Time-series Poisson Regression Model Research Articles

Psychological distress among individuals with a suicide attempt or suicidal ideation and suicide attempts patterns: first two years of the pandemic.

The COVID-19 pandemic and related restrictions may have led to increased stress, particularly in people with mental health problems. Since stress factors play important role in the emergence of suicide attempts (SA) and suicidal ideation (SI), they may have been exacerbated by the pandemic, which could have led to an increased number of suicide attempts. Thus, we first investigated whether the pandemic affected personal stress experiences and appraisal of coping potential in individuals with and without SA and SI. In a second step, we analyzed the frequency and dynamics of SAs by patients admitted to a psychiatric university clinic over a period of four years. We examined stress experiences and appraisal of coping resources of inpatients recruited between March 2021 and February 2022 with SA (n=38), SI (n=27), and with mood disorder without SA or SI (n=45). In the second study, we investigated the time course of prospectively recorded patients with a suicide attempt (n=399) between January 1st 2018 and December 31st 2021 using interrupted time-series Poisson regression models. There was a significant main effect of group (F[2,107]=6.58, p=0.002) regarding psychological stress levels, which was significantly higher in the SA and SI groups than in the psychiatric control group. No significant differences were found in the appraisal of coping resources or in the frequency of SAs before and during pandemic. However, the pandemic had a significant impact on the seasonal pattern of SAs. The pandemic increased psychological stress levels in individuals with SA and SI, which may be related to SI and do not necessarily result in SA. The pandemic did not affect the overall frequency of SA between March 2020 and December 2021, but interfered with the seasonal pattern of SA occurrence. Effective intervention strategies during a pandemic should include programs to strengthen the psychological resilience of people who are susceptible to mental health problems.

Impact of COVID-19 pandemic on marriage, divorce, birth, and death in Kerman province, the ninth most populous province of Iran

This study examined the impact of the COVID-19 pandemic on marriage, divorce, birth, and death rates using the Poisson regression model and an interrupted time-series Poisson regression model. Before the pandemic, marriage and birth rates were decreasing, while divorce and death rates were increasing, with only the trend in birth rates being statistically significant. The immediate effect of the pandemic was a significant decrease in the divorce rate, but there were non-significant effects on birth and marriage rates. However, in the months following the onset of the pandemic, there was a statistically significant sustained effect on increasing death and divorce rates. Forecasts based on pre-pandemic data showed that by the end of 2020, marriage, divorce, death, and birth rates were higher compared to pre-pandemic levels. In conclusion, the pandemic has greatly impacted society, particularly in terms of death and divorce rates. Birth rates were not immediately affected to the time lag between decisions and actual births. Fear of COVID-19 may have increased death rates as people avoided seeking medical help. Vaccination and effective treatment strategies are vital in reducing the pandemic's impact on mortality. Supporting families financially is important due to the role of economic issues in couples’ decisions.

Association between airborne particulate matter（PM 2.5） concentration and the incidence of allergic rhinitis in Shanghai

Objective:To explore the impact of PM 2.5 concentration in Shanghai on the incidence of allergic rhinitis（AR） in the population, and provide strategies for early warning and prevention of AR. Methods:Collect daily average concentrations of atmospheric pollutants monitored in Shanghai from January 1, 2017 to December 31, 2019, and clinical data of AR patients from five hospitals in Shanghai during the same period. We used a time-series analysis additive Poisson regression model to analyze the correlation between PM 2.5 levels and outpatient attendance for AR patients. Results:During the study period, a total of 56 500 AR patients were included, and the daily average concentration of PM 2.5 was（35.28±23.07）μg/m³. There is a correlation between the concentration of PM 2.5 and the number of outpatient attendance for AR cases. There is a positive correlation between the daily average number of outpatient for AR and levels of PM 2.5 air pollution（（P<0.05）） . We found that every 10 μg/m³ increase in PM 2.5, the impact of on the number of AR visits was statistically significant on the same day, the first day behind, and the second day behind, with the strongest impact being the exposure on the same day. Every 10 μg/m³ increases in PM 2.5, the number of outpatient visits increased by 0.526% on the same day（95%CI 1.000 50-1.010 04）. Conclusion:The atmospheric PM 2.5 concentration in Shanghai is positively correlated with the number of outpatient for AR, and PM 2.5 exposure is an independent factor in the onset of AR. This provides an important theoretical basis for AR.

Immediate and Ongoing Impact of COVID-19 on Chlamydia Treatment in Australia.

The COVID-19 pandemic has impacted the sexual health and well-being of individuals, directly through risk of contracting COVID-19, and indirectly through government lockdowns. Government restrictions were especially strict and long-lasting in Australia, they also varied by state, offering an interesting opportunity to study the impacts of varying restrictions. This study compares the impact of the COVID-19 pandemic and resulting restrictions on chlamydia treatment prescriptions during 2020, through to July 2021 between different states and demographic groups in Australia. The rate of prescriptions per 100,000 population filled each month from January 2017 to July 2021 from Australia's Pharmaceutical Benefits Scheme for Azithromycin with a restricted indication to treat Chlamydia trachomatis was used to measure chlamydia treatment. The impact of COVID-19 lockdowns was modeled using an interrupted time-series Poisson regression model. The data included 520,025 prescriptions to treat chlamydia, averaging 37.5 prescriptions per month per 100,000 population. Prescriptions declined 26% in April to May 2020 when initial COVID-19 lockdowns began in Australia; prescriptions increased in the following months but remained on average 21% below prepandemic (2017-2019) levels through to July 2021. Prescriptions declined the most in 1 Australian state, Victoria, both in the initial lockdown and the following period; generally, states with more COVID-19 cases saw bigger reductions in prescriptions. This is the first study to examine how treatment for chlamydia in Australia was impacted by the COVID-19 pandemic and restrictions not only in the immediate-term, but also ongoing up to July 2021, providing important information for planning for sexual health services in future pandemics.

Effects of the COVID-19 pandemic on suicide attempts in a rural region in Germany, a 5-year observational study

BackgroundThe COVID-19 pandemic and public life restrictions may have a negative impact on people's mental health. Therefore, we analyzed whether this condition affected the occurrence of suicide attempts (SA) over 20 months during the pandemic period. MethodsWe included patient records according to DSM-5 criteria for suicidal behavior disorders (n = 825) between Jan 1, 2017, and Dec 31, 2021. We applied interrupted time-series Poisson regression models to investigate the effect of the pandemic on SA occurrence, time trends, and seasonal patterns in the whole group of patients as well as stratified by age and gender. ResultsThere was no significant effect of the pandemic on the occurrence of SA in the overall group. However, we observed a significant impact of the pandemic on the seasonal pattern of SA, also the variance differed significantly (pre-pandemic mean ± variance: 13.33 ± 15.75, pandemic: mean ± variance: 13.86 ± 7.26), indicating less periodic variation in SA during the pandemic. Male patients and young adults mainly contributed to this overall effect. Subgroup analysis revealed a significant difference in SA trends during the pandemic in older adults (>55 years) compared with younger adults (18–35 years); SA numbers increased in older adults and decreased in younger adults as the pandemic progressed. LimitationsA few patients may have received initial care in an emergency department after SA without being referred to psychiatry. ConclusionsIn general, the COVID-19 pandemic and related measures did not significantly affect the occurrence of SA but did significantly affect the dynamics. In addition, the pandemic appeared to affect suicidal behavior differently across age groups as it progressed. Particularly for the older adult group, negative long-term effects of the pandemic on suicidal behavior can be derived from the present results, indicating the need to strengthen suicide prevention for the elderly.

Association between sequential extreme precipitation-heatwaves events and hospitalizations for schizophrenia: The damage amplification effects of sequential extremes

ObjectivesIn the context of frequent global extreme weather events, there are few studies on the effects of sequential extreme precipitation (EP) and heatwaves (HW) events on schizophrenia. We aimed to quantify the effects of the events on hospitalizations for schizophrenia and compare them with EP and HW alone to explore the amplification effect of successive extremes on health loss. MethodsA time-series Poisson regression model combined with a distributed lag non-linear model was applied to estimate the association between sequential EP and HW events (EP-HW) and schizophrenia hospitalizations. The effects of EP-HW with different intervals and intensities on the admission of schizophrenia were compared. In addition, we calculated the mean attributable fraction (AF) and attributable numbers (AN) per exposure of extreme events to reflect the amplification effect of sequential extreme events on health hazards compared with individual extreme events. ResultsEP-HW increased the risk of hospitalization for schizophrenia, with significant effects lasting from lag0 (RR and 95% CI: 1.150 (1.041–1.271)) to lag11 (1.046 (1.000–1.094)). Significant associations were found in the subgroups of male, female, married people, and those aged≥ 40 years old. Shorter-interval (0–3days) or higher-intensity EP-HW (both precipitation ≥ P97.5 and mean temperature ≥ P97.5) had a longer lag effect compared to EP-HW with longer intervals or lower intensity. We found that the mean AF and AN caused by each exposure to EP-HW (AF: 0.074% (0.015%–0.123%); AN: 4.284 (0.862–7.118)) were higher than those induced by each exposure to HW occurring alone (AF:0.032% (0.004%–0.058%); AN:1.845 (0.220–3.329)). ConclusionsSequential extreme precipitation-heatwaves events significantly increase the risk of hospitalizations for schizophrenia, with greater impact and disease burden than independently occurring extremes. The impact of consecutive extremes is supposed to be considered in local sector early warning systems for comprehensive public health decision-making.

Impact of the naloxone standing order on trends in opioid fatal overdose: an ecological analysis

ABSTRACT Background: Maryland expanded its “Statewide Naloxone Standing Order” (NSO) in 2017 to eliminate training and prescription requirements for obtaining naloxone, improve naloxone access, help reverse opioid overdose, and reduce overdose fatality rates. Objectives: To assess the change in the trends of fatal opioid overdose rates following the expansion of the Naloxone Standing Order (eNSO) and its association with the social determinants of health (SDoH). Methods: Data on overdose deaths and SDoH from 2015–2019 was collected and analyzed using interrupted time series and multivariate Poisson regression models to study the change in trends and the associations. Results: There was a significant decrease in the rate of fatal overdoses after the intervention: prescription opioid estimate number of deaths declined by .25 per 100,000 (p = .02), heroin estimate number of deaths declined by 1.83 per 100,000 (p < .001), fentanyl estimate number of deaths declined by 2.54 per 100,000 (p < .001). After controlling for eNOS implementation in Maryland, state-level estimates with high proportions of female residents and those with bachelor’s degree or higher were associated with reduction in overdose, while state-level estimates with high proportions of African Americans and higher employment rates were associated with an increase in overdose. Conclusions: Our analysis shows that the expanded naloxone standing order is associated with reducing opioid-related overdose death rates. Even though we observed a significant reduction in overdose death rate in fentanyl-related deaths, the rate of deaths post-eNSO was still increasing, suggesting the need for additional measures to impact the rates of fentanyl.

Acute bronchiolitis and respiratory syncytial virus seasonal transmission during the COVID-19 pandemic in Spain: A national perspective from the pediatric Spanish Society (AEP).

Introduction and ObjectivesThe COVID-19 pandemic and the widespread associated use of non-pharmaceutical interventions have impacted viral circulation and the incidence of respiratory tract infections. We compared Pediatric Emergency Department visits, bronchiolitis admissions, and respiratory syncytial virus (RSV) cases in 2020 with those documented for the preceding four years.MethodsThis was a retrospective multicentric national survey study, driven by the Pediatric Spanish Society, and gathering monthly data from Spanish hospitals between 1st January 2016 and 31st December 2020. An Interrupted Time Series Analysis and Poisson regression models were performed for each index.ResultsThirty-eight hospitals representing most of the different regions of Spain participated. Compared to the preceding four years, in 2020, Pediatric emergency department visits significantly decreased immediately after initiation of the national lockdown. The median number of visits averted per month was 39,754 (IQR 26,539–50,065). RSV diagnoses during the 2020 winter season nearly disappeared with only 21 cases being documented among participating hospitals. The expected seasonal peak of bronchiolitis hospitalizations never occurred. The median number of admissions in 2020 averted per month was 100 (IQR 37–185) compared to 2016–2019. Only 3 hospitalized cases were RSV-confirmed. Reopening of schools and kindergarten was not associated with a remarkable increase in RSV cases or bronchiolitis hospitalizations.ConclusionA dramatic reduction of bronchiolitis admissions and near disappearance of RSV cases was observed in Spanish hospitals coinciding with the peak of the COVID-19 pandemic.

Effects of Russian tobacco control law on rates of hospital admissions for acute coronary events

Abstract Background The Russian tobacco control law (TCL), implemented nationwide, aims to reduce smoking-related morbidity and mortality. However, its effects may vary among Russian regions. We aimed to assess the effects of TCL on rates of hospital admissions (HA) for angina pectoris (AP) and myocardial infarction (MI) in the Russian Federation (RF) and 10 Russian regions in relation to enforcement of the TCL. Methods We analysed HA rates for AP and MI to compare the periods before and after TCL in 2013, adjusting for possible confounders and long-term trends. Models were based on time-series of annual HA in the RF and 10 Russian regions during the years 2005-2019. We used interrupted time-series design and Poisson regression model with calculation of risk ratio (RR) and 95%CI. Regions were compared by means of TCL implementation scale (TCIS), developed based on the results of Russian TC policy evaluation survey in 10 Russian regions (n = 11625). We analysed the relationship between the TCL measures implementation scores and RR of reduction of HA for AP and MI after the TCL by means of Spearman's rank correlation and linear regression models. Results Results showed a 16.6% decrease in HA rates for AP (RR 0.83 95% CI 0.74-0.93) and 3.5% - for MI (RR 0.96 95% CI 0.96-0.97) after the TCL introduction in RF and effects of various magnitude in the regions. Regions with higher TCIS scores, i.e. better enforcement of full TCL package had greater reduction in HA rates for AP (rsp = −0.627 95%CI−1.05;−0.199; p=.004); with better enforcement of smoke-free policies - grater reduction in HA rates for MI (rsp = −0.793 95%CI−1.08;−0.506, p&amp;lt;.001). Both HA rates for AP and MI correlated with the higher scores for help to quit tobacco use (rsp = −0.56 95%CI −1.1; −0.01, p=.045), (rsp = −0.74 95%CI−1.12;−0.36, p=.027). Conclusions TCL leads to a decrease of HA for AP and MI with sustained effect. Differences in the magnitude of these effects in the regions are related to the extent of enforcement of TC measures. Key messages Tobacco control legislative measures may lead to reduction of hospital admission rates for acute coronary events. The effect of tobacco control law on hospital admission rates for acute coronary events may vary in relation with the extent of enforcement of tobacco control measures.

Effectiveness of legislative actions against tobacco smoking regarding the reduction of in-hospital morbidity of angina pectoris and myocardial infarction in Russia as a whole and 10 Russian constituent entities

Russian anti-tobacco policy is aimed at reducing long-term morbidity and mortality from smoking-related diseases.Aim. To assess the associations of tobacco control (TC) legislative measures with hospitalization rate for myocardial infarction (MI) and angina in Russia as a whole and in 10 Russian constituent entities, as well as to compare the effectiveness of anti-smoking measures in regions.Material and methods. We analyzed data on hospitalizations of patients with angina (I20) and acute (I21) and subsequent (I22) MI, as well as chronic rheumatic heart diseases (I05-I09), for 2005-2019 in Russia as a whole and in 10 Russian constituent entities. We analyzed hospital admission rates for angina and MI to compare the periods before and after introduction of Federal TC law in 2013, adjusting for possible confounders and long-term trends. We used interrupted time-series design and Poisson regression model with calculation of rate ratio (RR) and 95% CI. Regions were compared by means of original TC law implementation scale (TCIS) developed based on the results of Russian TC policy evaluation survey in 10 Russian regions (n=11625). We analyzed the relationship between the TC law measures implementation scores and RR of hospital admissions reductions for angina and MI after the TC law by means of Spearman’s rank correlation (coefficient with 95% CI) and linear regression models. Statistical package STATA 11.2 was used.Results. The actual trend of hospital admission rates for angina after TC law introduction demonstrates the greatest slope change from the predicted trend (without the law) (p=0,004); less, but still significant slope change for MI (p=0,049), and no slope change for chronic rheumatic heart disease (p=0,332). Results showed a 16,6% decrease in hospital admission rates for angina (RR, 0,83; 95% CI, 074-0,93) and 3,5% — for MI (RR, 0,96; 95% CI, 0,96-0,97) after the TC law introduction in RF and effects of various magnitude in the regions. Regions with higher TCIS scores, i.e. better enforcement of full TC package had greater reduction in hospital admission rates for angina (rsp=-0,627; 95% CI, -1,05−-0,199; p=0,004); with better enforcement of smoke-free policies — grater reduction in hospitalization rates for MI (rsp= -0,793 95%CI, -1,08−-0,506, p&lt;0,001). Reduction of hospital admission rates for angina and MI correlated with the higher scores for help to quit tobacco use (rsp=-0,555; 95% CI, -1,098−-0,01, p=0,045), (rsp= -0,736; 95% CI, -1,12−-0,357, p=0,027). Also, hospital admission rates for angina and MI were associated with the changes in smoking cessation prevalence in 2013-2018 in the regions (β=-0,345; 95% CI, -0,67−-0,02 p=0,041) and smoking prevalence in 2019 (β=2,964; 95% CI, 1,28-5,92, p=0,049), respectively.Conclusion. TC legislation can lead not only to immediate reductions in hospital admission rates for angina and MI, but also to longer-term results. These effects may be due not only to the introduction of TC law, as such, but also to the enforcement of the law, as well as the direct results of TC measures — the decrease in smoking prevalence in the population.

Impact of Government Interventions on COVID-19 Outbreak in Different Provinces of Pakistan: Interrupted Time-Series Analysis

Introduction: From the start of COVID-19 pandemic governments have been taking many decisions to control the outbreak. The impact of these decisions and policy changes on the outbreak is required to be analyzed.Objective: This article aims to investigate the impact of interventions implemented by the Government of Pakistan on the recent outbreak of novel-coronavirus. It provides the changes in the behavior of the outbreak on the implementation of two different types of interventions.Material and Method: An interrupted time-series (ITS) Poisson regression model on the ratio of cases to tests conducted for COVID-19 to regional level data of Pakistan is implemented, after checking the over-dispersion and autocorrelation problems. Selecting the level and slope change models, the effects of interventions, and the comparison of the selected models was also made. To examine future behavior of the pandemic the new cases of COVID-19, after 30 days, 60 days, and 90 days was also predicted.Result and Discussions: The estimated changes in positive ratio due to first and second interventions were reported 21.1% and 46.7% respectively for Pakistan. The country-wide COVID-19 cases predicted assuming full lockdown show an increasing trend i.e. 18,404, 37,288, and 75,545 after 30, 60, and 90 days, respectively. Assuming the partial lockdown the COVID-19 cases in the country might again reach the spike. However, 1,428, 1,004, and 706 cases are predicted under smart lockdown after 30, 60, and 90 days, respectively.Funding Statement: None.Declaration of Interests: None.

Real-time suicide mortality data from police reports in Queensland, Australia, during the COVID-19 pandemic: an interrupted time-series analysis

BackgroundDeaths by suicide can increase during infectious disease outbreaks. This study analysed suspected suicide rates in 2020 relative to 2015–19 to assess any early effects of the COVID-19 pandemic in Queensland, Australia.MethodsWe analysed data from the interim Queensland Suicide Register (iQSR), a state-wide real-time suicide surveillance system, using an interrupted time-series design. The data source for the iQSR is the Form 1 police report of a death to a coroner. Two QSR staff independently classed the probability of a death by suicide as possible, probable, or beyond reasonable doubt. The analysis included the probable or beyond reasonable doubt categories as suspected suicides. The primary outcome was the monthly suspected suicide rate. We applied Poisson and negative binomial regressions to assess whether Queensland's Public Health Emergency Declaration on Jan 29, 2020, affected suspected suicides from Feb 1 to Aug 31, 2020. Secondary outcomes included absolute or relative changes in police-reported motives of recent unemployment, financial problems, domestic violence, and relationship breakdown.Findings3793 suspected suicides were recorded with an unadjusted monthly rate of 14·85 deaths per 100 000 people (from Jan 1, 2015, to Jan 31, 2020) before the declaration, and 443 suspected suicides were recorded with an unadjusted monthly rate of 14·07 deaths per 100 000 people (Feb 1, 2020, onwards) after the declaration. An interrupted time-series Poisson regression model unadjusted (rate ratio [RR] 0·94, 95% CI 0·82–1·06) and adjusted for overdispersion, seasonality, and pre-exposure trends (RR 1·02, 95% CI 0·83–1·25) indicated no evidence of a change in suspected suicide rates. We found no absolute or relative increases in the motives for suspected suicides, including recent unemployment, financial problems, relationship breakdown, or domestic violence from February to August, 2020, compared with the pre-exposure period.InterpretationThere does not yet appear to be an overall change in the suspected suicide rate in the 7 months since Queensland declared a public health emergency. Despite this, COVID-19 has contributed to some suspected suicides in Queensland. Ongoing community spread and increasing death rates of COVID-19, and its impact on national economies and mental health, reinforces the need for governments to maintain the monitoring and reporting of suicide mortality in real time.FundingNone.

Modeling Desert Dust Exposures in Epidemiologic Short-term Health Effects Studies.

Desert dust is assumed to have substantial adverse effects on human health. However, the epidemiologic evidence is still inconsistent, mainly because previous studies used different metrics for dust exposure and its corresponding epidemiologic analysis. We aim to provide a standardized approach to the methodology for evaluating the short-term health effects of desert dust. We reviewed the methods commonly used for dust exposure assessment, from use of a binary metric for the occurrence of desert dust advections to a continuous one for quantifying particulate matter attributable to desert dust. We presented alternative time-series Poisson regression models to evaluate the dust exposure-mortality association, from the underlying epidemiological and policy-relevant questions. A set of practical examples, using a real dataset from Rome, Italy, illustrate the different modeling approaches. We estimate substantial effects of desert dust episodes and particulate matter with diameter <10 μm (PM10) on daily mortality. The estimated effect of non-desert PM10 was 1.8% (95% confidence interval [CI] = 0.4, 3.2) for a 10 μg/m rise of PM10 at lag 0 for dust days, 0.4% (95% CI = -0.1, 0.8) for non-dust days, and 0.6% (95% CI = -0.5, 2.1) for desert PM10. The standardized modeling approach we propose could be applicable elsewhere, in and near hot spots, which could lead to more consistent evidence on the health effects of desert dust from future studies.

Durational effect of particulate matter air pollution wave on hospital admissions for schizophrenia

BackgroundShort-term exposure to high level of ambient particulate matters (PM) concentrations has been linked with increased hospital admissions (HA) for schizophrenia. However, evidence is inconclusive about the added effect of multi-day exposure to high-level PM concentration on schizophrenia. This study aims to evaluate the durational effect of PM air pollution wave on schizophrenia. MethodData on daily HA for schizophrenia, PM (PM2.5 and PM10) and meteorological variables over the period of 2014–2017 was collected in Jining, Shandong, China. Air pollution wave of PM was defined as ≥2 or ≥3 or ≥4 consecutive days with PM concentration ≥90th or ≥92.5th or ≥95th or ≥97.5th percentiles, respectively. A time-series Poisson regression model with duration as the variable of interest was used to evaluate the associations of PM air pollution wave with HA for schizophrenia. ResultsA total of 14650 hospital admissions for schizophrenia were identified. Under various air pollution wave definitions, both PM2.5 and PM10 had significant adverse effects on schizophrenia HA. PM2.5 wave defined as ≥2 consecutive days with concentration ≥90th, ≥92.5th, ≥95th and ≥97.5th percentile was associated with 4.8% (2.0%–7.6%), 4.9% (1.9%–7.9%), 5.5% (2.0%–9.2%), and 7.6% (2.9%–12.6%) increase of HA for schizophrenia at lag 6. PM2.5 waves defined as ≥3 consecutive days with concentration ≥90th, ≥92.5th, ≥95th and ≥97.5th percentile respectively corresponded to 5.0% (2.3%–7.8%), 5.1% (1.9%–8.4%), 6.9% (3.0%–10.8%) and 12.0% (5.3%–19.1%) increases in HA for schizophrenia at lag 6. The most significant associations were observed on the sixth day in different lag models. ConclusionsPM air pollution wave was associated with increased risk of hospital admissions for schizophrenia, with stronger associations among married and female patients.

The association between short-term ambient air pollution and daily outpatient visits for schizophrenia: A hospital-based study

Schizophrenia is a devastating neuropsychiatric disorder with increasing concern. Limited studies have been conducted to assess the relationship between short-term exposure to ambient air pollution and schizophrenia attacks. This study aimed to investigate the associations between short-term air pollution exposure and schizophrenia outpatient visits based on a time-series study performed in China. Daily data of schizophrenia outpatient admissions and air pollution from 1 October 2010 to 31 December 2013 were collected in Xi'an, a heavily-polluted city in China. We utilized a time-series Poisson regression model to examine the associations between short-term air pollution and schizophrenia outpatient visits with different lag days. A total of 34,865 outpatient-visits for schizophrenia were identified. A 10 μg/m3 increase of PM10, SO2, and NO2 concentrations corresponded to 0.289% (95% Cl: 0.118%, 0.460%), 1.374% (95% Cl: 0.723%, 2.025%), and 1.881% (95% Cl: 0.957%, 2.805%) elevation in outpatient-visits for schizophrenia at lag 0, and the associations appeared to be stronger, although not statistically significantly, in females and in middle and older age adults (40 and over). The most significant associations were observed on the concurrent day in different lag models. In conclusion, short-term exposure to ambient air pollution (PM10, SO2, and NO2) can be associated with increased risk of daily outpatient visits for schizophrenia, which may contribute to the further understanding of the potential adverse effects of air pollution in schizophrenia and other neuropsychiatric disorders.

Projected Temperature-Related Years of Life Lost from Stroke Caused by Climate Change

Global warming has attracted worldwide attention. Numerous studies have indicated that stroke is associated with temperature; however, few studies are available on the projections of the burden of stroke attributable to future climate change. We aimed to investigate the future trends of stroke years of life lost (YLL) associated with global warming.We collected death records to examine YLL in Tianjin, China, from 2006 to 2011. We fitted a standard time-series Poisson regression model after controlling for trends, day of the week, relative humidity, and air pollution. We estimated temperature&amp;#8211;YLL associations with a distributed lag nonlinear model. These models were then applied to the local climate projections to estimate temperature-related YLL in the 2050s and 2070s. We projected temperature-related YLL from stroke in Tianjin under 19 global-scale climate models and 3 different greenhouse gas emission scenarios.The results showed a slight decrease in YLL with percent decreases of 0.85%, 0.97%, and 1.02% in the 2050s and 0.94%, 1.02%, and 0.91% in the 2070s for the 3 scenarios, respectively. The increases in heat-related annual YLL and the decreases in cold-related YLL under the high emission scenario were the strongest. The monthly analysis showed that the most significant increase occurred in the summer months.Future changes in climate are likely to lead to an increase in heat-related YLL, and this increase will not be offset by adaptation under both medium emission and high emission scenarios. Health protections from hot weather will become increasingly necessary, and measures to reduce cold effects will also remain important.

The potential impact of the demographic shift on the incidence of salmonellosis in seniors in Canada

Background: Salmonella infections remain an important public health issue in Canada and worldwide. Although the majority of Salmonella cases are self-limiting, some will lead to severe symptoms and occasionally invasive infections, especially in vulnerable populations. Among this group, seniors (those 60 years and over) are one sub-population that is expected to change significantly in the next decade, especially considering the Canadian population is experiencing a demographic shift toward an increase in seniors. This study was performed to predict temporal trends of Salmonella cases in seniors by 2028 and assess the possible impacts of a demographic shift on the national incidence. Methods & Materials: The number of reported Salmonella cases in seniors in eight provinces and territories (90% of the Canadian population) for a period of 15 years were analysed using a time-series Poisson regression model taking into account annual seasonal oscillation. Results: Between January 1999 and December 2013, an annual average of 842 Salmonella reported cases were recorded in seniors, resulting in a mean annual incidence rate of 15.45 cases per 100,000 persons. With the demographic changes predicted in the age-structure of the population and in the absence of any targeted interventions, our analysis showed the incidence of Salmonella cases in seniors could increase by 16% by 2028, representing an increase of almost 700 cases per year. As a result, the age distribution of salmonellosis in Canada is expected to increase in seniors from 15% of all reported cases (1999 to 2013) to 26% by 2028. Conclusion: Over the following decades, cases of infection, hospitalizations and deaths associated with Salmonella in seniors could represent a challenge to public health due to an increasing aging population. As higher hospitalization and death rates have been reported for seniors, this would have an enormous impact on the health care system in terms of capacity and expenditures. The economic burden of Salmonella is substantial and hospitalizations and deaths associated with severe infections account for much of this cost. As life expectancy increases in Canada, identification of unique risk factors and targeted prevention in seniors should be pursued to reduce the impact of the demographic shift on disease incidence.

Implementation of a multifaceted program to sustainably improve appropriate intraoperative antibiotic redosing

National guidelines recommend intraoperative redosing of prophylactic antibiotics at defined intervals to reduce the risk of surgical site infections. Compliance with these guidelines is poor. A quality improvement project-including education, progress reports, and automated redosing reminders in the anesthesia electronic health record-was implemented at a large university-affiliated hospital to increase rates of intraoperative antibiotic redosing for surgeries lasting more than 4 hours. A retrospective, observational study was then conducted. The primary outcome was the compliance rate with intraoperative antibiotic redosing criteria for all surgeries lasting more than 4 hours in the pre- and post-project period. The effect of the intervention was assessed by an interrupted time-series Poisson regression model. A total of 13,695 surgical procedures were evaluated. Time-series analysis demonstrated that the project was associated with significant improvement of compliance rates (incidence rate ratio [IRR]: 1.16; P = .002) with no significant change in underlying improvement trend (IRR: 1.00; P = .22). Few peer-reviewed manuscripts describe effective methods to ensure appropriate antibiotic redosing during prolonged surgeries. We demonstrated that a multipronged approach was very effective at producing immediate and sustained improvements in guideline compliance. Implementation of a multifaceted intervention improved rates of guideline-concordant redosing of intraoperative prophylactic antibiotics.

EFFECTS OF CLIMATE VARIATIONS ON HAND-FOOT-MOUTH DISEASE IN HO CHI MINH CITY

Abnormal emergence of epidemics has been believed to be one of the most significant effects of climate change on human health, especially in the tropical zone. Hand-foot-mouth disease (HFMD) which possibly related to climatic changes has emerged in Vietnam since 2003. Ho Chi Minh City (HCMC) is particularly a Southern city with the highest cases and mortality numbers of HFMD in the whole country. Therefore, we conducted a retrospective observational study to analyse the association between climate variations and HFMD in HCMC. HFMD and meteorological data from 2010 to 2014 were collected from The Preventive Medicine Centre of HCMC and Sub-Institute of Hydrometeorology and Environment of South Vietnam. The research used time-series analysis and Poisson regression model to analyse the effects of climate fluctuations on HFMD, adjusting for seasonal and trend effects, lag effects and degrees of freedom. The research findings showed that climate variables (average temperature, average humidity, minimum humidity, precipitation, and the Southern Oscillation Index (SOI) daily data) had a significant influence on HFMD. Noticeably, the effects of climate variations on HFMD were considerable in children aged 1-3 and 3-5 years. The maximum lag effects were 3 weeks for temperature and humidity, 4 weeks for precipitation, and 6 weeks for SOI. Specifically, the relative risk of HFMD increased by 7.2 % for every 1°C increase in temperature, 6.75 % for every 1 % increase in humidity, 6.32 % for every 5 mm increase in precipitation, 4.42 % for every 5 units increase in SOI. The study provided a quantitative evidence that the increase of HFMD was significantly affected by the increase of climate variations. Therefore, the study provided the foundation for developing theory that is used in models and, ultimately, for making forecasts about future impacts of HFMD associated with climatic changes.

Projected Temperature-Related Years of Life Lost From Stroke Due To Global Warming in a Temperate Climate City, Asia: Disease Burden Caused by Future Climate Change.

Global warming has attracted worldwide attention. Numerous studies have indicated that stroke is associated with temperature; however, few studies are available on the projections of the burden of stroke attributable to future climate change. We aimed to investigate the future trends of stroke years of life lost (YLL) associated with global warming. We collected death records to examine YLL in Tianjin, China, from 2006 to 2011. We fitted a standard time-series Poisson regression model after controlling for trends, day of the week, relative humidity, and air pollution. We estimated temperature-YLL associations with a distributed lag nonlinear model. These models were then applied to the local climate projections to estimate temperature-related YLL in the 2050s and 2070s. We projected temperature-related YLL from stroke in Tianjin under 19 global-scale climate models and 3 different greenhouse gas emission scenarios. The results showed a slight decrease in YLL with percent decreases of 0.85%, 0.97%, and 1.02% in the 2050s and 0.94%, 1.02%, and 0.91% in the 2070s for the 3 scenarios, respectively. The increases in heat-related annual YLL and the decreases in cold-related YLL under the high emission scenario were the strongest. The monthly analysis showed that the most significant increase occurred in the summer months, particularly in August, with percent changes >150% in the 2050s and up to 300% in the 2070s. Future changes in climate are likely to lead to an increase in heat-related YLL, and this increase will not be offset by adaptation under both medium emission and high emission scenarios. Health protections from hot weather will become increasingly necessary, and measures to reduce cold effects will also remain important.