Exploring atmospheric environmental drivers of asthma among children in Shanghai, China: Evidence-informed policies are required

It is important to identify atmospheric environmental drivers of childhood asthma because asthma is the most common chronic disease in children globally.We provided an overview of the impacts of exposure to atmospheric environmental factors(e.g.,meteorological factors and air pollutants)on childhood asthma,based on a series of studies with the cutting-edge environmental epidemiological methodology in Shanghai,China.Overall,we found that the prevalence of asthma among the children aged 3–7 years had increased by approximately 7 fold,from 2.1%in 1990 to 14.6%in 2019.Most meteorological factors(i.e.daily mean temperature,temperature difference,air pressure,air pressure difference,precipitation,relative humidity,sunshine and wind speed)and air pollutants(PM10,PM2.5,NO2,SO2 and O3)were significantly associated with childhood asthma(p<0.05),but meteorological factors appeared to play more important roles than air pollutants in the occurrence of asthma exacerbations.We also found that temperature variability was significantly associated with the elevated relative risk of daily outpatient visits for childhood asthma(p<0.05).Furthermore,we conducted a systematic review on climate change adaptation measures and childhood asthma and found that there were a number of adaptation measures proposed for childhood asthma in response to climate change,including vulnerability assessment,improving ventilation and heating,enhancing community education,developing forecast models,and early warning systems.However,the effectiveness of most adaptation measures,except for improving ventilation and heating in winter,have not been explored and quantified.Since asthma is sensitive to the variation of atmospheric environmental conditions,it is critical to develop and implement appropriate climate change mitigation and adaptation strategies as global heating becomes apparent.

Chinese guidelines for the diagnosis and treatment of hand, foot and mouth disease (2018 edition)

Background Hand, foot, and mouth disease (HFMD) is a common infectious disease in childhood caused by an enterovirus (EV), and which is principally seen in children under 5 years of age. To promote diagnostic awareness and effective treat-ments, to further standardize and strengthen the clinical management and to reduce the mortality of HFMD, the guidelines for diagnosis and treatment have been developed. Methods National Health Commission of China assembled an expert committee for a revision of the guidelines. The com-mittee included 33 members who are specialized in diagnosis and treatment of HFMD. Results Early recognition of severe cases is utmost important in diagnosis and treatment of patients with HFMD. The key to diagnosis and treatment of severe cases lies in the timely and accurate recognition of stages 2 and 3 of HFMD, in order to stop progression to stage 4. Clinicians should particularly pay attention to those EV-A71 cases in children aged less than 3 years, and those with disease duration less than 3 days. The following indicators should alert the clinician of possible deterioration and impending critical disease: (1) persistent hyperthermia;(2) involvement of nervous system;(3) worsening respiratory rate and rhythm;(4) circulatory dysfunction;(5) elevated peripheral WBC count;(6) elevated blood glucose and (7) elevated blood lactic acid. For treatment, most mild cases can be treated as outpatients. Patients should be isolated to avoid cross-infection. Intense treatment modalities should be given for those severe cases. Conclusion The guidelines can provide systematic guidance on the diagnosis and management of HFMD.

Increasing prevalence and influencing factors of childhood asthma: a cross-sectional study in Shanghai, China

Background Asthma has been a global problem,especially in children.We aim to evaluate the contemporary prevalence and influencing factors of asthma among children aged 3–7 years in Shanghai,China.Methods A random sample of preschool children was included in this study.The International Study of Asthma and Allergies in Childhood questionnaire was adopted to assess the childhood asthma.Multivariable logistic regression models were used to evaluate the associations between independent variables and childhood asthma.Results Of 6389 preschool children who were invited to take part in this study,6163(response rate:96.5%)completed the questionnaire and were included in the analysis.The overall prevalence of asthma was 14.6%which increased more than six folds from 2.1%in 1990.Being male,younger age,preterm delivery,being born in spring or autumn,being delivered by elective cesarean section without indication,miscarriage,high socioeconomic status,having allergy history,and exposure to passive smoking,latex paint,and dust were potential risk factors for childhood asthma.Spending more time outdoors(>30 min/day),having indoor plants,and cleaning rooms more frequently were potential protective factors.Conclusions The prevalence of childhood asthma in Shanghai has increased dramatically during the past three decades.The findings about risk and protective factors of childhood asthma could be used to develop appropriate strategies to prevent and control childhood asthma in Shanghai and in other similar metropolitan cities.