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.

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.

Development of fetal growth charts in twins stratified by chorionicity and mode of conception:a retrospective cohort study in China

Background:Twin pregnancies continue to increase worldwide;however,the current clinical prenatal evaluation for the intrauterine growth of twins still relies on the growth standards of singletons.We attempted to establish a set of fetal biometric references for Chinese twin pregnancies,stratified by chorionicity and conception mode as spontaneously conceived monochorionic diamniotic(SC-MCDA),spontaneously conceived dichorionic diamniotic(SC-DCDA),and assisted reproductive technology dichorionic diamniotic(ART-DCDA)twins.Methods:From 2016 to 2019,the ultrasonographic fetal biometric measurements were longitudinally collected in pregnant women,including fetal weight,biparietal diameter,head circumference,abdominal circumference,femur length,and humerus length.The linear mixed models were used to test the difference of growth patterns between groups,and the growth curve of each biometric parameter was modeled by a generalized additive model for location scale and shape.Results:A total of 929 twin pregnant women and 2019 singleton pregnant women,met the inclusion criteria.Among twin pregnancies,148 were SC-MCDA,215 were SC-DCDA,and 566 were ART-DCDA twins.Overall,SC-DCDA twins grew faster than SC-MCDA twins,while slower than ART-DCDA twins(all P<0.05),and all of the three groups showed significant differences comparing with singletons,especially during the third trimester.Hence,the customized fetal growth charts of each fetal biometric parameter were,respectively,constructed for SC-MCDA,SC-DCDA,and ART-DCDA twins.Conclusions:The fetal biometric trajectories demonstrated characteristic patterns according to chorionicity and conception mode.To fill the gap,we modeled fetal biometric parameters for Chinese SC-MCDA,SC-DCDA,and ART-DCDA twin pregnancies,hoping to provide a reference for the further establishment of fetal growth reference values for Chinese twin fetuses.