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南京市气象因素对哺乳期乳腺炎发病的影响：基于分布滞后非线性模型的研究
王慧源, 贺宇恒, 张淳子, 杜雅菡, 谭容容, 浦丹华, 吴洁
中国实用妇科与产科杂志 ›› 2025, Vol. 41 ›› Issue (9) : 936-940.
PDF(1642 KB)
PDF(1642 KB)
南京市气象因素对哺乳期乳腺炎发病的影响：基于分布滞后非线性模型的研究
Effects of meteorological factors on incidence of lactational mastitis in Nanjing： based on a distributed lag nonlinear model
目的 探讨南京市多种气象因素与哺乳期乳腺炎发病风险之间的关联。方法 将2023年1月1日至2023年12月31日在南京医科大学第一附属医院门诊就诊哺乳期乳腺炎患者作为研究对象，采用流行病学方法对其发病特征进行描述。通过南京市气象探测中心获取研究期间南京市每日气象因素数据，建立时间序列数据库，采用Spearman秩相关分析哺乳期乳腺炎日发病数和气象因素之间的相关性。构建分布滞后非线性模型（distributed lag nonlinear model，DLNM）分析和评估多种气象因素对哺乳期乳腺炎发病的暴露-滞后效应，以及极端气象条件下的哺乳期乳腺炎发病风险。结果 （1）共纳入哺乳期乳腺炎患者282例，2023年哺乳期乳腺炎日发病数总体呈先升后降趋势，表现为周期性双峰结构，具有明显的季节效应，5月份和12月份分别为哺乳期乳腺炎日发病数的小高峰。（2）随着气压升高，哺乳期乳腺炎发病风险降低。当暴露于低气压时，相对风险在滞后第9日到达峰值（RR 1.14，95% CI 1.01~1.28）。当暴露于高气压时，相对风险在滞后的14 d内持续升高。（3）随着气温升高，哺乳期乳腺炎发病风险升高。当暴露于低温时，相对风险在滞后的14 d内持续升高。当暴露于高温时，相对风险在第8天到达峰值（RR 1.07，95% CI 0.99~1.16）。结论 日平均气压和日最高气温与南京市哺乳期乳腺炎发病呈非线性关系，并存在明显滞后效应。暴露于低气压和高气温，均显著增加哺乳期乳腺炎发病风险。
Objective To explore the association between various meteorological factors and the risk of lactational mastitis in Nanjing. Methods The patients with lactational mastitis admitted to the First Affiliated Hospital of Nanjing Medical University between January 1，2023 and December 31，2023 were enrolled as study subjects.Epidemiological methods were used to describe the epidemic characteristics of lactational mastitis.The daily data of meteorological factors during the study period were obtained from Nanjing Meteorological Observation Center.Then a time series database was established，and Spearman rank correlation analysis was used to analyze the correlation between daily number of cases of lactational mastitis and meteorological factors.Distributed lag nonlinear model（DLNM）was built to quantitatively analyze and evaluate the exposure-lag effects of various meteorological factors on the incidence of lactational mastitis as well as the incidence risk of lactational mastitis under extreme meteorological conditions. Results （1）A total of 282 lactational mastitis patients were included in the study.The incidence of lactational mastitis showed an overall trend of first increasing and then decreasing in 2023，showing a periodical bimodal structure and a significant seasonal effect， with minor peaks in May and December.（2）The risk of lactational mastitis decreased as air pressure increased.When exposed to low pressure，the relative risk of lactational mastitis peaked on the 9th lag day（RR 1.14，95% CI 1.01-1.28）.When exposed to high pressure，the relative risk of lactational mastitis continued to increase within the 14 lag days.（3）The risk of lactational mastitis increased as temperature rose.When exposed to low temperature，the relative risk of lactational mastitis gradually increased during the lag period of 0~14 days.However，when exposed to high temperature，the relative risk of lactational mastitis peaked on the 8th day（RR 1.07，95% CI 0.99-1.16）. Conclusions Daily mean pressure and highest daily temperature have a non-linear relationship with the incidence of lactational mastitis in Nanjing， and there is a significant lag effect.Exposure to low pressure and high temperature significantly increases the incidence risk of lactational mastitis.
lactational mastitis / meteorological factors / distributed lag nonlinear model
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European Society for Paediatric Gastroenterology, Hepatology & Nutrition (ESPGHAN), European Academy of Paediatrics (EAP); European Society for Paediatric Research (ESPR), European Academy for Allergy and Clinical Immunology (EAACI), et al. World Health Organization (WHO) guideline on the complementary feeding of infants and young children aged 6-23 months 2023: A multisociety response [J]. J Pediatr Gastroenterol Nutr, 2024, 79(1): 181-188. DOI:10.1002/jpn3.12248.
The recent World Health Organization (WHO) guideline aims to provide evidence‐based recommendations on complementary feeding (CF) of healthy term infants and young children 6−23 months living in low‐, middle‐, and high‐income countries, including both breastfed and non‐breastfed children. Like WHO, our organizations aim to promote optimal infant and young child nutrition and health, with a focus on promoting breastfeeding as well as appropriate and timely CF. In this paper, we share our concerns about aspects of the guideline, some of which may have the potential to cause unintended harm in infants and young children and suggest alternative or modified proposals.
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Mastitis represents a spectrum of inflammatory conditions. Lactational mastitis is the most common, with an approximate incidence of 10% in the United States, and it usually occurs in the first 3 months postpartum. Diagnosis is made clinically based on the presence of symptoms such as fever, malaise, focal breast tenderness, and overlying skin erythema or hyperpigmentation without the need for laboratory tests or imaging. However, obtaining milk cultures should be considered to guide antibiotic therapy, and ultrasonography should be performed to identify abscesses in immuno-compromised patients or those with worsening or recurrent symptoms. Because most cases of mastitis are caused by inflammation and not a true infection, a 1- to 2-day trial of conservative measures (i.e., nonsteroidal anti-inflammatory drugs, ice application, feeding the infant directly from the breast, and minimizing pumping) is often sufficient for treatment. If there is no improvement in symptoms, narrow-spectrum antibiotics may be prescribed to cover common skin flora (e.g., Staphylococcus, Streptococcus). Most patients can be treated as outpatients with oral antibiotics; however, if the condition worsens or there is a concern for sepsis, intravenous antibiotics and hospital admission may be required. Use of probiotics for treatment or prevention is not supported by good evidence. Factors that increase the risk of mastitis include overstimulation of milk production and tissue trauma from aggressive breast massage; therefore, frequent overfeeding, excessive pumping to empty the breast, heat application, and breast massage are no longer recommended because they may worsen the condition. The best prevention is a proper lactation technique, including a good infant latch, and encouraging physiologic breastfeeding rather than pumping, if possible.
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Lactational mastitis is a maternal morbidity that affects the wellbeing of women and their babies, including through breastfeeding discontinuation.
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Commercial dairy establishments are relatively young in the United Arab Emirates (UAE), and as a result, there is lack of epidemiological data on mastitis in dairy farms.
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Climate change is a major risk factor for overall health, including reproductive health, and well-being. Increasing temperatures, due mostly to increased greenhouse gases trapping excess heat in the atmosphere, result in erratic weather patterns, wildfires, displacement of large communities, and stagnant water resulting in vector-borne diseases that, together, have set the stage for new and devastating health threats across the globe. These conditions disproportionately affect disadvantaged and vulnerable populations, including women, pregnant persons, young children, the elderly, and the disabled. This review reports on the evidence for the adverse impacts of air pollution, wildfires, heat stress, floods, toxic chemicals, and vector-borne diseases on male and female fertility, the developing fetus, and obstetric outcomes. Reproductive health care providers are uniquely positioned and have an unprecedented opportunity to educate patients and policy makers about mitigating the impact of climate change to assure reproductive health in this and future generations.Copyright © 2022. Published by Elsevier Inc.
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Many studies have reported the association between ambient temperature and mortality from cardiovascular disease (CVD). However, the health effects of humidity are still unclear, much less the combined effects of temperature and humidity. In this study, we used humidex to quantify the effect of temperature and humidity combined on CVD mortality.
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Various epidemiological studies have focused on the adverse health outcomes of meteorological factors. However, there has been little research on the impact of humidex on allergic conjunctivitis, especially in child and adolescent populations. We aimed to explore the impact of humidex, a comprehensive index of relative humidity and temperature, on child and adolescent allergic conjunctivitis admissions.Outpatient visit data for allergic conjunctivitis, meteorological factors and air pollutants in Shanghai for the 2017-2022 period were retrieved. For the purpose of analysing the nonlinear connection and lag impact between humidex and admissions for paediatric and adolescent allergic conjunctivitis, the distributed lag nonlinear model (DLNM) was fitted.A total of 147 090 cases were included in our cohort. We found a significantly nonlinear effect on humidex and allergic conjunctivitis. In the single-day lag pattern, the relative risks (RR) of allergic conjunctivitis were significant at lag 0 (RR = 1.08, 95% confidence interval (CI) = 1.05-1.11) to lag 2 (RR = 1.01, 95% CI = 1.00-1.01), lag 5 (RR = 1.01, 95% CI = 1.00-1.01) to lag 9 (RR = 1.01, 95% CI = 1.00-1.01), and lag 14 (RR = 1.02, 95% CI: 1.01-1.03). In the cumulative-lag day pattern, the RR of allergic conjunctivitis were significant at lag 0-0 (RR = 1.08, 95% CI = 1.05-1.11) to lag 0-14 (RR = 1.21, 95% CI = 1.13-1.28). We found that boys, children aged 7-17 years, and children in the warm season were more vulnerable to humidex. In addition, the highest attributable fraction (AF) and attributable number (AN) of humidex are at lag 0-14 (AF = 0.17, AN = 25 026).Humidex exposure markedly increased the risk of allergic conjunctivitis, especially in highly high humidex. Appropriate public health management is needed for disease management and early intervention.Copyright © 2023 by the Journal of Global Health. All rights reserved.
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Preterm birth (PTB) is associated with adverse health outcomes. The outcomes of heat exposure during pregnancy and the moderating association of greenness with PTB remain understudied.
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The climate crisis poses profound risks to women particularly during pregnancy. With rising global temperatures and increasing frequency of extreme weather events, there is an urgent need for health initiatives and guidelines tailored to the unique vulnerabilities of pregnant individuals. We conducted a review of English-language literature from 2000–2024 using PubMed, Scopus, and Web of Science, focusing on “climate change,” “pregnancy,” and “maternal health,” and included original studies, reviews. Relevant policy documents, including some published in 2025 were also included. We examine the multifaceted challenges posed by climate change, such as extreme weather events, water scarcity, malnutrition, and exposure to environmental pollutants like contaminated air and water, which directly and indirectly affect maternal and fetal health. The review explores the associations between these environmental stressors and adverse pregnancy outcomes, including preterm births, low birth weight, and developmental complications. These challenges are compounded in low-resource settings where healthcare infrastructure is limited, exacerbating inequities in maternal care. Furthermore, we focus on key areas for further investigation, including the long-term health effects of in-utero exposure to pollutants. The review addresses evidence-based strategies to reduce the environmental impact of healthcare through early interventions, innovation, and strengthened initiatives. It emphasises empowering healthcare professionals to educate others, raise awareness among policymakers, advocate for climate-conscious policies, and promote sustainable practices reducing the carbon footprint of the healthcare system, with a focus on the UK. In response to these pressing concerns, leading professional organizations, such as the Royal College of Obstetricians and Gynaecologists (RCOG) in the UK, and the American College of Obstetricians and Gynaecologists (ACOG) in the US, are prioritizing the intersection of climate change and women's health. Their initiatives, which aim to mitigate the climate-change impacts on pregnancies and fetal health by promoting research, raising awareness, and developing actionable strategies, are also highlighted. By amplifying awareness and global collaboration, the suggested strategies aim to protect maternal and fetal health in the face of an escalating climate crisis.
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Allergic rhinitis (AR) is an allergic disease induced by the T helper 2 (TH2) lymphocyte immune response, where its mediators are the primary cause of clinical symptoms. Environmental factors are the primary determinants of the allergic response in genetically susceptible individuals. This study investigates the effects of climate conditions (warm, cold, humid, and dry) on allergic rhinitis. AR models were created in mice under 4 different conditions. We investigated AR-related behavior (sneezing and nose rubbing), as well as total immunoglobulin E (IgE), histamine, interleukin-4 (IL-4), leukotriene (LT) B4 and LTC4 levels, and gene expression of CysLT1R, HRH1, and MUC5a. Nose rubbing, histamine levels, and the expression of MUC5a and HRH1 were increased in AR models in cold conditions, and sneezing was increased in AR models kept in dry conditions. LTB4 and LTC4 levels and the expression of CysLT1R in AR models kept in a wet environment also significantly increased compared with the control group. The levels of total IgE and IL-4 showed no significant changes. Air temperature and humidity affect AR pathophysiology, and weather conditions can be essential in controlling AR.
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The present narrative review explores the multifactorial aetiology of rheumatoid arthritis (RA) and other immunemediated inflammatory disorders (IMIDs), emphasising the significant role of various environmental factors in disease development and exacerbation. Key modifiable environmental factors such as cigarette smoking and air pollution are identified as major contributors to RA. We will also focus on the influence of weather, seasonality, and particularly vitamin D levels, on RA activity, suggesting potential for seasonal management and supplementation to mitigate disease severity. The emerging role of diet and the gut microbiome in RA pathogenesis and progression is discussed as well, with dietary interventions and specific nutrients like omega-3 fatty acids offering protective benefits against inflammation. Despite the mounting evidence around these factors, further research is needed, to better understand the clinical impacts on RA, including well-designed randomised clinical trials.
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Prolactin (PRL) is a peptide hormone secreted from anterior pituitary involved in milk production in the females and regulation of sex drive in both sexes. PRL has pro-inflammatory and anti-inflammatory functions. High PRL serum level or hyperprolactinemia is associated with different viral infections. In coronavirus disease 2019 (Covid-19), which caused by positive-sense single-strand RNA virus known as severe acute respiratory distress syndrome coronavirus type 2 (SARS-CoV-2), PRL serum level is increased. PRL in Covid-19 may exacerbate the underlying inflammatory status by induction release of pro-inflammatory cytokines. However, PRL through its anti-inflammatory effects may reduce the hyperinflammatory status in Covid-19. The underlying mechanism of increasing PRL in Covid-19 is poorly understood. Therefore, in this review we try to find the potential anti-inflammatory or pro-inflammatory role of PRL in Covid-19. As well, this review was aimed to discuss the underlying causes and mechanisms for Covid-19-induced hyperprolactinemia.© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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