatial scale.

Environ Res 2021 07 3;198:111213. Epub 2021 May 3.

Department of Public Health, School of Medicine, Jinan University, Guangzhou, 510630, China; Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China. Electronic address:

The frequency and intensity of compound hot extremes will be likely to increase in the context of global warming. Epidemiological studies have demonstrated the adverse effect of simple hot extreme events on mortality, but little is known about the effects of compound hot extremes on mortality. Daily meteorological, demographic, and mortality data during 2011-2017 were collected from 160 streets in Guangzhou City, China. We used distributed lag non-linear model (DLNM) to analyze the associations of different hot extremes with mortality risk in each street. Street-specific associations were then combined using a meta-analysis approach. To assess the spatial distribution of vulnerability to compound hot extremes, vulnerable characteristics at street level were selected using random forest model, and then we calculated and mapped spatial vulnerability index (SVI) at each street in Guangzhou. At street level, compared with normal day, compound hot extreme significantly increased mortality risk (relative risk(RR)=1.43, 95%CI:1.28-1.59) with higher risk for female (RR=1.54 [1.35-1.76]) and the elderly(RR for aged 65-74=1.41 [1.14-1.74]; RR for ≥75years=1.63 [1.45-1.84]) than male (RR=1.32 [1.15-1.52]) and population <65 years (RR=1.01 [0.83-1.22]). Areas with high vulnerability were in the urban center and the edge of suburban. High proportion of population over 64 years old in urban center, and high proportions of outdoor workers and population with illiteracy in suburban areas were the determinants of spatial vulnerability. We found that compound hot extreme significantly increased mortality risk at street level, which is modified by socio-economic and demographic factors. Our findings help allocate resources targeting vulnerable areas at fine-spatial scale.°.
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http://dx.doi.org/10.1016/j.envres.2021.111213DOI Listing
July 2021

The mediation effect of placental weight change in the association between prenatal exposure to selenium and birth weight: Evidence from a prospective birth cohort study in China.

Environ Epidemiol 2021 Apr 2;5(2):e139. Epub 2021 Apr 2.

Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.

Selenium (Se) is an essential element and also toxic at an excessive level for human body. However, few studies have investigated adverse effects of Se exposure on birth weight and placental weight.

Methods: All participants were selected from the Prenatal Environment and Offspring Health cohort conducted in 2016 in Guangzhou, China. Se in each participant was measured by inductively coupled plasma mass spectrometry in their urine samples. The urinary Se concentrations were corrected by creatinine and transformed by natural logarithm (ln-Se). Multiple-linear regression models were applied to estimate the associations among Se exposure levels, placenta weight, and birth weight.

Results: A total of 2758 mother-newborn pairs were included in this study. Each interquartile range (0.53 μg/g creatinine) increment in urine ln-Se concentration during the first trimester was associated with a mean 21.7 g (95% CI = -41.3g to -2.1g) decrease in birth weight and 3.6g (95% CI = -6.3g to -0.9g) decrease in placental weight. Compared with the lowest quartile (Q1) of ln-Se concentrations during the first trimester, significantly lower birth weight was found in the highest quartile (Q4) (β = -45.7g; 95% CI = -90.7g to -0.7g). Similar dose-response associations with birthweight and placental weight were found for Se exposure during the third trimester. Mediation analyses showed that 44.2% and 18.2% of the effects of Se exposure in first and third trimester on birth weight were mediated by decreased placental weight, respectively.

Conclusion: Maternal Se exposure during pregnancy was negatively associated with birth weight, the reduction of placental weight may partially mediate the association of prenatal Se exposure with birth weight.
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http://dx.doi.org/10.1097/EE9.0000000000000139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043733PMC
April 2021

Susceptibility of Isolates from the China-Myanmar Border Area to Piperaquine and Association with Candidate Markers.

Antimicrob Agents Chemother 2021 Mar 8. Epub 2021 Mar 8.

Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, Tampa, FL, USA

from the Greater Mekong subregion has evolved resistance to the artemisinin-based combination therapy dihydroartemisinin and the partner drug piperaquine. To monitor the potential westward spread or independent evolution of piperaquine resistance, we evaluated the susceptibility of 120 isolates collected at the China-Myanmar border during 2007-2016. The parasite isolates displayed a relatively wide range of piperaquine susceptibility estimates. While 56.7% of the parasites showed bimodal drug response curves, all but five generated area-under-the-curve (AUC) estimates consistent with a susceptible phenotype. Using the piperaquine survival assay (PSA), 5.6% parasites showed reduced susceptibility. Of note, parasites from 2014-2016 showed the highest AUC value and the highest proportion with a bimodal curve, suggesting falling effectiveness in these later years. Unsupervised K-mean analysis of the combined data assigned parasites into three clusters and identified significant correlations between IC, IC and AUC values. No parasites carried the E415G mutation in a putative exo-nuclease, new mutations in PfCRT, or amplification of the genes, suggesting mechanisms of reduced piperaquine susceptibility that differ from those described in other countries of the region. The association of increased AUC, IC, and IC values with major PfK13 mutations (F446I and G533S) suggests that piperaquine resistance may evolve in these PfK13 genetic backgrounds. Additionally, the Pfmdr1 F1226Y mutation was associated with significantly higher PSA values. Further elucidation of piperaquine resistance mechanisms and continuous surveillance are warranted.
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http://dx.doi.org/10.1128/AAC.02305-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092910PMC
March 2021

Bi-channel image registration and deep-learning segmentation (BIRDS) for efficient, versatile 3D mapping of mouse brain.

Elife 2021 Jan 18;10. Epub 2021 Jan 18.

School of Optical and Electronic Information- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China.

We have developed an open-source software called bi-channel image registration and deep-learning segmentation (BIRDS) for the mapping and analysis of 3D microscopy data and applied this to the mouse brain. The BIRDS pipeline includes image preprocessing, bi-channel registration, automatic annotation, creation of a 3D digital frame, high-resolution visualization, and expandable quantitative analysis. This new bi-channel registration algorithm is adaptive to various types of whole-brain data from different microscopy platforms and shows dramatically improved registration accuracy. Additionally, as this platform combines registration with neural networks, its improved function relative to the other platforms lies in the fact that the registration procedure can readily provide training data for network construction, while the trained neural network can efficiently segment-incomplete/defective brain data that is otherwise difficult to register. Our software is thus optimized to enable either minute-timescale registration-based segmentation of cross-modality, whole-brain datasets or real-time inference-based image segmentation of various brain regions of interest. Jobs can be easily submitted and implemented via a Fiji plugin that can be adapted to most computing environments.
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http://dx.doi.org/10.7554/eLife.63455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7840180PMC
January 2021

Temperature-adjusted hypertension prevalence and control rate: a series of cross-sectional studies in Guangdong Province, China.

J Hypertens 2021 05;39(5):911-918

Guangdong Provincial Institute of Public Health.

Background: Previous studies have shown negative relationships between ambient temperature and blood pressure (BP). However, few studies estimated temperature-adjusted hypertension prevalence and control rate in different population.

Objective: To estimate the effects of temperature on BP, and further calculate temperature-adjusted hypertension prevalence and control rate.

Methods: Meteorological and BP data in Guangdong Province from 2004 to 2015 were collected. There were 31 351 participants aged 18 years and over. Based on 2018 European society Arterial Hypertension Guidelines, participants were divided into normotensive patients (n = 23 046), known hypertensive patients (n = 2807), and newly detected hypertensive patients (n = 5498). We first used generalized additive model to establish the nonlinear relationship between daily mean temperature and BP, and then calculated the linear effects of temperature on BP among populations with different hypertension status. Finally, we calculated the temperature-adjusted hypertension prevalence and control rate.

Results: Generally, there is an inverse relationship between temperature and BP. For a 1 °C increase in temperature, the decreased SBPs for normotensive patients, newly detected hypertensive patients, and known hypertensive patients were 0.37 [95% confidence interval (CI): -0.40, -0.33] mmHg, 0.21 (95% CI: -0.32, -0.10) mmHg and 0.81 (95% CI: -1.02, -0.59) mmHg, while reduced DBPs were 0.19 (95% CI: -0.21, -0.16) mmHg, 0.01 (95% CI: -0.06,0.08) mmHg, and 0.44 (95% CI: -0.56, -0.32) mmHg, respectively. At 5, 10, 15, 20, and 25 °C, the hypertension prevalence rates were 32.5, 29.7, 27.7, 26.0, and 25.0%, respectively, and the control rates were 12.0, 17.5, 23.5, 30.1, and 37.1%, respectively.

Conclusion: Low temperature increased BP for all populations, especially for known hypertensive patients, which makes hypertension prevalence increase and control rate decrease if temperature reduce. Our findings suggest that temperature should be considered in hypertension clinic management and epidemiological survey.
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http://dx.doi.org/10.1097/HJH.0000000000002738DOI Listing
May 2021

The time-varying transmission dynamics of COVID-19 and synchronous public health interventions in China.

Int J Infect Dis 2021 Feb 9;103:617-623. Epub 2020 Nov 9.

Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China. Electronic address:

Objectives: We aimed to estimate the time-varying transmission dynamics of COVID-19 in China, Wuhan City, and Guangdong province, and compare to that of severe acute respiratory syndrome (SARS).

Methods: Data on COVID-19 cases in China up to 20 March 2020 was collected from epidemiological investigations or official websites. Data on SARS cases in Guangdong Province, Beijing, and Hong Kong during 2002-3 was also obtained. We estimated the doubling time, basic reproduction number (R), and time-varying reproduction number (R) of COVID-19 and SARS.

Results: As of 20 March 2020, 80,739 locally acquired COVID-19 cases were identified in mainland China, with most cases reported between 20 January and 29 February 2020. The R value of COVID-19 in China and Wuhan was 5.0 and 4.8, respectively, which was greater than the R value of SARS in Guangdong (R = 2.3), Hong Kong (R = 2.3), and Beijing (R = 2.6). At the start of the COVID-19 epidemic, the R value in China peaked at 8.4 and then declined quickly to below 1.0 in one month. With SARS, the R curve saw fluctuations with more than one peak, the highest peak was lower than that for COVID-19.

Conclusions: COVID-19 has much higher transmissibility than SARS, however, a series of prevention and control interventions to suppress the outbreak were effective. Sustained efforts are needed to prevent the rebound of the epidemic in the context of the global pandemic.
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http://dx.doi.org/10.1016/j.ijid.2020.11.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836966PMC
February 2021

Life loss of cardiovascular diseases per death attributable to ambient temperature: A national time series analysis based on 364 locations in China.

Sci Total Environ 2021 Feb 1;756:142614. Epub 2020 Oct 1.

Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China. Electronic address:

Background: Although the effect of ambient temperature on cardiovascular disease (CVDs) has been well explored, studies using years of life lost (YLLs) as the outcome especially evaluating the average life loss per death attributable to temperatures were rare. We examine the associations between ambient temperature and YLLs of CVDs, and further quantify temperature-related life loss per death.

Methods: Daily YLL rates were calculated using death data from 364 locations across China during 2006-2017, and meteorological data were collected for the same period. A distributed-lag nonlinear model and meta-regression were applied to examine the relationships between temperature and YLL rates of CVDs. Subgroup analyses by age, gender, region, and cause-specific CVDs were investigated. The total YLLs and average YLLs per death attributable to temperature were further quantified to assess life loss caused by non-optimal temperature.

Results: Both high and low temperatures significantly increased YLL rates of CVDs, with greater effects for cold than heat. Cerebrovascular diseases (CEDs) account for the largest proportion (47.17%) of total YLLs of CVDs attributable to non-optimal temperature. On average, life loss per CVD death attributable to non-optimal temperatures was 1.51 (95% eCI: 1.33, 1.69) years, with 1.07 (95% eCI: 1.00, 1.15) years from moderate cold. Average life losses per death were observed higher for males (1.71, 95% eCI: 1.43, 1.99), younger population (3.82, 95% eCI: 2.86, 4.75), central China (1.62; 95% eCI: 1.41, 1.83) and hemorrhagic stroke (2.86, 95% eCI: 2.63, 3.10) than their correspondents.

Conclusions: We found that non-optimal temperature significantly aggravated premature death of CVD, with CEDs being the most affected, and most of temperature-related life loss of CVD was attributed to moderate cold. Our findings imply that peoples with CEDs in moderate cold days are vulnerable populations, which may contribute to a better understanding the adverse effects and pathogenesis of temperature on CVDs.
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http://dx.doi.org/10.1016/j.scitotenv.2020.142614DOI Listing
February 2021

Comparison of life loss per death attributable to ambient temperature among various development regions: a nationwide study in 364 locations in China.

Environ Health 2020 09 15;19(1):98. Epub 2020 Sep 15.

Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, No.160, Qunxian Road, Panyu District, Guangzhou, 511430, Guangdong, China.

Background: Several studies have investigated the associations between ambient temperature and years of life lost (YLLs), but few focused on the difference of life loss attributable to temperature among different socioeconomic development levels.

Objectives: We investigated the disparity in temperature-YLL rate relationships and life loss per death attributable to nonoptimal temperature in regions with various development levels.

Methods: Three hundred sixty-four Chinese counties or districts were classified into 92 high-development regions (HDRs) and 272 low-development regions (LDRs) according to socioeconomic factors of each location using K-means clustering approach. We used distributed lag non-linear models (DLNM) and multivariate meta-analysis to estimate the temperature-YLL rate relationships. We calculated attributable fraction (AF) of YLL and temperature-related average life loss per death to compare mortality burden of temperature between HDRs and LDRs. Stratified analyses were conducted by region, age, sex and cause of death.

Results: We found that non-optimal temperatures increased YLL rates in both HDRs and LDRs, but all subgroups in LDRs were more vulnerable. The disparity of cold effects between HDRs and LDRs was significant, while the difference in heat effect was insignificant. The overall AF of non-optimal temperature in LDRs [AF = 12.2, 95% empirical confidence interval (eCI):11.0-13.5%] was higher than that in HDRs (AF = 8.9, 95% eCI: 8.3-9.5%). Subgroups analyses found that most groups in LDRs had greater AFs than that in HDRs. The average life loss per death due to non-optimal temperature in LDRs (1.91 years, 95% eCI: 1.72-2.10) was also higher than that in HDRs (1.32 years, 95% eCI: 1.23-1.41). Most of AFs and life loss per death were caused by moderate cold in both HDRs and LDRs.

Conclusions: Mortality burden caused by temperature was more significant in LDRs than that in HDRs, which means that more attention should be paid to vulnerable populations in LDRs in planning adaptive strategies.
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http://dx.doi.org/10.1186/s12940-020-00653-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491140PMC
September 2020

Efficacy of artemether-lumefantrine for treating uncomplicated Plasmodium falciparum cases and molecular surveillance of drug resistance genes in Western Myanmar.

Malar J 2020 Aug 27;19(1):304. Epub 2020 Aug 27.

Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, 33612, USA.

Background: Currently, artemisinin-based combination therapy (ACT) is the first-line anti-malarial treatment in malaria-endemic areas. However, resistance in Plasmodium falciparum to artemisinin-based combinations emerging in the Greater Mekong Sub-region is a major problem hindering malaria elimination. To continuously monitor the potential spread of ACT-resistant parasites, this study assessed the efficacy of artemether-lumefantrine (AL) for falciparum malaria in western Myanmar.

Methods: Ninety-five patients with malaria symptoms from Paletwa Township, Chin State, Myanmar were screened for P. falciparum infections in 2015. After excluding six patients with a parasite density below 100 or over 150,000/µL, 41 P. falciparum patients were treated with AL and followed for 28 days. Molecular markers associated with resistance to 4-amino-quinoline drugs (pfcrt and pfmdr1), antifolate drugs (pfdhps and pfdhfr) and artemisinin (pfk13) were genotyped to determine the prevalence of mutations associated with anti-malarial drug resistance.

Results: For the 41 P. falciparum patients (27 children and 14 adults), the 28-day AL therapeutic efficacy was 100%, but five cases (12.2%) were parasite positive on day 3 by microscopy. For the pfk13 gene, the frequency of NN insert after the position 136 was 100% in the day-3 parasite-positive group as compared to 50.0% in the day-3 parasite-negative group, albeit the difference was not statistically significant (P = 0.113). The pfk13 K189T mutation (10.0%) was found in Myanmar for the first time. The pfcrt K76T and A220S mutations were all fixed in the parasite population. In pfmdr1, the Y184F mutation was present in 23.3% of the parasite population, and found in both day-3 parasite-positive and -negative parasites. The G968A mutation of pfmdr1 gene was first reported in Myanmar. Prevalence of all the mutations in pfdhfr and pfdhps genes assessed was over 70%, with the exception of the pfdhps A581G mutation, which was 3.3%.

Conclusions: AL remained highly efficacious in western Myanmar. Pfk13 mutations associated with artemisinin resistance were not found. The high prevalence of mutations in pfcrt, pfdhfr and pfdhps suggests high-degree resistance to chloroquine and antifolate drugs. The pfmdr1 N86/184F/D1246 haplotype associated with selection by AL in Africa reached > 20% in this study. The detection of > 10% patients who were day-3 parasite-positive after AL treatment emphasizes the necessity of continuously monitoring ACT efficacy in western Myanmar.
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http://dx.doi.org/10.1186/s12936-020-03376-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450958PMC
August 2020

Risk factors associated with COVID-19 infection: a retrospective cohort study based on contacts tracing.

Emerg Microbes Infect 2020 Dec;9(1):1546-1553

Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, People's Republic of China.

This study aimed to estimate the attack rates, and identify the risk factors of COVID-19 infection. Based on a retrospective cohort study, we investigated 11,580 contacts of COVID-19 cases in Guangdong Province from 10 January to 15 March 2020. All contacts were tested by RT-PCR to detect their infection of SARS-COV-2. Attack rates by characteristics were calculated. Logistic regression was used to estimate the risk factors of infection for COVID-19. A total of 515 of 11,580 contacts were identified to be infected with SARS-COV-2. Compared to young adults aged 20-29 years, the infected risk was higher in children (RR: 2.59, 95%CI: 1.79-3.76), and old people aged 60-69 years (RR: 5.29, 95%CI: 3.76-7.46). Females also had higher infected risk (RR: 1.66, 95%CI: 1.39-2.00). People having close relationship with index cases encountered higher infected risk (RR for spouse: 20.68, 95%CI: 14.28-29.95; RR for non-spouse family members: 9.55, 95%CI: 6.73-13.55; RR for close relatives: 5.90, 95%CI: 4.06-8.59). Moreover, contacts exposed to index case in symptomatic period (RR: 2.15, 95%CI: 1.67-2.79), with critically severe symptoms (RR: 1.61, 95%CI: 1.00-2.57), with symptoms of dizzy (RR: 1.58, 95%CI: 1.08-2.30), myalgia (RR: 1.49, 95%CI: 1.15-1.94), and chill (RR: 1.42, 95%CI: 1.05-1.92) had higher infected risks. Children, old people, females, and family members are susceptible of COVID-19 infection, while index cases in the incubation period had lower contagiousness. Our findings will be helpful for developing targeted prevention and control strategies to combat the worldwide pandemic.
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http://dx.doi.org/10.1080/22221751.2020.1787799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473290PMC
December 2020

Molecular Surveillance and in vitro Drug Sensitivity Study of Isolates from the China-Myanmar Border.

Am J Trop Med Hyg 2020 09;103(3):1100-1106

Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China.

The emergence and spread of resistance in to the frontline treatment artemisinin-based combination therapies in Southeast Asia require close monitoring of the situation. Here, we collected 36 clinical samples of from the China-Myanmar border in 2014-2016, adapted these parasites to continuous culture, and performed in vitro drug assays on seven antimalarial drugs. Data for 23 parasites collected in 2010 and 2012 from the same area reported in an early study were used to assess longitudinal changes in drug sensitivity. Parasites remained highly resistant to chloroquine (CQ) and pyrimethamine, whereas they were generally sensitive to mefloquine (MFQ), lumefantrine (LMF), naphthoquine (NQ), and pyronaridine (PND). Parasites showed a similar temporal trend in sensitivity to CQ, NQ, and PND, with gradual reduction in the half-maximal inhibitory concentrations (ICs) after 2012. The ICs to the aminoalcohol drugs MFQ, LMF, and quinine (QN) all significantly declined in 2014, followed by various degrees of increase in 2016. Pyrimethamine displayed a continuous increase in IC over the years. The Dd2-like mutations were fixed or nearly fixed in the parasite population. The F1226Y mutation was detected in 80% parasites in 2016 and associated with reduced sensitivity to LMF and QN ( < 0.05). The N51I in and K540E/N and A581G in that are associated with antifolate resistance were either fixed or were approaching fixation in recent years. This study provides an updated picture and temporal trend of antimalarial drug resistance in the China-Myanmar border region, which will serve as a reference for antimalarial treatment.
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http://dx.doi.org/10.4269/ajtmh.20-0235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7470591PMC
September 2020

Ex vivo susceptibilities of Plasmodium vivax isolates from the China-Myanmar border to antimalarial drugs and association with polymorphisms in Pvmdr1 and Pvcrt-o genes.

PLoS Negl Trop Dis 2020 06 12;14(6):e0008255. Epub 2020 Jun 12.

Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America.

Background: Vivax malaria is an important public health problem in the Greater Mekong Subregion (GMS), including the China-Myanmar border. Previous studies have found that Plasmodium vivax has decreased sensitivity to antimalarial drugs in some areas of the GMS, but the sensitivity of P. vivax to antimalarial drugs is unclear in the China-Myanmar border. Here, we investigate the drug sensitivity profile and genetic variations for two drug resistance related genes in P. vivax isolates to provide baseline information for future drug studies in the China-Myanmar border.

Methodology/principal Findings: A total of 64 P. vivax clinical isolates collected from the China-Myanmar border area were assessed for ex vivo susceptibility to eight antimalarial drugs by the schizont maturation assay. The medians of IC50 (half-maximum inhibitory concentrations) for chloroquine, mefloquine, pyronaridine, piperaquine, quinine, artesunate, artemether, dihydroartemisinin were 84.2 nM, 34.9 nM, 4.0 nM, 22.3 nM, 41.4 nM, 2.8 nM, 2.1 nM and 2.0 nM, respectively. Twelve P. vivax clinical isolates were found over the cut-off IC50 value (220 nM) for chloroquine resistance. In addition, sequence polymorphisms in pvmdr1 (P. vivax multidrug resistance-1), pvcrt-o (P. vivax chloroquine resistance transporter-o), and difference in pvmdr1 copy number were studied. Sequencing of the pvmdr1 gene in 52 samples identified 12 amino acid substitutions, among which two (G698S and T958M) were fixed, M908L were present in 98.1% of the isolates, while Y976F and F1076L were present in 3.8% and 78.8% of the isolates, respectively. Amplification of the pvmdr1 gene was only detected in 4.8% of the samples. Sequencing of the pvcrt-o in 59 parasite isolates identified a single lysine insertion at position 10 in 32.2% of the isolates. The pvmdr1 M908L substitutions in pvmdr1 in our samples was associated with reduced sensitivity to chloroquine, mefloquine, pyronaridine, piperaquine, quinine, artesunate and dihydroartemisinin.

Conclusions: Our findings depict a drug sensitivity profile and genetic variations of the P. vivax isolates from the China-Myanmar border area, and suggest possible emergence of chloroquine resistant P. vivax isolates in the region, which demands further efforts for resistance monitoring and mechanism studies.
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http://dx.doi.org/10.1371/journal.pntd.0008255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314094PMC
June 2020

Spatiotemporal heterogeneity of social contact patterns related to infectious diseases in the Guangdong Province, China.

Sci Rep 2020 04 15;10(1):6119. Epub 2020 Apr 15.

Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.

The social contact patterns associated with the infectious disease transmitted by airborne droplets or close contact follow specific rules. Understanding these processes can improve the accuracy of disease transmission models, permitting their integration into model simulations. In this study, we performed a large-scale population-based survey to collect social contact patterns in three cities on the Pearl River Delta of China in winter and summer. A total of 5,818 participants were face-to-face interviewed and 35,542 contacts were recorded. The average number of contacts per person each day was 16.7 considering supplementary professional contacts (SPCs). Contacts that occurred on a daily basis, lasted more than 4 hours, and took place in households were more likely to involve physical contact. The seasonal characteristics of social contact were heterogeneous, such that contact in the winter was more likely to involve physical contact compared to summer months. The spatial characteristics of the contacts were similar. Social mixing patterns differed according to age, but all ages maintained regular contact with their peers. Taken together, these findings describe the spatiotemporal distribution of social contact patterns relevant to infections in the Guangdong Province of China. This information provides important parameters for mathematical models of infectious diseases.
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http://dx.doi.org/10.1038/s41598-020-63383-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160103PMC
April 2020

Associations of maternal ambient temperature exposures during pregnancy with the placental weight, volume and PFR: A birth cohort study in Guangzhou, China.

Environ Int 2020 06 2;139:105682. Epub 2020 Apr 2.

Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China. Electronic address:

Background: The placenta performs crucial functions to ensure normal fetal development. Experimental studies have indicated associations between exposure to elevated temperatures during pregnancy and reduction in placental weight and volume. However, epidemiological studies in humans are lacking.

Objective: To estimate the associations between prenatal exposure to ambient temperature with placental weight, volume, and the placental weight to birth weight ratio (PFR).

Methods: We conducted a prospective birth cohort study using the Prenatal Environment and Offspring Health Cohort (PEOH Cohort) beginning in 2016 in Guangzhou, China. Women in early pregnancy were recruited and followed up during their hospitalization for childbirth. An inverse distance-weighted method was employed to estimate the average temperature exposure of every 4 weeks as well as the trimester-specific average temperature exposure at the individual's residential address. A generalized linear model was applied to estimate the effects of temperature exposure during pregnancy on the placental weight, volume, and PFR.

Results: A total of 4051 pregnant women were enrolled. Compared with the reference temperature of 20 °C, maternal exposure to 29 °C (95th centile) during late pregnancy was associated with an average of -6.03 g (95% confidence interval [CI]: -11.28 g, -0.78 g) in placental weight, -16.15 cm (95% CI: -26.24 cm, -6.07 cm) in placental volume, and 0.26 (95% CI: 0.07, 0.45) in PFR. The peak effects of high temperatures on placental weight, volume, and PFR were found from 29 to 32 weeks (β = -3.79 g, 95% CI: -8.39 g, 0.82 g), 37 to 40 weeks (β = -19.34 cm, 95% CI: -30.99 cm, -7.69 cm), and 25 to 28 weeks (β = 0.35, 95% CI: 0.04, 0.66), respectively.

Conclusions: Maternal exposure to elevated temperatures was associated with a decrease in placental weight and volume and an increase in PFR. The associations were stronger when exposures occurred during late pregnancy.
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http://dx.doi.org/10.1016/j.envint.2020.105682DOI Listing
June 2020

The interplay of haze characteristics on mortality in the Pearl River Delta of China.

Environ Res 2020 05 20;184:109279. Epub 2020 Feb 20.

Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, 511430, China; Naihai Hospital of Southern Medical University, Foshan, Guangdong, 528244, China. Electronic address:

To estimate the mortality risk from haze and the modifying effects by three characteristics of haze (intensity, duration and timing), data on haze and mortality in the Pearl River Delta region from 2013 to 2016 were collected. We first estimated mortality risk during haze days compared with non-haze days. Then we classified haze into several categories by considering one or any two of the three haze characteristics together, and further calculated the mortality risks separately. The mortality risk increased 5.0% (95% confidence intervals (CI): 3.1%-6.9%) during hazy days compared with non-haze days, with larger effect for the elderly ≥ 85 years old (Excess risk (ER): 8.7%, 95% CI: 3.9%-13.6%) than other age groups. Mortality risk increased in longer haze (ER: 4.4%, 95% CI: 2.9%-6.0%) compared with shorter haze (ER: 1.9%, 95% CI: 0.7%-3.2%). The greatest effect of any two of haze characteristics was observed when haze was intense and long (ER: 4.8%, 95% CI: 3.0%-6.6%). Our study indicates that haze significantly increased mortality risk in the Pearl River Delta. The health effects of haze may be under-estimated when using a single air pollutant concentration during haze periods to assess health risk of haze events. The haze intensity, duration, and time of occurrence should be accounted for in appropriate risk assessment of haze.
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http://dx.doi.org/10.1016/j.envres.2020.109279DOI Listing
May 2020

Associations of maternal ambient temperature exposures during pregnancy with the risk of preterm birth and the effect modification of birth order during the new baby boom: A birth cohort study in Guangzhou, China.

Int J Hyg Environ Health 2020 04 12;225:113481. Epub 2020 Feb 12.

School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510080, China; Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China. Electronic address:

Maternal exposures to ambient temperatures during pregnancy may increase the preterm birth (PTB) risk; however, which periods have stronger effects remain controversial. The effects of temperature exposure on PTB in first- and second-born neonate groups may be different during the new baby boom that has followed the Two-child Policy in China. We examined a birth cohort of 4928 pregnant women beginning in 2016 in Guangzhou, China. An inverse distance weighted method was used to estimate the temperature exposure at each individual residential address. A distribution lag non-linear model incorporating a Cox proportional hazard model was employed to estimate the effects of temperature exposure on PTB and test the effects modification of birth order related to the new baby boom. A total of 4101 pregnant women were included, of which 234 (5.7%) experienced PTB. Compared with the mean temperature (23.0 °C), we found a significantly higher risks of PTB associated with high temperatures (i.e, 30 °C [95th centile]) from the 4th to 8th, and 22nd to 27th gestational weeks. A peak effect was found during the 6th week (HR = 1.79, 95% CI: 1.26, 2.54) and 24th week (HR = 1.83, 95% CI: 1.27, 2.62). The risks of PTB were reduced for low temperatures (i.e. 14 °C [5th centile] versus 23.0 °C) from the 2nd to 10th and 20th to 26th gestational weeks, and the negative peak effect was found during the 4th week (HR = 0.43, 95% CI: 0.26, 0.72) and 23rd week (HR = 0.59, 95% CI: 0.43, 0.83). Stratification analyses showed that significant effects of 30 °C versus 23 °C on PTB were observed during the 4th to 8th weeks in the second-born neonate, and the peak effect was found in the 6th week (HR = 2.13, 95% CI: 1.31, 3.47). However, we did not find significant effects of 30 °C during the same weeks in the first-born neonate group. Maternal exposures to higher temperatures during pregnancy may increase the risk of PTB, and lower temperatures may decrease the risk of PTB. Stronger effects of temperature exposures during the first trimester on PTB risk were found among the second-born neonates than among the first-born neonates.
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http://dx.doi.org/10.1016/j.ijheh.2020.113481DOI Listing
April 2020

Associations of maternal ozone exposures during pregnancy with maternal blood pressure and risk of hypertensive disorders of pregnancy: A birth cohort study in Guangzhou, China.

Environ Res 2020 04 5;183:109207. Epub 2020 Feb 5.

Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China. Electronic address:

Although studies have assessed the associations of maternal exposure to ozone (O) during pregnancy with blood pressure and the risk of hypertensive disorders of pregnancy (HDP), the results were inconsistent. Furthermore, no studies have been conducted in China where the ambient O concentration continuedly increased. The present study aimed to estimate the effects of maternal exposure to O during pregnancy on the HDP risk, systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP). All participants of pregnant women were selected from the prospective birth cohort study on Prenatal Environments and Offspring Health conducted in Guangzhou, China. A spatiotemporal land-use-regression model was used to estimate individual monthly air pollution exposure from three months before pregnancy to childbirth date. Information on HDP, SBP, DBP and PP was obtained from maternal medical records. A Logistic regression model and a mixed linear model were used to estimate the associations of maternal exposure to O with the risk of HDP and blood pressure (SBP, DBP and PP), respectively. We found significant associations of maternal exposure to O during the third (OR = 1.31, 95%CI: 1.07, 1.60) and the second month (OR = 1.25, 95%CI: 1.02, 1.51) before pregnancy with the risk of HDP. Observed significantly positive associations of O exposures with SBP, DBP and PP during the two months before pregnancy and during the early pregnancy. The peak effects of O exposure on SBP, DBP and PP were respectively observed during the second month of pregnancy (β = 1.07  mmHg, 95%CI: 0.84, 1.31  mmHg), the first month before pregnancy (β = 0.40  mmHg, 95%CI: 0.21, 0.50  mmHg) and the second month of pregnancy (β = 0.78  mmHg, 95%CI: 0.59, 0.97  mmHg). Our results suggest that maternal exposure to O were positively associated with blood pressure and the risk of HDP, and the period from three months before pregnancy to the first trimester might be the critical exposure window.
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http://dx.doi.org/10.1016/j.envres.2020.109207DOI Listing
April 2020

Associations among Soil-Transmitted Helminths, G6PD Deficiency and Asymptomatic Malaria Parasitemia, and Anemia in Schoolchildren from a Conflict Zone of Northeast Myanmar.

Am J Trop Med Hyg 2020 04;102(4):851-856

Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China.

In tropical areas of developing countries, the interactions among parasitic diseases such as soil-transmitted helminths (STHs) and malaria, and glucose-6-phosphate dehydrogenase deficiency (G6PDd), are complex. Here, we investigated their interactions and impact on anemia in school students residing in a conflict zone of northeast Myanmar. A cross-sectional survey was conducted between July and December 2015 in two schools located along the China-Myanmar border. Stool samples from the schoolchildren were analyzed for STH infections, whereas finger-prick blood samples were analyzed for G6PDd, hemoglobin concentrations, and infections. Among 988 enrolled children, , , hookworm, , and infections occurred in 3.3%, 0.8%, 31.5%, 1.2%, and 0.3%, respectively. Glucose-6-phosphate dehydrogenase deficiency was present in 16.9% of the children, and there was a very high prevalence of anemia (73%). Anthropometric measures performed on all children showed that 50% of the children were stunted and 25% wasted. Moderate to severe anemia was associated with STH infections, stunting, and wasting. In addition, children had increasing odds of anemia with increasing burden of infections. This study revealed a high prevalence of G6PDd, STHs, and anemia in schools located in a conflict zone. In areas where malnutrition and STH infections are rampant, testing for both glucose-6-phosphate dehydrogenase and anemia should be considered before treating vivax malaria with 8-aminoquinolines.
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http://dx.doi.org/10.4269/ajtmh.19-0828DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7124928PMC
April 2020

Widespread resistance mutations to sulfadoxine-pyrimethamine in malaria parasites imported to China from Central and Western Africa.

Int J Parasitol Drugs Drug Resist 2020 04 29;12:1-6. Epub 2019 Nov 29.

Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, 650500, Yunnan, PR China. Electronic address:

Background: Imported cases of infectious disease provide invaluable information about epidemiological conditions abroad, and should guide treatment decisions at home and abroad. Here, we examined cases of malaria imported from Africa to China for mutations eroding the efficacy of sulfadoxine-pyrimethamine (SP), sometimes used as an intermittent preventive treatment during for pregnant women and infants.

Methods: A total of 208 blood samples were collected from P. falciparum-infected workers who had returned from Western and Central Africa to Guangxi Province Frequency distribution. Samples were analyzed for the mutations in dhfr and dhps genes by PCR -sequencing. The prevalence of dhfr and dhps polymorphisms was analyzed. Among the isolates, polymorphisms were detected in mutants N51I, C59R, S108N and I164L of Pfdhfr and I431V, S436 A/F, A437G, K540 E/N, A581G and A613T of pfdhps.

Results: Mutations promoting drug resistance were widespread in this cohort. For pfdhfr and pfdhps, wild types were equally rare among patients returned from Western Africa and Central Africa. A triple-mutant dhfr haplotype was most prevalent (>70%). We report for the first time mutation I164L-dhfr and I431V-dhps in Ghana, and for the first time we found A581G to exceed a clinically-relevant threshold that may counter-indicate current clinical practices. For Pfdhps, the double-mutant IAGKAA was high prevalent haplotype in Ghana, Western Africa. The single-mutant ISGKAA was a majority haplotype in Cameroon. Alarmingly, a "super resistance" quintuple mutant was detected, for the first time, in parasites of West African origin (defined by IAGKAA/IRNI in combination with pfdhps 581G and dhfr I164L). This may limit the efficacy of this drug combination for even intermittent clinical applications.

Conclusions: These data are cause for great concern and call for continued surveillance of the efficacy of SP in source and recipient populations, and should be considered when developing treatment policy for imported malaria cases in China and elsewhere.
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http://dx.doi.org/10.1016/j.ijpddr.2019.11.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6909128PMC
April 2020

Associations of county-level cumulative environmental quality with mortality of chronic obstructive pulmonary disease and mortality of tracheal, bronchus and lung cancers.

Sci Total Environ 2020 Feb 14;703:135523. Epub 2019 Nov 14.

Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong 511430, China. Electronic address:

Chronic obstructive pulmonary disease (COPD) and tracheal, bronchus, and lung (TBL) cancers are among the leading causes of mortality worldwide. Many environmental factors have been linked to COPD and TBL cancers. This study examined the associations of cumulative environmental quality indices with COPD mortality and TBL cancers mortality, respectively. Environmental Quality Index (EQI) was constructed to represent cumulative environmental quality for the overall environment and 5 major environmental domains (e.g., air, water, built). Associations of each EQI indices with COPD mortality and TBL cancers mortality, across 3109 counties in the 48 contiguous states of the US, were examined using simultaneous autoregressive (SAR) models. Stratified analyses were conducted in females versus males and according to rural-urban continuum codes (RUCC) to assess the heterogeneity across the overall population. Overall poor environmental quality was associated with a percent difference (PD) of 0.75 [95% confidence intervals (95% CI), 0.46, 1.05] in COPD mortality and an PD of 1.22 (95% CI, 0.97, 1.46) in TBL cancers mortality. PDs were higher in females than in males for both COPD and TBL cancers. The built domain had the largest effect on COPD mortality (PD, 0.85; 95% CI, 0.58, 1.12) while the air domain had the largest effect on TBL cancers mortality (PD, 1.54; 95% CI, 1.31, 1.76). The EQI-mortality associations varied among different RUCCs, but no consistent trend was found. This result suggests that poor environmental quality, particularly poor air quality and built environment quality may increase the mortality risk for COPD and that for TBL cancers. Females appear to be more susceptible to the effect of cumulative environmental quality. Our findings highlight the importance of improving overall and domain-specific cumulative environmental quality in reducing COPD and TBL cancer mortalities in the United States.
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http://dx.doi.org/10.1016/j.scitotenv.2019.135523DOI Listing
February 2020

A weekly time-weighted method of outdoor and indoor individual exposure to particulate air pollution.

MethodsX 2019 18;6:2439-2442. Epub 2019 Oct 18.

Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China.

The aim of this study was to estimate the weekly time-weighted (outdoor and indoor activity patterns) individual exposure to particulate air pollutants (PM, PM and PM) of pregnant women. A total of 4928 pregnancy women were recruited during their early pregnancy, and 4278 (86.8%) were successfully followed-up at childbirth. Each individual weekly average PM and PM concentrations at the residential and workplace addresses from three months before pregnancy to childbirth was estimated using a spatiotemporal land use regression (ST-LUR) model, and the weekly PM concentration was estimated employing a generalized additive model (GAM) which utilized weekly PM and meteorological factors as independent predictors. Then, the time-weighted individual exposure to particulate air pollutants during workdays and non-workdays during the period from three months before pregnancy to childbirth was estimated based on the estimated weekly air pollutant concentrations and each participant's indoor and outdoor activity model, respectively. Data analysis was carried out by R software (version 3.5.1) and packages "SpatioTemporal", "mgcv" and "splines" were mainly used. This method takes a full consideration of indoor and outdoor activity patterns in the individual exposure to particulate air pollutants. •A ST-LUR model was used to estimate the individual weekly average PM and PM concentrations at their residential and workplace addresses.•A GAM was applied to estimate the weekly average PM concentration at individual residential and workplace addresses.•Individual weekly exposure to particulate air pollutants during workdays and non-workdays was assessed based on the estimated particulate air pollutant concentrations and their indoor and outdoor activity model.
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http://dx.doi.org/10.1016/j.mex.2019.10.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6838529PMC
October 2019
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