Relationships between air pollution and preterm birth in California

Air pollution from vehicular emissions and other combustion sources is related to cardiovascular and respiratory outcomes. However, few studies have investigated the relationship between air pollution and preterm birth, a primary cause of infant mortality and morbidity. This analysis examined the effect of fine particulate matter (PM(2.5)) and carbon monoxide (CO) on preterm birth in a matched case-control study. PM(2.5) and CO monitoring data from the California Air Resources Board were linked to California birth certificate data for singletons born in 1999-2000. Each birth was mapped to the closest PM monitor within 5 miles of the home address. County-level CO measures were utilised to increase sample size and maintain a representative population. After exclusion of implausible birthweight-gestation combinations, preterm birth was defined as birth occurring between 24 and 36 weeks' gestation. Each of the 10 673 preterm cases was matched to three controls of term (39-44 weeks) gestation with a similar date of last menstrual period. Based on the case's gestational age, CO and PM(2.5) exposures were calculated for total pregnancy, first month of pregnancy, and last 2 weeks of pregnancy. Exposures were divided into quartiles; the lowest quartile was the reference. Because of the matched design, conditional logistic regression was used to adjust for maternal race/ethnicity, age, parity, marital status and education. High total pregnancy PM(2.5) exposure was associated with a small effect on preterm birth, after adjustment for maternal factors (adjusted odds ratio [AOR] = 1.15, [95% CI 1.07, 1.24]). The odds ratio did not change after adjustment for CO. Results were similar for PM(2.5) exposure during the first month of pregnancy (AOR = 1.21, 95% CI [1.12, 1.30]) and the last 2 weeks of pregnancy (AOR = 1.17, 95% CI [1.09, 1.27]). Conversely, CO exposure at any time during pregnancy was not associated with preterm birth (AORs from 0.95 to 1.00). Maternal exposure to PM(2.5), but not CO, is associated with preterm birth. This analysis did not show differences by timing of exposure, although more detailed examination may be needed.     

兰州地区早产影响因素的研究

目的 探讨早产、自发性早产和医源性早产的相关高危因素.方法 回顾性调查2010年1月至2012年12月在甘肃省妇幼保健院住院分娩足月儿和早产儿的孕妇的住院资料,分娩足月活产儿5639例、早产儿540例,分为足月产组(≥37周孕龄)和早产组(<37周孕龄),比较早产组和足月产组发生早产的相关危险因素,以及自发性早产和医源性早产的相关高危因素.结果 ①Logistic回归分析发现教育年限(≥16年)(OR=0.61,95%CI:0.48~0.78)、家庭平均月收入(>3000元)(OR=0.62,95%CI:0.50~0.78)是早产发生的保护因素,而母亲妊娠合并症,比如妊娠期糖尿病(GDM)(OR=3.97,95%CI:1.70~9.25)、妊娠期高血压疾病(HDP)(OR=4.43,95%CI:3.35~5.87)、妊娠期胆汁淤积症(ICP)(OR=4.88,95%CI:3.25~7.32)是早产发生的独立高危因素.②按早产的病因分类,本研究中340例为自发性早产儿,余200例为医源性早产.经分层多因素非条件Logistic回归分析表明,与足月产相比,经产妇(OR=2.66,95%CI:1.87~3.76)、GDM(OR=4.52,95%CI:1.42~14.38),尤其是HDP孕妇(OR=14.19,95%CI:10.10~19.93)更易发生医源性早产,而ICP孕妇更多出现自发性流产(OR=12.875,95%CI:12.75~13.00).结论 应及早识别早产潜在的高危因素,加强围生期管理,以减少早产的发生,改善围生儿结局.     

某院近五年婴儿出生发生早产状况及预后分析

目的 分析近五年来首都医科大学附属北京妇产医院早产儿发生状况及预后,为早产儿研究提供流行病学资料。方法 选择2013年 1 月1日-2017年 12 月31日本院产科出生的6 038例活产早产儿(胎龄＜37周)为研究对象,按照自发性早产、医源性早产进行分类,并进一步根据胎龄分为极早早产儿(胎龄<28周)、早期早产儿(胎龄28~<32周)、中期早产儿(胎龄32~34周)、晚期早产儿(胎龄34~<37周),分别研究早产儿预后。结果 2013-2017年本院早产儿年发生率在7.38%~8.57%之间,平均为8.03%。近五年晚期早产儿发病率呈上升趋势,到2017年达到74.25%。医源性早产病因构成排名前3位的包括:妊娠高血压疾病(978,39.96%)、前置胎盘(478,19.53%)、胎儿宫内窘迫(222,9.07%)。医源性早期早产儿重度窒息发生率高于自发性早产儿(4.1% vs.1.2%,P<0.05),出生体重低于自发性早产儿[(1 338.0±264.4)g vs.(1 381.8±328.0)g,P<0.05)];医源性中期早产儿出生体重低于自发性早产儿[(1 843.9±341.5) vs.(1 897.0±392.7)g,P<0.05)];医源性晚期早产儿住院率高于自发性早产儿(43.9%vs.38.8%,P<0.01)。结论 晚期早产儿发生率呈上升趋势,相对于相应孕周范围的自发性早产儿,医源性早期早产儿重度窒息发生率更高、早期及中期早产儿出生体重偏低、晚期早产儿需要住院的比例更高,应加强医源性早产孕母妊娠期管理、重视医源性早产儿分娩后管理。     

早产相关因素的研究进展

早产是当今世界导致新生儿死亡率、发病率及远期并发症增加的主要原因,其具体影响因素目前尚未研究透彻。目前国内外对于早产影响因素的研究颇多,且诸多因素已被证实与早产有明显相关性,例如胎膜早破、多胎妊娠及胎盘因素。而产妇的个人因素、蛋白、多肽及基因等一直是早产相关因素研究的热点,该文就当前国内外关于早产相关因素的研究进行归纳总结。     

Socioeconomic inequalities and infant mortality of 46,470 preterm infants born in Sweden between 1992 and 2006

Studies on possible sociodemographic inequities in the survival of preterm infants are scarce. Individual and neighbourhood sociodemographic factors are related to preterm birth and to infant mortality in full-term infants. The aim here was to examine whether infant mortality in Swedish preterm infants is related to individual and neighbourhood sociodemographic factors, and to study whether the hypothesised association between neighbourhood deprivation and infant mortality persists after accounting for individual sociodemographic factors. The study included 46,470 infants with a gestational length of <37 weeks, born in Sweden between 1992 and 2006. Neighbourhood deprivation was assessed by an index (education, income, unemployment, welfare assistance) in small geographical units, and categorised into low, moderate and high deprivation. Adjusted odds ratios for infant mortality were examined in relation to individual and neighbourhood sociodemographic factors. After adjusting for maternal age, infant mortality was associated with the following sociodemographic variables: maternal non-married/non-cohabiting status, low family income, low maternal education and rural status. After full adjustment, the odds ratio [95% confidence interval] was 2.98 [2.42, 3.67] for low family income compared with high family income. An increase in infant mortality was also associated with high neighbourhood deprivation; however, this increased risk no longer remained statistically significant after adjusting for individual sociodemographic factors. In conclusion, this study showed an increased infant mortality in preterm infants born to women with a less favourable sociodemographic profile.     

早产儿出院后配方奶对早产/低出生体重儿生长发育影响的研究

目的探讨早产儿出院后配方奶对早产/低出生体重儿生长发育的影响。方法将59例早产/低出生体重儿根据出院后喂养方式分为母乳+早产儿配方奶混合喂养组(Ⅰ组)和早产儿出院后配方奶喂养组(Ⅱ组),监测入组后6个月内体重、身长、头围、Kaup指数及部分理化指标,并作组间比较,藉此评价早产儿出院后配方奶对出院后的早产/低出生体重儿生长发育影响的临床意义。结果入组时两组在性别比例、孕周和出生体重上差异无统计学意义(P0.05)。体重、Kaup指数,在喂养后2月内差异无统计学意义(P0.05),从3个月始Ⅱ组较Ⅰ组增长快(P0.05);身长从第4个月,头围从第5个月起,Ⅱ组较Ⅰ组增长快(P0.05);血色素从第5个月以后,Ⅱ组高于Ⅰ组(P0.05)。观测过程中两组的Ca、P、AKP差异无统计学意义(P0.05)。结论早产儿出院后配方奶是早产儿出院后喂养品的良好选择,有益于低体重早产儿实现追赶性生长。     

早产相关因素的临床分析

目的 探讨不同孕周早产相关因素及早产对母婴妊娠结局的影响.方法 随机选取2015年1月至12月在南京医科大学附属南京妇幼保健院分娩的1010例早产病例进行回顾性分析,同时随机选取同期的1010例足月分娩病例为对照.比较不同孕周早产(早、中、晚期早产)的相关因素,不同孕周早产儿的并发症和早产的母婴结局.结果 ①胎膜早破在早、中、晚期早产中均占首要因素(分别为44.44%、49.43%、52.86%),其余存在明显相关性的因素为子宫因素、多胎妊娠、胎位异常、妊娠期糖尿病、妊娠期高血压及胎盘因素;②早产组中孕妇年龄在18岁以下或35岁以上、有人工流产史、有早产史和运用辅助生殖技术受孕的人数显著高于对照组(χ2值分别为4.21、10.53、7.21、57.87,均P<0.05);③不同孕周早产儿新生儿呼吸窘迫综合征(NRDS)、新生儿颅内出血(NICH)、新生儿高胆红素血症(NHB)、新生儿肺炎、新生儿坏死性小肠结肠炎(NEC)的发生率不同(χ2值分别为418.89、31.65、45.54、104.69和8.14,均P<0.05),其中NRDS、NICH及新生儿肺炎的发生率随着孕周的增加显著降低,NRDS早期和中期(χ2值分别为78.16、436.51和79.83)、早期和晚期(χ2值分别为8.15、30.31和4.76)、中期和晚期组(χ2值分别为15.43、108.52和19.61)相比较,均P<0.05);NHB在早期与中期早产儿中差异没有统计学差异(χ2=0.41,P>0.05),但早期组及中期组早产儿的NHB发生率明显高于晚期早产组(χ2值分别为23.56、35.47,P<0.05);NEC在早期早产儿中发生率明显高于中期及晚期早产组(χ2值分别为5.66、5.81,均P<0.05),在中期与晚期早产儿中NEC的发生率未见统计学差异(χ2=0.40,P>0.05);④早产组和对照组相比,其产后出血、剖宫产、新生儿窒息及死亡的发生率明显增高,差异有统计学意义(χ2值分别是35.24、43.99、17.51、49.67,均P<0.05).结论 早产是多因素综合作用的结果,重视产前检查及孕期保健,及早识别早产的危险因素,积极采取干预措施,改善早产儿预后,是提高妇幼保健质量的保证.     

早产儿贫血程度的相关因素分析

目的 通过回顾性研究,对影响早产儿贫血程度的相关因素进行分析。方法 收集2012年6月-2013年6月期间生后24 h内收入珠海市妇幼保健院新生儿科并在住院期间出现贫血的167例早产儿的临床资料,分为轻-中度贫血组和重度贫血组,利用单因素分析和Logistic回归分析对影响早产儿贫血程度的相关因素进行分析。结果 重度贫血组出生体重、胎龄明显低于轻-中度贫血组,差异有统计学意义(P<0.01),而住院时间、采血量明显高于轻-中度贫血组,差异有统计学意义(P<0.01)。出生体重和住院时间是发生重度贫血的危险因素。结论 出生体重、胎龄、住院时间以及采血量均与早产儿贫血程度有关。其中出生体重和住院时间是早产儿重度贫血的独立危险因素。     

早产儿不同时期生长发育迟缓及相关影响因素分析

目的 评价早产儿不同时期生长发育迟缓发生率,并分析其相关影响因素。方法 对2011年9月-2012年12月在本院NICU住院的符合入选条件的191例早产儿住院情况及出院后随访情况进行分析。结果 1)以体重进行评价,出生时、出院时及矫正胎龄至48周时、6月龄时生长发育迟缓发生率分别为19.4%、32.5%、24.7%,16.0%,差异有统计学意义。2)以出院体重评价,胎龄、出生体重10、有肠外营养PN、首次应用PN日龄、应用PN持续时间是早产儿发生宫外生长发育迟缓(extrauterine growth retardation,EUGR)影响最大的因素。3)以矫正至6月龄时体重评价,出院体重10是早产儿发生出院后生长发育迟缓的最大影响因素。结论 应加强对宫内生长发育迟缓(intrauterine growth retardation,IUGR)及EUGR早产儿管理;对早产儿的不同时期均应进行积极的营养支持治疗。     

Pneumonia and influenza,and respiratory and circulatory hospital admissions in Belgium: a retrospective database study

Background

Influenza infections can lead to viral pneumonia, upper respiratory tract infection or facilitate co-infection by other pathogens. Influenza is associated with the exacerbation of chronic conditions like diabetes and cardiovascular disease and consequently, these result in acute hospitalizations. This study estimated the number, proportions and costs from a payer perspective of hospital admissions related to severe acute respiratory infections.

Methods

We analyzed retrospectively, a database of all acute inpatient stays from a non-random sample of eleven hospitals using the Belgian Minimal Hospital Summary Data. Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification was used to identify and diagnose cases of pneumonia and influenza (PI), respiratory and circulatory (RC), and the related complications.

Results

During 2002–2007, we estimated relative hospital admission rates of 1.69% (20960/1237517) and 21.79% (269634/1237517) due to primary PI and RC, respectively. The highest numbers of hospital admissions with primary diagnosis as PI were reported for the elderly patient group (n = 10184) followed by for children below five years of age (n = 3451).Of the total primary PI and RC hospital admissions, 56.14% (11768/20960) and 63.48% (171172/269634) of cases had at least one possible influenza-related complication with the highest incidence of complications reported for the elderly patient group. Overall mortality rate in patients with PI and RC were 9.25% (1938/20960) and 5.51% (14859/269634), respectively. Average lengths of hospital stay for PI was 11.6 ± 12.3 days whereas for RC it was 9.1 ± 12.7 days. Annual average costs were 20.2 and 274.6 million Euros for PI and RC hospitalizations. Average cost per hospitalization for PI and RC were 5779 and 6111 Euros (2007), respectively. These costs increased with the presence of complications (PI: 7159, RC: 7549 Euros).

Conclusion

The clinical and economic burden of primary influenza hospitalizations in Belgium is substantial. The elderly patient group together with children aged <18 years were attributed with the majority of all primary PI and RC hospitalizations.

Trial registration

Not applicable.     

上海市徐汇区2006-2012年新生儿早产的危险因素分析

目的 了解徐汇区新生儿早产发生的危险因素,为预防早产的发生提供依据。方法 采集徐汇区2006年1月1日-2012年12月31日所有在上海市医院内出生的户籍婴儿信息,根据病例对照研究方法,采用单因素非条件Logistic回归分析和多因素非条件Logistic回归分析方法,分析新生儿早产的危险因素。结果 2006-2012年徐汇区共38 585例婴儿,平均早产发生率为5.81%。单因素非条件Logistic回归分析认为出生畸形、胎次、产次、胎数、母亲年龄、父亲年龄为早产可能的危险因素。最后通过多因素Logistic回归进行分析,采用逐步前进法,认为母亲年龄、出生畸形和胎数是对早产发生有影响,其OR值分别为1.041(95%CI:1.029~1.054)、2.362(95%CI:1.621~3.442)、31.325(95%CI:27.200~36.074)。结论 母亲年龄的增加、多胎以及出生畸形等会增加新生儿早产的危险性。     

Chemical properties of air pollutants and cause-specific hospital admissions among the elderly in Atlanta, Georgia

Background: Health risks differ by fine particle (aerodynamic diameter ≤ 2.5 μm) component, although with substantial variability. Traditional methods to assess component-specific risks are limited, suggesting the need for alternative methods.Objectives: We examined whether the odds of daily hospital admissions differ by pollutant chemical properties.Methods: We categorized pollutants by chemical properties and examined their impacts on the odds of daily hospital admissions among Medicare recipients > 64 years of age in counties in Atlanta, Georgia, for 1998–2006. We analyzed data in two stages. In the first stage we applied a case-crossover analysis to simultaneously estimate effects of 65 pollutants measured in the Aerosol Research and Inhalation Epidemiology Study on cause-specific hospital admissions, controlling for temperature and ozone. In the second stage, we regressed pollutant-specific slopes from the first stage on pollutant properties. We calculated uncertainty estimates using a bootstrap procedure. We repeated the two-stage analyses using coefficients from first-stage models that included single pollutants plus ozone and meteorological variables only. We based our primary analyses on exposures on day of admission.Results: We found that 24-hr transition metals and alkanes were associated with increased odds [0.26%; 95% confidence interval (CI), 0.02–0.48; and 0.37%; 95% CI, 0.04–0.72, respectively] of hospital admissions for cardiovascular disease (CVD). Transition metals were significantly associated with increased hospital admissions for ischemic heart disease, congestive heart failure, and atrial fibrillation. Increased respiratory-related hospital admissions were significantly associated with alkanes. Aromatics and microcrystalline oxides were significantly associated with decreased CVD- and respiratory-related hospital admissions.Conclusions: The two-stage approach showed transition metals to be consistently associated with increased odds of CVD-related hospital admissions.     

深圳市新生儿早产影响因素的病例对照研究

目的 探讨深圳市新生儿早产相关危险因素,为预防早产提供参考依据。 方法 在深圳市某妇幼保健院选取2015年1月1日－12月31日分娩的产妇和新生儿为研究对象,以妊娠满28周不足37周的200例新生儿母亲为病例组,妊娠满37周~42周的200例新生儿母亲为对照组。收集2014年1月1日－2015年12月31日SO₂、NO₂、PM₁₀、PM_2.5、CO和O₃逐日浓度。运用logistic回归模型分析早产影响因素。 结果 2014－2015年深圳市空气质量良好。病例组和对照组孕早期SO₂暴露浓度分别为(10.00±5.10)μg/m³、(8.66±5.03)μg/m³,NO₂暴露浓度分别为(38.23±15.98)μg/m³、(35.33±15.01)μg/m³,差异均有统计学意义(P＜0.05);病例组和对照组孕晚期PM₁₀暴露浓度分别为(54.26±28.00)μg/m³、(51.39±27.92)μg/m³,PM_2.5暴露浓度分别为(32.96±19.20)μg/m³、(30.11±18.36)μg/m³,差异均有统计学意义(P＜0.05)。病例组和对照组产妇年龄分别为(29.2±5.4)岁、(27.6±6.0)岁,家族早产史所占比例分别为38.5%、26.5%,大专及以上文化程度所占比例分别为62.5%、73.5%,差异均有统计学意义(P＜0.05)。进一步进行早产影响因素的多因素logistic回归分析发现:产妇年龄(OR=1.009, 95%CI:1.002~1.018)、有家族早产史(OR=1.308,95%CI:1.019~1.714)、孕晚期PM_2.5(OR=1.387,95%CI:1.112~1.579)、孕晚期PM₁₀(OR=1.267,95%CI:1.108~1.531)、孕早期SO₂(OR=1.118,95%CI:1.009~1.329)、孕早期NO₂(OR=1.106,95%CI:1.009~1.273)对早产有影响。 结论 深圳市空气SO₂、NO₂、PM₁₀、PM_2.5污染、产妇年龄和家族早产史与早产有关。     

上海市徐汇区大气污染物与新生儿早产的关联性研究

目的 本研究旨在分析上海市徐汇区大气污染物对早产发生的影响,定量评估不同大气污染物(PM₁₀、SO₂、NO₂)对早产发生的影响。方法 根据时间序列研究方法,采用过分散的广义相加模型(GAM),在控制时间平滑趋势、气温、气湿和星期几效应等混杂因素后,分析PM₁₀、SO₂、NO₂和每日早产发生数的关联。结果 对于不同污染物来说,PM10仅在累积暴露为产前1周时,对早产发生的影响有统计学意义,PM₁₀每升高10 μg/m³,早产发生率上升1.868%(95%CI0.339%~3.397%);NO₂在累积暴露为产前1、2和3周时,对早产发生的影响均有统计学意义,NO₂每升高10 μg/m³,早产发生率分别上升6.214%(95%CI2.294%~10.134%)、7.098%(95%CI2.100%~12.096%)和6.498%(95%CI0.344%~12.652%);SO₂无论累积暴露为产前1、2、3周还是4周,对早产发生的影响均无统计学意义(P>0.05)。根据母亲年龄、胎数和是否出生畸形分层后,发现对于单胎、出生畸形、以及母亲年龄为≤24岁和≥35岁的层组来说,产前1周的PM₁₀平均浓度水平上升对早产发生有影响。产前1周的NO₂平均浓度水平和早产的发生,仅与母亲年龄≥35岁组有关。各层组均未观察到SO₂平均浓度水平的改变和早产发生的效应。3种污染物的单日滞后0~6 d(lag0~lag6)的急性期暴露效应,结果显示仅对于NO₂的lag4和lag5的滞后效应有统计学意义。结论 大气污染物PM₁₀和NO₂对早产发生的影响有统计学意义,尤其是NO₂的累积暴露浓度滞后时间更长,且产前3周内的累积效应比产前7日的急性期滞后效应更有意义,研究中未发现SO₂对早产的影响。     

Association of air quality with respiratory and cardiovascular morbidity rate in Delhi,India

The present study reports short-term impact of poor air quality on cardiovascular and respiratory morbidity rate in Delhi. The data on monthly count of patients visiting Out Patient Department (OPD) and hospital admission due to respiratory and cardiovascular illnesses from hospitals along with daily air quality data from air quality monitoring stations of Central Pollution Control Board (CPCB), Government of India, across Delhi were collected for the period 2008 to 2012. A semi-parametric Quasi-Poisson regression model was used to examine the association of high pollution episodes with relative risk of hospital OPD visit and hospital admission due to respiratory and cardiovascular diseases. This study has confirmed the substantial adverse health effects due to air pollution across criterion air pollutants. The study reports the short-term effects of air pollution on morbidity from a time-series study first time in India. The study findings illustrate the evidence of adverse health impact of air pollution from India to the global pool and can influence the policy makers to implement better air quality management system for Indian cities.

Abbreviations: OPD: Out Patient Department; IPD: Inpatient Department; RD: Respiratory Disease; CVD: Cardiovascular Disease; COPD: Chronic Obstructive Pulmonary Disease; CPCB: Central Pollution Control Board; NAAQMP: National Ambient Air Quality Monitoring Programme; NAAQS: National Ambient Air Quality Standards; RR; Relative Risk; IMD: Indian Meteorological Department; PM₁₀: Particulate Matter less than 10 μm in aerodynamic diameter; SO₂: Sulphur dioxide; NO₂: Nitrogen dioxide; CO: Carbon Monoxide; O₃: Ozone; DCE: Delhi College of Engineering; GTB Hospital: Guru Teg Bahadur Hospital; VPCH: Vallabhbhai Patel Chest Hospital; RMLH: Ram Manohar Lohia Hospital; SJH: Safdarjung Hospital; LNJPH: Lok Narayan Jai Prakash Hospital; GTBH: Guru Teg Bahadur Hospital; AH: Ambedkar Hospital; HRH: Hindu Rao Hospital; ESIH: ESI Hospital; SGRH: Sir Ganga Ram Hospital     

Rural-urban differences in sociodemographic,social network and lifestyle factors related to mortality of middle-aged Japanese men from the Komo-Ise cohort study

To examine rural-urban differences in the relationships of sociodemographic, social network, and lifestyle factors to mortality in middle-aged men, we used the data from a community based prospective cohort study, the Komo-Ise study. The subjects were all men aged 40-69 years living in Komochi Village, the rural group (n=2,295), or the downtown district of Isesaki City, the urban group (n=3,334), as of 1993. They completed a self-administered questionnaire in 1993 and were followed for all-cause deaths until 2000. The Cox proportional hazards model was used to compute relative risks (RRs) with 95% confidence intervals (CIs). Low educated men and men without a spouse in the rural group had an increased risk of mortality (RR=4.4; 95%CI: 1.1-18.2, RR=2.4; 95%CI: 1.2-4.5). Men who did not enjoy good fellowship with their neighbors in the rural group had a decreased risk of mortality (RR=0.58; 95%CI: 0.35-0.97). Mortality risks were significantly higher in urban men not participating in hobbies, club activities or community groups (RR=1.6; 95%CI: 1.1-2.4). These variables remained significant risk factors, even after controlling for all sociodemographic, social network, lifestyle, and health status variables. Educational level, marital status and relation to neighborhoods showed significant rural-urban differences.