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Xuanwei City (formerly known as Xuanwei County) locates in the northeastern of Yunnan Province and is rich in coal, iron, copper and other mines, especially the smoky (bituminous) coal. Unfortunately, the lung cancer morbidity and mortality rates in this region are among China's highest, with a clear upward trend from the mid-1970s to mid-2000s. In 2004-2005, the crude death rate of lung cancer was 91.3 per 100,000 in the whole Xuanwei City, while that for Laibin Town in this city was 241.14 per 100,000. The epidemiologic distribution (clustering patterns by population, time, and space) of lung cancer in Xuanwei has some special features, e.g., high incidence in rural areas, high incidence in females, and an early age peak in lung cancer deaths. The main factor that associates with a high rate of lung cancer incidence was found to be indoor air pollution caused by the indoor burning of smoky coal. To a certain extent, genetic defects are also associated with the high incidence of lung cancer in Xuanwei. Taken together, lung cancer in this smoky coal combustion region is a unique model for environmental factor-related human cancer, and the current studies indicate that abandoning the use of smoky coal is the key to diminish lung cancer morbidity and mortality.

The accessibility of hospital facilities is of great importance not only for maintaining social stability, but also for protecting the basic human right to health care. Traditional accessibility research often lacks consideration of the dynamic changes in transport costs and does not reflect the actual travel time of urban residents, which is critical to time-sensitive hospital services. To avoid these defects, this study considered the city of Kaifeng, China, as an empirical case, and directly acquired travel time data for two travel modes to the hospital in different time periods through web mapping API (Application Program Interface). Further, based on travel time calculations, we compared five baseline indicators. For the last indicator, we used the optimal weighted accessibility model to measure hospital accessibility for each residential area. The study discovered significant differences in the frequency and spatial distribution of hospital accessibility using public transit and self-driving modes of transportation. In addition, there is an imbalance between accessibility travel times in the study area and the number of arrivals at hospitals. In particular, different modes of transportation and different travel periods also have a certain impact on accessibility of medical treatment. The research results shed new light on the accessibility of urban public facilities and provide a scientific basis with which local governments can optimize the spatial structure of hospital resources.

The aim of this study is to provide an overview of deaths caused by poisoning (especially illicit drugs) in Estonia from 2000 to 2009. The data on poisoning deaths (N = 4132) were collected from the autopsy reports of the Estonian Forensic Science Institute. Ethanol poisoning was the most frequent cause of death (N = 1449, 35.1%), followed by carbon monoxide (N = 1151, 27.9%) and poisoning from illicit drugs (N = 888, 21.5%). The study included 3267 male (79.1%) and 865 female fatalities, with the prevalent age group being 35-64 years. Since 2002, deaths from fentanyles have increased sharply and remained at a high level - from 63 cases in 2002 to 138 cases in 2009. This high number indicates that in spite of the state's drug policies, illegal drugs remain easily available and that this area requires more attention. Alcohol abuse prevention policies - restrictions on alcohol advertisements in the media, limitations on sale times and anti-alcohol campaigns concerning traffic - have not brought about a significant decrease in ethanol poisoning.

Environmental pollution damages public health and affects economic development. Environmental regulation is the main way for the government to solve environmental pollution. So what type of environmental regulation works better for public health and economic development? Can environmental regulation have an influence on economic development through public health? To solve these problems, this research uses China’s provincial panel data from 2013 to 2017 to divide environmental regulation into command-control policy tools and economic incentive policy tools and uses the mediating effect model to examine the relationship among environmental regulation, public health and economic development. The results show that: (1) There is a positive correlation between economic incentive policy tools and economic development; while no significant relationship between command-control policy tools and economic development is founded; (2) The relationship between command-control policy tools and public health is not significant, while the relationship between economic incentive policy tools and public health is positive; (3) Public health does not play a mediating role between command-control policy tools and economic development but plays a partial mediating role between economic incentive policy tools and economic development. Therefore, the government should strengthen the use of economic incentive policy tools to promote public health and sustainable economic development.

Dietary change presents an opportunity to meet the dual challenges of non-communicable diseases and the effects of climate change in China. Based on a food survey and reviewed data sets, we linked nutrient composition and carbon footprint data by aggregating 1950 types of foods into 28 groups. Nine dietary scenarios for both men and women were modeled based on the current diet and latest National Program for Food and Nutrition. Linear uncertainty optimization was used to produce diets meeting the Chinese Dietary Reference Intakes for adults aged 18-50years while minimizing carbon footprints. The theoretical optimal diet reduced daily footprints by 46%, but this diet was unrealistic due to limited food diversity. Constrained by acceptability, the optimal diet reduced the daily carbon footprints by 7-28%, from 3495 to 2517-3252g CO2e, for men and by 5-26%, from 3075 to 2280-2917g CO2e, for women. Dietary changes for adults are capable of benefiting China in terms of the considerable footprint reduction of 53-222Mt.CO2eyear-1, when magnified based on the Chinese population, which is the largest worldwide. Seven of eight scenarios showed that reductions in meat consumption resulted in greater reductions in greenhouse gas emissions. However, dramatic reductions in meat consumption may produce smaller reductions in emissions, as the consumption of other ingredients increases to compensate for the nutrients in meat. A trade-off between poultry and other meats (beef, pork, and lamb) is usually observed, and rice, which is a popular food in China, was the largest contributor to carbon footprint reductions. Our findings suggest that changing diets for climate change mitigation and human health is possible in China, though the per capital mitigation potential is slight lower than that in developed economies of France, Spain, Sweden, and New Zealand.

Few studies on population-specific health effects of extreme temperature on cardiovascular diseases (CVDs) deaths have been conducted in the subtropical and tropical climates of China. We examined the association between extreme temperature and CVD across four cities in China. We performed a two-stage analysis; we generated city-specific estimates using a distributed lag non-linear model (DLNM) and estimated the overall effects by conducting a meta-analysis. Heat thresholds of 29 °C, 29 °C, 29 °C, and 30 °C and cold thresholds of 6 °C, 10 °C, 14 °C, and 15 °C were observed in Hefei, Changsha, Nanning, and Haikou, respectively. The lag periods for heat-related CVD mortality were observed only for 0–2 days, while those of cold-related CVD mortality were observed for 10–15 days. The meta-analysis showed that a 1 °C increase above the city-specific heat threshold was associated with average overall CVD mortality increases of 4.6% (3.0%–6.2%), 6.4% (3.4%–9.4%), and 0.2% (−4.8%–5.2%) for all ages, ≥65 years, and <65 years over a lag period of 0–2 days, respectively. Similarly, a 1 °C decrease below the city-specific cold threshold was associated with average overall CVD mortality increases of 4.2% (3.0%–5.4%), 4.9% (3.5%–6.3%), and 3.1% (1.7%–4.5%), for all ages, ≥65 years, and <65 years over a lag period of 0–15 days, respectively. This work will help to take appropriate measures to reduce temperature-mortality risk in different populations in the subtropical and tropical climates of China.

To determine the safety and effectiveness of transarterial embolization ablation (TEA) of hepatocellular carcinoma (HCC) with a lipiodol-ethanol mixture.Between January 1 and December 31, 2009, 15 patients with HCC (13 men/two women, aged 38-75 years) accepted TEA treatment and were enrolled in this study, including five newly diagnosed patients and 10 with refractory disease. Two months after TEA, angiography and contrast computed tomography (CT) were performed, and responses were assessed using a modified version of Response Evaluation Criteria in Solid Tumors (RECIST version 1.1). The follow-up period was to June 30, 2010.Every new case was treated once. Angiography was performed immediately after TEA, and showed that the tumor-feeding vessels were completely embolized and that lipiodol was densely deposited inside tumors. Two months after treatment, contrast CT showed no enhanced lesions. Alpha fetoprotein levels returned to normal in four patients and markedly decreased in another. mean ± SD survival after treatment was 10.8 ± 4.5 mo. All five patients survived during the follow-up period. Ten patients with refractory disease were treated a total of 14 times. Angiography immediately after TEA showed that blood flow to the tumors was obviously decreased in all cases, and contrast CT showed obvious depositions of lipiodol. Two months after treatment, the tumors had shrunk (6/10) or were stable (3/10). One had progressed after 2 mo and died of tumor rupture 3 mo after TEA. mean ± SD survival after treatment was 8.6 ± 4.3 mo; two patients survived during the follow-up period. Adverse effects included reversible hepatic decompensation, upper abdominal pain, and fever.TEA is an effective therapy for patients with HCC and might be more effective than transcather arterial chemoembolization for treating refractory disease.

Abstract Aims  The association between low-to-moderate alcohol consumption and atrial fibrillation (AF) has yet to be fully elucidated. The main purpose of this meta-analysis was to estimate the risk of incident AF related to low-to-moderate alcohol consumption. Methods and results  A meta-analysis was performed on 13 publications discussing the estimated risk for AF with habitual low-to-moderate alcohol intake in 10 266 315 participants. Graphical augmentations to the funnel plots were used to illustrate the potential impact of additional evidence on the current meta-analysis. Thirteen eligible studies were included in this meta-analysis. We found that moderate alcohol consumption was associated with an increased risk of incident AF in males [hazard ratio (HR) 1.09, 95% confidence interval (CI): 1.07–1.11, P &lt; 0.00001], Europeans (HR 1.32, 95% CI: 1.23–1.42, P &lt; 0.00001), and Asians (HR 1.09, 95% CI: 1.07–1.11, P &lt; 0.00001). Moderate beer consumption was associated with an increased risk of developing AF (HR 1.11, 95% CI: 1.02–1.21, P = 0.01). Low alcohol consumption conferred an increased risk of AF in males (HR 1.14, 95% CI: 1.01–1.28, P = 0.04) and Europeans (HR 1.12, 95% CI: 1.07–1.17, P &lt; 0.00001). Conclusions  This analysis represents the increased risk of incident AF in males, Europeans, and Asians at moderate alcohol consumption levels and in males and Europeans at low alcohol consumption levels. Those who drink any preferred alcohol beverage at moderate levels should be cautious for incident AF. More studies are warranted to find those factors that influence alcohol’s effect on predisposing AF.