Number Of Daily Outpatient Visits Research Articles

[Effect of daily average temperature on the incidence of allergic rhinitis in Lanzhou].

Objective: To evaluate the effect of daily average temperature on the atteck of allergic rhinitis (AR) by analyzing the changes of the outpatient visits of AR in Lanzhou. Methods: The meteorological and air pollution data of Lanzhou City and the outpatient visits of AR in Departments of Otorhinolaryngology and head and neck surgery of The First Hospital of Lanzhou University, The Second Hospital of Lanzhou University and Gansu Provincial People's Hospital from 2013 to 2017 were collected to describe the meteorological factors, air pollutants and the outpatient visits of AR. The correlation among the three factors was then analyzed by Spearman rank correlation analysis. Using the distributed lag non-linear model, the relationship between daily average temperature and the number of daily outpatient visits of AR was studied and stratified by gender and age with the long-term trend, seasonal trend and other confounding factors controlled. Results: From 2013 to 2017, the outpatient visits of AR in the above three hospitals reached 20 008 person times. Daily average temperature in Lanzhou showed a non-linear correlation to the outpatient visits of AR, with a certain lag effect. When the daily average temperature was 22 ℃ and the cumulative lag was 21 days (lag 0-21 d), the relative risk (RR) peaked at 4.851 (95%CI: 3.986-5.904). The effect of relatively low temperature (2.3 ℃, P25), relatively high temperature (19.8 ℃, P75) and high temperature (25.5 ℃, P95) on lag 0-21 d were the highest, which were 1.761 (95%CI: 1.375-2.255), 4.299 (95%CI: 3.574-5.171) and 3.656 (95%CI: 3.046-4.389), respectively. According to the stratified analysis, low and relatively low temperature had more significant effect on the outpatient visits of AR among women and people aged 0-14 years. When lag was 0-21 days, the RR value of low temperature for female outpatient visits of AR was 1.433 (95%CI: 1.105-1.860); the RR value of relatively low temperature for female outpatient visits of AR was 1.879 (95%CI: 1.460-2.419); the RR value of low temperature for AR outpatient visits for people aged 0-14 years was 1.511 (95%CI: 0.999-2.287), the RR value of relatively low temperature for AR outpatient visits for people aged 0-14 years was 2.051 (95%CI: 1.383-3.042). Relatively high temperature, on the other hand, had a more significant effect on men and people aged 15-59 years. High temperature had a greater impact on the number of AR outpatients in men and people aged 0-14 years. Conclusions: Temperature may be an important influencing factor of AR onset in Lanzhou. At relatively high temperature (19.8 ℃), the risk of AR outpatient visits is significantly increased, and the cumulative lagged effects are observed. The sensitivity of AR patients to temperature is different in different genders and ages.

COVID-19流行期间武汉某医院皮肤科门诊患者流行病学特点及疾病谱分析

Objective: To investigate epidemiological characteristics of outpatients and disease spectrum in the dermatology department during the COVID-19 epidemic Methods: A retrospective comparison of outpatient visits, gender, age and disease types in the dermatology department of Wuhan No.1 Hospital was performed between COVID-19 epidemic period (from 23th January 2020 to 15th April 2020) and the same period in 2019. Enumeration data were analyzed by Pearson's chi-square test. Results: During the COVID-19 epidemic, the number of outpatient visits to the dermatology department of the hospital decreased markedly, and the average daily number of outpatient visits (236 visits/day) was only 8.81% of that during the same period in 2019 (2 678 visits/day) ;the ratio of male to female patients was reversed from 1:1.37 in 2019 to 1.16:1 in 2020;the proportions of patients aged 0-6, 7-12, 13-17 and 18-45 years significantly decreased compared with those in 2019 (all P 69 years significantly increased (both P < 0.001). During the COVID-19 epidemic, there were 171 types of skin diseases in the dermatology outpatient department, and the number of disease categories decreased compared with that during the same period in 2019 (442 types) ;the number of patient visits for allergic skin diseases, erythematous papulosquamous skin diseases, viral infectious skin diseases and bacterial infectious skin diseases significantly increased compared with that during the same period in 2019 (all P < 0.001), while the number of patient visits for sebaceous and sweat gland disorders, pigmented skin diseases and physical skin diseases significantly decreased (all P < 0.001). Conclusion: Compared with the same period in 2019, the number of outpatient visits, patient sex ratio, age distribution and disease types in the dermatology department have undergone marked changes during the COVID-19 epidemic, and this study provides a reference for healthcare workers in dermatology department to respond to various epidemics and natural disasters in the future. Copyright © 2021 by the Chinese Medical Association.

The association between diurnal temperature range and clinic visits for upper respiratory tract infection among college students in Wuhan, China.

The effects of daily mean temperature on health outcomes have been discussed in many previous studies, but few have considered the adverse impacts on upper respiratory tract infection (URTI) due to variance of temperature in one day. Diurnal temperature range (DTR) was a novel indicator calculated as maximum temperature minus minimum temperature on the same day. In this study, generalized additive model (GAM) with quasi-Poisson distribution was used to investigate the association between DTR and the number of daily outpatient visits for URTI among college students. Data about meteorological factors and air pollutants were provided by Hubei Meteorological Bureau and Wuhan Environmental Protection Bureau, respectively. Outpatient visits data were collected from the Hospital of Wuhan University from January 1, 2016, to December 31, 2018. Short-term exposure to DTR was associated with the increased risk of outpatient for URTI among all college students. Per 1 °C increased in DTR was associated with 0.73% (95%CI: 0.24, 1.21) increased in outpatient visits of all college students for URTI at lag 0 day. The greatest effect values were observed in males [1.35% (95%CI: 0.33,2.39)] at lag 0-6 days, and in females [0.86% (95%CI: 0.24, 1.49)] at lag 0-1 days. DTR had more adverse health impact in autumn and winter. Public health departments should consider the negative effect of DTR to formulate more effective prevention and control measures for protecting vulnerable people.

Impact of the COVID-19 pandemic on mental health service use among psychiatric outpatients in a tertiary hospital

BackgroundThe aim was to explore the impact of the COVID-19 pandemic on mental health service use according to mental disorder diagnosis among psychiatric outpatients. MethodsPsychiatric outpatient visits and patient diagnostic information were extracted from the EHR(electronic health records) of a Korean tertiary hospital during 3 months of the COVID-19 pandemic and 3 months before the COVID-19 outbreak. Visit rates of psychiatric outpatients according to primary psychiatric diagnosis category before and after the COVID-19 pandemic were compared using an over-dispersed Poisson regression model. The temporal associations between the number of daily outpatient visits and the daily number of newly confirmed cases were examined by time-series analysis within each diagnosis category. ResultsTotal daily outpatient visit rate was significantly reduced during the pandemic. Among the nine most prevalent diagnosis categories, the daily visit rates for anxiety disorders, depressive disorders, and schizophrenia-spectrum disorders were significantly reduced by about 29.8%, 14.8%, and 13.3% respectively. Time-series analysis showed significant temporal correlations between the daily number of newly confirmed cases and the daily visit rates for anxiety disorders and depressive disorders, whereas patients with schizophrenia-spectrum disorders showed no significant temporal association. LimitationsPotential confounding factors unrelated to the pandemic might have influenced the results. ConclusionsThe present findings suggest that patients with anxiety or depressive disorders may have concerns regarding the spread of COVID-19, and may be more reluctant to visit psychiatry outpatient clinics. Delivery strategies for mental healthcare services, such as telepsychiatry, would be helpful to enhance continuity of care during the pandemic.

[Effect of Gaseous Pollutant Concentration on the Number of Daily Outpatient Visits for Acne in Lanzhou].

Objective To determine the relationship between air pollutants [SO2,NO2,8 hours average concentration of ozone(O38h)] and outpatient visits for acne in Lanzhou,China. Methods Data of daily outpatient visits for acne and concentrations of air pollutants(SO2,NO2,and O38h)from January 2013 to December 2017 were collected.With the control of long-term trend and day-of-week effect,a distributed lag nonlinear model was used to analyze the lag and cumulative effects of air pollutants on the outpatient visits.The model was established based on the different groups of gender and age. Results During the study period,the average daily outpatient visits were 34.94±15.27,and the average concentrations of SO2,NO2,and O38h were 24.09,43.77,and 82.94 μg/m3,respectively.The Spearman's correlation analysis showed that the daily outpatient visits for acne were positively correlated with NO2 concentration while negatively correlated with O38h concentration;SO2 concentration was negatively correlated with O38h concentration;NO2 concentration was positively correlated with SO2 and O38h concentrations.A 10 μg/m3 increase in daily concentrations of NO2 and SO2 was respectively associated with 2.61%(95% CI=0.98%-4.27%)and 1.71%(95% CI=0.54%-2.89%)increase in the outpatient visits for acne.A 10 μg/m3 increase in O38h concentration was associated with -0.62%(95% CI=-1.12%--0.11%)increase in the outpatient visits.Multipollutant models indicated that air pollutant concentrations were significantly associated with the daily outpatient visits for acne. Conclusions SO2 and NO2 are positively associated with daily dermatological department visits for acne in Lanzhou,while O38h concentration has a negative correlation with the visits.The sensitivity of acne daily outpatient visits to changes in SO2,NO2,and O38h varies among patients of different genders and at different ages.

Effects of meteorological factors on daily outpatient visits for skin diseases: a time series study in a Chinese population

To the Editor: There is limited evidence as to the association between outpatient visits in dermatology and meteorological factors. A previous study has focused on the effects of meteorological factors on a certain disease, and seemed to lack systematic analysis for a class of diseases.[1] Here, we investigated the short-term effects of meteorological factors on the number of daily outpatient visits for skin diseases. Data on daily outpatient visits (emergency department visits were excluded) for skin conditions between January 1st, 2014 and December 31st, 2016 (1096 days) were collected from the Affiliated Hospital of Guizhou Medical University, located in the downtown area of Guiyang. The identity card (ID), visit date, age, sex, contact number, residential address, and diagnosis (with its International Classification of Disease code 10) of each patient were included in the collected data, which only focused on patients living in the areas of Guiyang. Patients who repeatedly visited the hospital on the same day were excluded according to patient ID. This study was approved by the Ethics Committee of the Affiliated Hospital of Guizhou Medical University. The clinical information, records, and data involved in this study were analyzed anonymously without intervention. The need for informed consent was waived. Meteorological data on the daily mean temperature (T, °C), mean atmospheric pressure (P, hPa), relative humidity (RH, %), mean wind speed (W, m/s), and total hours of sunshine (ST, h) in 24 h during the study period were collected from the Guiyang Meteorological Information Center. The average concentrations of six air pollutants, including particulate matter with an aerodynamic diameter less than 2.5 microns and an aerodynamic diameter less than 10 microns, sulfur dioxide, nitrogen dioxide, carbon monoxide in 24 h, and ozone in 8 h during the period of this study were obtained from the Guiyang Environment Monitoring Center. To estimate the impacts of the main meteorological factors on daily outpatient visits, we choose generalized additive models to calculate the relative risk increase of 10 units for the main meteorological factors.[2,3] Several independent models were constructed to evaluate the associations between the main meteorological factors and daily outpatient visits to the department of dermatology. In each model, the regression spline function was used to control categorical variables including long-term time trends, seasonal patterns (Season), and the effect of holidays (Holiday) and day of the week.[2] We used the partial autocorrelation function (PACF) to select the degrees of freedom (df) of time trends based on minimization of the absolute values of the PACF. Akaike Information Criterion and a study of residuals were applied to evaluate the choice of df. All data analyses were conducted in R 3.3.3 statistical software with the “mgcv” package.[4] Supplementary Table 1, http://links.lww.com/CM9/A406 presents a detailed summary of the statistical distribution of diurnal outpatient visits, meteorological factors, and air pollutants. The mean number of daily outpatient visits in the total population was 143.0, while those of preschoolers (≤6 years), school-aged children and teenagers (7–17 years), adults (18–64 years), and the elderly (≥65 years) were 17.8, 15.6, 96.9, and 12.8, respectively, meaning that adults made up the majority of the daily outpatient visits. When classified by sex, the mean numbers of daily outpatient visits were 79.1 and 63.9 for females and males, respectively, indicating a minor difference between males and females with respect to daily outpatient visits. Additionally, all the descriptive indicators of daily outpatient visits in the warm season were higher than those in the cool season, suggesting that daily outpatient visits are more common in warm season. Given that meteorological factors are highly correlated with each other, as are air pollutants [Supplementary Table 2, http://links.lww.com/CM9/A406], we introduced them as covariates into models. In single-day lag structures, the significant effect estimates varied for T, W, and ST [Supplementary Table 3, http://links.lww.com/CM9/A406]. A significant association was found for T with the number of outpatient visits at lag 0 day. W was associated with the number of outpatient visits at lag 4, lag 5, and lag 6 days, and ST at lag 2, lag 3, and lag 4. However, no significant associations between P and RH and the number of daily outpatient visits were found in single-day lag structures. The multi-day metrics of the daily outpatient visit number showed a larger effect of meteorological factors than for single-day exposures. Generally, daily outpatient visits numbers showed similar results for its multi-day lag effects on T, W, and ST. The effects of the number of daily outpatient visits increased from lag 01 day and were the highest at lag 06 day. In Supplementary Figure 1, http://links.lww.com/CM9/A406, there were similar positive linear relationships between daily outpatient visits numbers and T, P, W, and ST, indicating that the RR of daily outpatient visits numbers increased as P, W, and ST increased during the study period, but the curve of P became flat when the pressure was high. The curve showed a negative linear relationship between T and daily outpatient visits below around 10°C, but a positive relationship above 10°C. By contrast, there was a negative linear relationship between daily outpatient visits numbers and RH. Although the effect estimates on daily outpatient visit number of T in the ≥65 years age group were slightly higher than those in the 7 to 17 years and 18 to 64 years age groups, significant effects on daily outpatient visit number of all meteorological factors except P among those aged 7 to 17 years were found. Meanwhile, W had the strongest association compared with the other age groups. Female was vulnerable to above all meteorological factors including T, P, RH, W, and ST. More pronounced associations were found between daily outpatient visit number and meteorological factors for T, W, and ST among males, with the exception of P and RH. In the season-specific analysis, significant positive relationships were observed between the number of daily outpatient visits and T, W, and ST in the warm season. By contrast, a significant negative association between the number of daily outpatient visits and T was observed in the cool season. Similarly, a significant positive association between the number of daily outpatient visits and W and ST was observed in the cool season. Only RH was significantly associated with a decrease in the number of daily outpatient visits in both the warm and cool seasons [Supplementary Table 4, http://links.lww.com/CM9/A406]. As sensitivity analysis [Supplementary Table 5, http://links.lww.com/CM9/A406] the effect on the number of daily outpatient visits of the five major meteorological factors remained statistically significant before and after adjustment for the covariates. The analyses showed that a change in covariates for weather conditions and air pollutants did not substantially affect the estimated effects on the number of daily outpatient visits, suggesting that the findings were relatively robust in this aspect. Our study showed a significant correlation between meteorological factors, especially T and W, and the number of daily outpatient visits. The association was positive between W and outpatient visits, and at the age of 7 to 17 years this effect was stronger than in the other age groups. This might be because allergic diseases account for a large proportion of patients in the department of dermatology, and allergic diseases are associated with the presence of allergens. Airborne pollen as a factor to induce allergic diseases is correlated with W. This could be one of the reasons why the W had a positive effect on the number of daily outpatient visits. The association was also positive between T and the number of outpatient visits, and in the warm season the number of daily outpatient visits increased as the T rose, whereas in the cold season an increase in temperature reduced the number of such visits. This result may be partly because the most suitable growth temperature for many human pathogens is 20 to 37°C. Above all, T and W were two independent risk factors for the number of daily outpatient visits to the department of dermatology. A new finding in our study was the positive correlation between temperature and daily outpatient visit number above a threshold temperature (about 10°C), and the negative correlation between these two variables below that threshold temperature. This is contrary to a previous study focusing on the relationships between meteorological factors and hospital outpatient visits for cardiovascular disease.[5] This also illustrated that different systems of the human body respond differently to meteorological factors; the causes of these different reactions require further exploration. Our study has some limitations because the health data were from existing administrative databases for outpatients, medication use, personal habits, such as smoking, and comorbidities could not be considered. Another limitation of our study was that we did not include daily rainfall in the weather variables, due to limited data access and availability, and this could have affected our final result. In conclusion, statistically significant evidence that meteorological factors have a non-negligible impact on the health of the general population was provided by our study, and further research with consistent methodology is needed to clarify the magnitude of these effects and the influence on each specific skin disease. Acknowledgements Thanks to all the subjects of our study. The authors also would like to thank Prof. Yin-Sheng Wan from the Department of Biology, Providence College, USA, for his insightful methodological advice and wisdom throughout the study. Funding This study was supported by grants from the National Natural Science Foundation of China (Nos. 81673069, 81972920). Conflicts of interest None.

Particulate matter pollution and risk of outpatient visits for psychological diseases in Nanjing, China

Exposure to air pollution has been associated with increased risk for a range of adverse mental health conditions. Less is known about whether air pollution is also associated with increases in the utilization of mental health services, especially outpatient mental health service utilization. This study aimed to examine the association between the number of daily outpatient visits at the psychological disease departments of two major hospitals (PSYC) and daily average concentrations of PM2.5 and PM10 in a heavily polluted city in China, Nanjing, from 2013/7/1 to 2019/2/28, using generalized additive models with a quasi-Poisson regression. Results showed that each 10 μg/m3 increase in PM2.5 concentration on lag0 day was associated with a 0.40% increase (95% CI: 0.07-0.72) in PSYC visits, and each 10 μg/m3 increase in PM10 concentration on the same day a 0.31% increase (95% CI: 0.09-0.54) in PSYC visits. Exposure-response curves suggested linear relationships between PM concentration and daily PSYC outpatient visits, without evidence of a threshold. Associations remained positive, but were non-significant, with adjustment for co-pollutants, SO2, NO2 and CO. Significantly larger effects were found for older and male participants, vs. their counterparts. These findings add to the growing literature linking air pollution to mental health service utilization, demonstrating the critical need for both air pollution mitigation measures and increased capacity of the mental health system in China.

Short-term effects of air pollution on cause-specific mental disorders in three subtropical Chinese cities

BackgroundThe effects of ambient air pollution on specific mental disorders are rarely studied, and the reported results are inconsistent. ObjectiveTo assess the short-term effect of ambient air pollution on the morbidity of mental disorders in three subtropical Chinese cities. MethodsDaily concentrations of air pollution were averaged from 19 fixed monitoring stations across each city, and data on patients were collected from three psychiatric specialty hospitals. A time-series study combined with a generalized additive Poisson model was conducted to investigate the association between air pollution and mental disorders. The exposure-response relationships were explored and stratified analyses by age and sex were conducted. ResultsA total of 1,133,220 outpatient visits were recorded in three subtropical cities (Huizhou, Shenzhen, and Zhaoqing). The number of daily outpatient visits for mental disorders increased with higher air pollutant (PM2.5, PM10, SO2 and NO2) concentrations, and the effect of NO2 appeared to be consistently significant across the three cities, with excess risk (ER) of 4.45% (95% CI: 2.90%, 6.04%) in Huizhou, 7.94% (95% CI: 6.28%, 9.62%) in Shenzhen, and 2.19% (95% CI: 0.51%, 3.89%) in Zhaoqing, respectively, at lag03. We also observed significant effect of PM2.5 at lag0 (ER = 1.20%, 95% CI: 0.28%, 2.13%), PM10 at lag0 (ER = 0.99%, 95% CI: 0.36%, 1.62%), and SO2 at lag0 (ER = 10.74%, 95% CI: 3.20%, 18.84%) in Shenzhen. For specific mental disorders, significant associations were found in all the air pollutants except between SO2 and affective disorder and between PM2.5 and schizophrenia. In addition, we found that air pollution exhibited stronger effects for males and adults (≥18 years). ConclusionAcute exposure to air pollution, especially NO2, might be an important trigger of mental disorders.

Effects of climate and air pollution factors on outpatient visits for eczema: a time series analysis.

Eczema resulting from external and internal factors accounts for the biggest global burden of disability owing to skin disease. This study aimed to determine an association between environmental factors and outpatient clinic visits for eczema. We collected data on dermatology clinic outpatient visits for eczema between January 2013 and July 2019. Data concerning environmental factors during this period were collated using national air quality network and air monitoring measurement parameters, namely barometric pressure, relative humidity, air temperature, and air pollutant concentrations, such as sulfur dioxide (SO2) and particulate matter (PM10). A distributed lag nonlinear model was used to investigate the relationship among eczema, environmental factors, and lagged effects. In total, 27,549 outpatient visits for eczema were recorded. In both single-factor and multiple-factor lag models, the effects of a 10-µg/m3 increase in PM10 and SO2 values had significantly positive effects on the number of daily outpatient visits over a total 5days of lag after adjusting for temperature, the number of daily outpatient visits increased with 0.87%, 7.65% and 0.69%, 5.34%, respectively. Relative humidity (RR = 1.3870, 95% CI 1.3117-1.4665) and pressure (RR = 1.0394, 95% CI 1.0071-1.0727) had significantly positive effects on the number of daily outpatients in single-factor lag models. However temperature had a significantly negative effect on them in the number of daily outpatients (RR = 0.9686, 95% CI 0.9556-0.9819). Exposure to air pollution exacerbated eczema. Outpatient visits for eczema were found to have strong positive associations with changes in PM10 levels.

The acute effects of ultraviolet radiation exposure on solar dermatitis in Shanghai, China.

Ultraviolet radiation (UVR) has long been considered associated with solar dermatitis, but the associations have not been well quantified. To depict the full-range exposure-response association between daily UVR exposures and daily outpatient visits of solar dermatitis. We collected the daily number of outpatient visits of solar dermatitis and monitored hourly ground data of UVR (the sum of A- and B-band) from 1 January 2013 to 31 December 2017 in Shanghai, China. The data were analyzed using the time-series approach, in which overdispersed generalized additive model was used and time trends and weather conditions were controlled for. During the study period, we recorded a total of 15,051 outpatient visits of solar dermatitis. There was a consistently increasing risk of solar dermatitis associated with stronger UVR without a discernible threshold. The effects occurred on the present day, increased to the largest at lag 1 or 2days, and attenuated to the null at lag 5days or more. A unit (w/m2) increase in daily maximum-hour UVR was associated with 1.70% (95%CI: 1.19%, 2.20%) increase of outpatient visits of solar dermatitis. Stronger effects occurred among the young people, females, and in the warm season. The risks of solar dermatitis due to UVR exposure would be overestimated if ambient temperature was not adjusted. This study provides quantitative epidemiological estimates for the positive associations between short-term exposure to UVR and increased risks of solar dermatitis. The associations were more prominent among young people, females, and in warm seasons.

Effects of daily average temperature on the daily number of outpatient visits for eczema in two third-grade class-A hospitals in Lanzhou city

Objective To evaluate effects of the daily average temperature on the daily number of outpatient visits for eczema in Lanzhou city. Methods Clinical data were obtained from outpatients with eczema in the Department of Dermatology of 2 third-grade class-A hospitals in Lanzhou city from January 1st 2007 to December 31st 2015, and meteorological data during this period were also collected. Controlling for confounding factors like long-term trends and day of the week, a distributed lag non-linear model (DLNM) fitted with quasi-Poisson link function was used to assess the effects of daily average temperature on the daily number of outpatient visits for eczema, and the analysis was stratified by season, age and gender. Results The exposure-response relationship between the daily average temperature and daily number of outpatient visits for eczema could be roughly described by aW-shaped curve. Stratification analysis showed that the effect of the daily average temperature on outpatient visits for eczema was strongest in autumn and winter, followed by summer, and weakest in spring. Low temperature may have lagged, cumulative and persistent effects on the daily number of outpatient visits for eczema, with the maximum relative risk (RR) value (1.12[95% CI: 1.03-1.22]) observed at-9 ℃ on lag day 14. With a 1 ℃ decrease in the temperature, 16% (RR= 1.16, 95% CI: 1.00-1.03) , 14% (RR= 1.14, 95% CI: 1.02-1.26) and 13% (RR= 1.13, 95% CI: 1.02-1.25) increases in the daily number of outpatient visits for eczema were observed in men, teenagers and middle-aged adults respectively (P 0.05) . The effect of high temperature usually occurred following exposure without lag periods, and was gradually weakened over lag time (P > 0.05) . Conclusions In Lanzhou, the effect of daily average temperature on outpatient visits for eczema was strongest in autumn and winter. Changes of the daily temperature may be one of risk factors for eczema. Low temperature had lagged effects on the daily number of outpatient visits for eczema, and the effects were strongest on lag day 14. Key words: Temperature; Eczema; Seasons; Distributed lag non-linear models; Daily mean temperature

Association between PM2.5 concentrations and the daily number of outpatient visits for urticaria in Beijing city

Objective To investigate the association between concentrations of environmental air pollutants and the daily number of outpatient visits for urticaria in Beijing. Methods Time series analysis in combination with distributed lag non-linear model (DLNM) and Spearman's rank correlation test was used to analyze the association between PM2.5 concentrations and the daily number of outpatient visits for urticaria. All effect estimates were expressed as a risk ratio (RR) for the daily number of outpatient visits with an interquartile range (IQR) increase of 82.8 μg/m3 in PM2.5. Results From January 1st 2013 to June 30th 2014, the daily average PM2.5 concentration, temperature, relative humidity and number of visits for urticaria were 89.3 μg/m3, 12.7 ℃, 51.9% and 27.3 respectively. Spearman's rank correlation test showed that the daily average PM2.5 concentration and number of visits for urticaria were correlated with daily mean temperature (rs =-0.21, 0.36, respectively, P 0.05). There was no significant correlation between daily number of outpatient visits for urticaria and daily PM2.5 concentration lagged by 0-14 days (RR = 1, 95% CI: 0.89, 1.13). After potential confounding factors were adjusted, an 82.8 μg/m3 increase in daily PM2.5 concentration at lag 0-20 days was significantly associated with a 22% (95% CI: 3%, 46%) increase in daily number of outpatient visits for urticaria, suggesting that the lagged effect of PM2.5 was obviously increased. Conclusion The association between PM2.5 concentrations and the number of visits for urticaria is easily affected by meteorological factors and biological confounding factors, and relative humidity and mean temperature are both positively correlated with the number of visits for urticaria. Key words: Urticaria; Air pollutants; Environmental pollution; Humidity; Statistics; PM2.5

The effect of particulate matter size on cardiovascular health in Taipei Basin, Taiwan

BackgroundAlthough the overall effect of particulate matter (PM) on cardiovascular disease (CVD) has been previously documented, the effect of different PM sizes (PM10, PM2.5-10 and PM2.5) has not been well studied. This study estimates the effect of different PM sizes on the incidence of CVD in Taipei, Taiwan. MethodsWe collected outpatients with CVD from 2006 to 2010 and data on the concentrations of air pollutants such as PM10, PM2.5-10, PM2.5, sulfur dioxide, carbon monoxide, nitrogen dioxide, and ozone. A Distributed Lag Non-linear Model (DLNM) was used to explore the effect of different PM sizes on CVD risk. ResultsIn high air pollution events, PM2.5 was significantly associated with elevated risk (4.9%) [95% confidence interval (CI): 1.010–1.089] for CVD with increasing interquartile range (IQR) in single air pollutant model. PM2.5-10 and PM10 did not show a significant positive association with CVD in this study. After adjusting for other air pollutants such as SO2, CO, NO2, and O3, the estimated effect of PM2.5 only decreased 0.2%. Moreover, patients under 40 years old did not show a significant association between PM2.5 and CVD. ConclusionThis study demonstrates that only PM2.5 is significantly positively correlated with the number of daily outpatient visits for CVD during high air pollution events.

Lag effect of daily average temperature on the occurrence of urticaria in Lanzhou city

Objective To evaluate effects of daily average temperature on the occurrence of urticaria in Lanzhou city, and to analyze differences in the effects between different populations. Methods Time-series data on daily outpatient visits for urticaria between January 1, 2007 and December 31, 2013 were collected from the First Hospital of Lanzhou University and Lanzhou University Second Hospital. Daily meteorological data during this peroid were obtained from the Gansu Meteorological Bureau. Distributed lag non-linear models were used to analyze the association between daily average temperature and occurrence of urticaria, and the analysis was stratified by age and gender. Results The association between daily average temperature and daily number of outpatient visits for urticaria was nonlinear. Low temperature had significant lag effects on the daily number of outpatient visits for urticaria, with the maximum relative risk(RR)value(1.014[95% CI 1.000-1.023])observed at 6 ℃ on lag day 18. Stratification analysis demonstrated that the effects of high temperature on the number of outpatient visits for urticaria were apparent on the day of exposure in age groups of 0-18 and 19-64 years, but decreased on the day of exposure in the age group ≥ 65 years. The effects of low temperature, which showed similar trends along with the increment of lag days in all groups, were relatively delayed and occurred 2 to 4 days after exposure. Conclusions Air temperature affects the occurrence of urticaria in Lanzhou city. Low temperature has evident lag effects on the occurrence of urticaria, while high temperature does not have. Key words: Urticaria; Medical meteorology; Time; Nonlinear dynamics; Hypothermia

Association between Daily Hospital Outpatient Visits for Accidents and Daily Ambient Air Temperatures in an Industrial City.

An accident is an unwanted hazard to a person. However, accidents occur. In this work, we search for correlations between daily accident rates and environmental factors. To study daily hospital outpatients who were admitted for accidents during a 5-year period, 2007–2011, we analyzed data regarding 168,366 outpatients using univariate regression models; we also used multivariable regression models to account for confounding factors. Our analysis indicates that the number of male outpatients admitted for accidents was approximately 1.31 to 1.47 times the number of female outpatients (P < 0.0001). Of the 12 parameters (regarding air pollution and meteorology) considered, only daily temperature exhibited consistent and significant correlations with the daily number of hospital outpatient visits for accidents throughout the 5-year analysis period. The univariate regression models indicate that older people (greater than 66 years old) had the fewest accidents per 1-degree increase in temperature, followed by young people (0–15 years old). Middle-aged people (16–65 years old) were the group of outpatients that were more prone to accidents, with an increase in accident rates of 0.8–1.2 accidents per degree increase in temperature. The multivariable regression models also reveal that the temperature variation was the dominant factor in determining the daily number of outpatient visits for accidents. Our further multivariable model analysis of temperature with respect to air pollution variables show that, through the increases in emissions and concentrations of CO, photochemical O3 production and NO2 loss in the ambient air, increases in vehicular emissions are associated with increases in temperatures. As such, increases in hospital visits for accidents are related to vehicular emissions and usage. This finding is consistent with clinical experience which shows about 60% to 80% of accidents are related to traffic, followed by accidents occurred in work place.

Association between air pollution and the number of outpatient visits for dermatitis in a hospital in Beijing city

Objective To investigate the association between air pollution and the daily number of outpatient visits for dermatitis in Beijing city, and to evaluate the sensitivity to air pollution in populations of different gender and age. Methods Time-series data on daily outpatient visits for dermatitis between April 2012 and April 2014 were collected from Air Force General Hospital of PLA. The daily average concentrations of sulfur dioxide (SO2) , nitrogen dioxide (NO2) , and particulate matters (PM2.5, PM10) were obtained from Beijing Municipal Environmental Monitoring Center, and routine meteorological data (including daily mean temperature, relative humidity and wind speed) were collected from the China Meteorological Data Sharing Service System. A generalized additive model was used to analyze the association between daily average concentrations of air pollutants and the number of daily outpatient visits for dermatitis. Results In single-pollutant models, an increase of 10 μg/m3 in daily concentrations of PM2.5, PM10, SO2, and NO2 was associated with the number of outpatient visits for dermatitis with the relative risk being 1.003 1 (95% CI, 1.001 6-1.004 5) , 1.0025 (95% CI, 1.001 4-1.003 7) , 1.0057 (95% CI, 1.001 5-1.009 9) and 1.009 7 (95% CI, 1.005 6-1.013 8) respectively. Similarly, multipollutant models showed that air pollutant concentrations were significantly associated with the daily number of outpatient visits for dermatitis. Distributed lag models showed that the effects of PM2.5, PM10 and NO2 on daily outpatient visits for dermatitis were mainly observed on the day of exposure, while the effect of SO2 increased along with the increment of lag days. Stratification analysis showed that people aged less than 60 years and females were relatively more sensitive to particulate matters (PM2.5, PM10) , while NO2 affected all groups of people at the same degree, and SO2 mainly affected people aged 35-60 years. Conclusion Air pollutants PM2.5, PM10, SO2 and NO2 may all increase the risk of dermatitis in Beijing area. Key words: Dermatitis; Air pollutants; Particulate matter; Sulfur dioxide; Nitrogen dioxide; Generalized additive model

Study On The Risk Of Air Pollutants For The Adult Outpatient And Emergency Room Visits During Haze Episode In Beijing

Objective: To descript the quantitative relationship between air pollution and outpatient or emergency room visits in Beijing at early 2013.Methods: Daily number of outpatient visits and emergency ...

Airborne particulate matter (PM2.5) and the prevalence of allergic conjunctivitis in Japan

ObjectiveExposure to particulate matter less than 2.5μm in diameter (PM2.5) is associated with asthma and respiratory symptoms, but little is known about the influence of PM2.5 on allergic conjunctivitis. The purpose of this study was to examine the association of PM2.5 with outpatient attendance for allergic conjunctivitis. MethodsWe conducted a time-series analysis of the association between outpatient attendance for allergic conjunctivitis and PM2.5 levels from May to July (non-pollen season) and from August to October (the autumnal pollen season) in 2012. Air pollution data (including the levels of PM2.5, oxidants, nitric oxide, nitrogen dioxide, nitrogen oxide, carbon monoxide, methane, non-methane hydrocarbons, and total hydrocarbons) and data on the daily weather conditions (temperature, wind speed, and humidity) were collected at a centrally located monitoring station in Tokyo. We calculated weekly average values for the daily number of outpatient visits, as well as the air pollution and weather data, and used the weekly average values for analysis. ResultsThere was a significant association between the number of outpatient visits for allergic conjunctivitis and the PM2.5 level (r=0.62, p=0.0177) from May to July, while no correlation was found between the number of outpatient visits and any variable assessed from August to November. Multivariate analysis also showed that PM2.5 was a significant predictor of the number of outpatient visits from May to July (odds ratio=9.05, p=0.0463), while there were no significant predictors of the number of outpatient visits from August to October. From May to July, PM2.5 showed a negative correlation with humidity (r=−0.53, p=0.0499). ConclusionsThese findings suggest a possible role of PM2.5 in the development of allergic conjunctivitis during the non-pollen season. This association between PM2.5 and allergic conjunctivitis may have broad public health implications in relation to allergic diseases.

A Study on Factors affecting Productivity of Outpatient Pharmacy of a Corporate Hospital

A brief study was carried out in outpatient pharmacy of a tertiary care corporate hospital, to evaluate its productivity, especially in relation to prescriptions being dispensed and its impact on revenue Relevant data has been collected from the outpatient departments, pharmacy records and personal interviews with concerned staff and from patient feedback. Number of prescriptions generated vis-a-vis number of daily outpatient visits, those reaching the pharmacy and out of which the number which could be dispensed and the reasons for bouncing of the prescriptions was analyzed .Patient feedback was also obtained through a limited survey on reasons for their not collecting prescribed medicines from the hospital's outpatient pharmacy . Based on the study findings, certain recommendations have been made, for enhancing the productivity of the pharmacy.