Air pollution and its associated health risks before and after COVID-19 in Shaanxi Province, China.

Air pollution is a serious environmental problem that damages public health. In the present study, we used the segmentation function to improve the health risk-based air quality index (HAQI) and named it new HAQI (NHAQI). To investigate the spatiotemporal distribution characteristics of air pollutants and the associated health risks in Shaanxi Province before (Period I, 2015-2019) and after (Period II, 2020-2021) COVID-19. The six criteria pollutants were analyzed between January 1, 2015, and December 31, 2021, using the air quality index (AQI), aggregate AQI (AAQI), and NHAQI. The results showed that compared with AAQI and NHAQI, AQI underestimated the combined effects of multiple pollutants. The average concentrations of the six criteria pollutants were lower in Period II than in Period I due to reductions in anthropogenic emissions, with the concentrations of PM2.5 (particulate matter ≤2.5 µm diameter), PM10 (PM ≤ 10 µm diameter) SO2, NO2, O3, and CO decreased by 23.5%, 22.5%, 45.7%, 17.6%, 2.9%, and 41.6%, respectively. In Period II, the excess risk and the number of air pollution-related deaths decreased considerably by 46.5% and 49%, respectively. The cumulative population distribution estimated using the NHAQI revealed that 61% of the total number of individuals in Shaanxi Province were exposed to unhealthy air during Period I, whereas this proportion decreased to 16% during Period II. Although overall air quality exhibited substantial improvements, the associated health risks in winter remained high.

Lag Effect of Temperature and Humidity on COVID-19 Cases in 11 Chinese Cities

The global transmission of COVID-19 has caused considerable health burdens, and epidemiological studies have proven that temperature and humidity play an important role in the transmission of infectious respiratory diseases. This effect may not be immediate and can be delayed by days to weeks. In this study, the comprehensive effect of temperature and humidity on COVID-19 was evaluated using the discomfort index (DI). We analyzed the lag effect of the DI on COVID-19 from 21 January to 29 February 2020 in 11 Chinese cities by designing a generalized additive model (GAM). We classified the 11 Chinese cities into southern cities and northern cities to compare the potential effects in these two types of cities. The results reveal that the DI had the same negative correlation and different lag effects on daily COVID-19 cases. There was a significant negative correlation between the DI and daily COVID-19 cases (p < 0.05), except in Wuhan. The lag effect was stronger in the cities located further north. In northern cities, each unit decrease in the DI increased the COVID-19 risk from 7 to 13 lag days. In southern China, each unit decrease in the DI increased the COVID-19 risk from 0 to 7 lag days, especially in Shanghai, Guangzhou, and Shenzhen.

Acupuncture for nasal congestion in COVID-19: A protocol for systematic review and meta-analysis.

BACKGROUND: From the end of 2019 to now, coronavirus disease 2019 (COVID-19) has put enormous strain on the world's health systems, causing significant deaths and economic losses worldwide. Nasal congestion, one of the symptoms of COVID-19, poses considerable problems for patients. In China, acupuncture has been widely used to treat nasal congestion caused by COVID-19, but there is still a lack of evidence-based medical evaluation. METHODS: According to the retrieval strategies, randomized controlled trials on the acupuncture for COVID-19 nasal congestion were obtained from China National Knowledge Infrastructure, WanFang, VIP, PubMed, Embase, and Cochrane Library, regardless of publication date, or language. Studies were screened based on inclusion and exclusion criteria, and the Cochrane risk bias assessment tool was used to evaluate the quality of the studies. The meta-analysis was performed using Review Manager (RevMan 5.3) and STATA 14.2 software. Ultimately, the evidentiary grade for the results will be evaluated. RESULTS: The study will provide a high-quality and convincing assessment of the efficacy and safety of acupuncture in the treatment of COVID-19's nasal congestion and will be published in peer-reviewed journals. CONCLUSION: Our findings will provide references for future clinical decision and guidance development. PROSPERO REGISTRATION NUMBER: NO.CRD42021299482.

Effects of moxibustion for COVID-19 convalescence: A protocol for systematic review and meta-analysis.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is still spreading around the world. Moxibustion, as a significant therapy in traditional Chinese medicine (TCM), has been widely used to treat COVID-19, especially in recovery period. The study will aim to assess the efficacy and safety of moxibustion for COVID-19 convalescence. METHODS: We will systematically search the relevant randomized controlled trials in the 7 databases from inception to February 2021, including PubMed, MEDLINE, Embase, Cochrane Clinical Trials Database, Web of Science, China National Knowledge Infrastructure and Chinese Biomedical Literature Database. No language and publication status restrictions will be applied. Two reviewers will independently conduct and screen all included studies and the meta-analysis will be performed with RevMan V5.3 (The Cochrane Collaboration, Oxford, England). RESULTS: The study will provide a high-quality convincing assessment of the efficacy and safety of moxibustion for the treatment of COVID-19 convalescence, which will be published in a peer-reviewed journal. CONCLUSION: Our study will give more comprehensive evidence of the effectiveness of moxibustion for COVID-19 convalescence. TRIAL REGISTRATION NUMBER: CRD42021230364.

Association between environmental factors and COVID-19 in Shanghai, China.

The outbreak of coronavirus disease 2019 (COVID-19) continues to spread worldwide and has led to recession, rising unemployment, and the collapse of the health-care system. The aim of this study was to explore the exposure-response relationship between daily confirmed COVID-19 cases and environmental factors. We used a time-series generalized additive model (GAM) to investigate the short-term association between COVID-19 and environmental factors by using daily meteorological elements, air pollutant concentration, and daily confirmed COVID-19 cases from January 21, 2020, to February 29, 2020, in Shanghai, China. We observed significant negative associations between daily confirmed COVID-19 cases and mean temperature (Tave), temperature humidity index (THI), and index of wind effect (K), whereas air quality index (AQI), PM2.5, PM10 NO2, and SO2 were significantly associated with the increase in daily confirmed COVID-19 cases. A 1 °C increase in Tave, one-unit increase in THI, and 10-unit increase in K (lag 0-7 days) were associated with 4.7, 1.8, and 1.6% decrease in daily confirmed cases, respectively. Daily Tave, THI, K, PM10, and SO2 had significant lag and persistence (lag 0-7 days), whereas the lag and persistence of AQI, PM2.5, and NO2 were significant at both lag 0-7 and 0-14 days. A 10-µg/m3 increase in PM10 and 1-µg/m3 increase in SO2 was associated with 13.9 and 5.7% increase in daily confirmed cases at lag 0-7 days, respectively, whereas a 10-unit increase in AQI and a 10-µg/m3 increase in PM2.5 and NO2 were associated with 7.9, 7.8, and 10.1% increase in daily confirmed cases at lag 0-14 days, respectively. Our findings have important implications for public health in the city of Shanghai.

Efficacy and safety of acupuncture for elderly patients with coronavirus disease 2019 (COVID-19): A protocol for systematic review and meta-analysis.

BACKGROUND: The study aims to evaluate the effectiveness and safety of acupuncture therapy for elderly patients with coronavirus disease 2019 (COVID-19). METHODS: Relevant articles from December 2019 to December 2020 will be searched in the following electronic databases: Medline, PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), and China Scientific Journals Database. All published randomized controlled trials (RCTs) and credible clinical observations about this topic will be included. Two independent researchers will operate article retrieval, duplication removing, screening and data analysis by EndNote X9.0 and Stata 15.0. We will use the Cochrane risk of bias tool for randomized trials to assess the risk of bias of included studies. Meta-analysis, subgroup analysis, and/or descriptive analysis will be performed according to the data conditions included. RESULTS: High-quality synthesis and/or descriptive analysis of current evidence will be provided from mortality rate, cure rate, C-reactive protein (CRP), creatine, troponin, aspartate aminotransferase, alanine aminotransferase, and improvements in chest CT scans, clinical symptoms (including fever, fatigue, cough, nausea, vomiting and diarrhea) and the side effects of acupuncture. CONCLUSION: This study will provide evidence of whether acupuncture is an effective and safe intervention for the elderly with COVID-19. PROSPERO REGISTRATION NUMBER: CRD42020225245.

Adjuvant therapeutic effects of moxibustion on COVID-19: A protocol for systematic review and meta-analysis.

BACKGROUND: COVID-9 has become a global pandemic with severe health issues around the world. However, there is still no effective drug to treat the disease, and many studies have shown that moxibustion plays a positive role in adjuvant treatment of COVID-19. Therefore, this meta-analysis is designed to evaluate the efficacy of moxibustion for COVID-19. METHODS: The relevant randomized controlled trials will be systematically retrieved from the electronic database, including PubMed, Embase, Cochrane Clinical Trials Database, Web of Science, and China National Knowledge Infrastructure, without restrictions on publication status and language. Two reviewers will independently review all included studies and assess the risk of bias. Two reviewers will independently extract data from the included studies based on a pre-designed standardized form. Any disagreements will be resolved by consensus. The meta-analysis will be performed with RevMan (V5.3.5) software. RESULT: The results of this study will be published in a peer-reviewed journal. CONCLUSION: This ongoing meta-analysis will provide up-to-date evidence of the efficacy of moxibustion for patients with COVID-19. REGISTRATION: The meta-analysis has been prospectively registered in PROSPERO (CRD42020211910).

Anxiety and Depression of Nurses in a North West Province in China During the Period of Novel Coronavirus Pneumonia Outbreak.

PURPOSE: To investigate the anxiety and depression levels of frontline clinical nurses working in 14 hospitals in Gansu Province, China, during this period. DESIGN: A cross-sectional survey was conducted online between February 7 and 10, 2020, with a convenience sample of 22,034 nurses working in 14 prefecture and city hospitals in Gansu Province, located in northwest China. METHODS: A self-reported questionnaire with four parts (demographic characteristics, general questions related to novel coronavirus-infected pneumonia, self-rating anxiety scale, and self-rating depression scale) was administered. Descriptive statistics including frequencies, means, and SDs were computed. The associations between anxiety and depression with sociodemographic characteristics, work-related concerns, and impacts were analyzed, followed by multiple stepwise linear regression to identify factors that best predicted the nurses' anxiety and depression levels. FINDINGS: A total of 21,199 questionnaires were checked to be valid, with an effective recovery rate of 96.21%. The mean ± SD age of the respondents was 31.89 ± 7.084 years, and the mean ± SD length of service was 9.40 ± 7.638 years. The majority of the respondents were female (98.6%) and married (73.1%). Some demographic characteristics, related concerns, and impacts of COVID-19 were found to be significantly associated with both anxiety (p < .001) and depression (p < .001). Nurses who needed to take care of children or elderly relatives, took leave from work because they were worried about COVID-19, avoided contact with family and friends, and wanted to obtain more COVID-19-related knowledge had higher levels of both anxiety and depression. CONCLUSIONS: Results show that nurses faced with the COVID-19 outbreak are at risk for experiencing anxiety and depression. Demographic background, psychosocial factors, and work-related factors predicted the psychological responses. The family responsibilities and burdens of women may explain the higher levels of anxiety and depression among nurses with these obligations as compared to those without. On the other hand, nurses who chose not to take leave from work or who did not avoid going to work during this period were less anxious and depressed. CLINICAL RELEVANCE: Professional commitment might be a protective factor for adverse psychological responses. It is pertinent to provide emotional support for nurses and recognize their professional commitment in providing service to people in need.