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Background:Although adverse effects of high temperature on mortality have been studied extensively in urban areas, little is known of the heat–mortality associations outside of cities.Objective:We investigated whether heat–mortality associations differed between urban and nonurban areas and how urbanicity affected the vulnerability to heat-related mortality.Methods:We first analyzed heat-related mortality risk in each of 102 counties in Jiangsu Province, China, during 2009–2013 using a distributed-lag nonlinear model. The county-specific estimates were then pooled for more urban (percentage of urban population ≥ 57.11%) and less urban (percentage of urban population < 57.11%) counties using a Bayesian hierarchical model. To explain the spatial variation in associations by county, county-level characteristics affecting heat vulnerability were also examined.Results:We found that the overall mortality risk comparing the 99th vs. 75th percentiles of temperature was 1.43 [95% posterior intervals (PI): 1.36, 1.50] in less urban counties and 1.26 (95% PI: 1.23, 1.30) in more urban counties. The heat effects on cardiorespiratory mortality followed a similar pattern. Higher education level and prevalence of air conditioning were significantly associated with counties having lower risks, whereas percentage of elderly people was significantly associated with increased risks.Conclusion:Our findings reveal that nonurban areas have significant heat-related mortality risks in Jiangsu, China. These results suggest the need for enhanced adaptation planning in Chinese nonurban areas under a changing climate.Citation:Chen K, Zhou L, Chen X, Ma Z, Liu Y, Huang L, Bi J, Kinney PL. 2016. Urbanization level and vulnerability to heat-related mortality in Jiangsu Province, China. Environ Health Perspect 124:1863–1869; http://dx.doi.org/10.1289/EHP204

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To investigate the effect of stress before pregnancy on memory function and serum corticosterone (COR) levels, as well as the expression of brain-derived neurotrophic factor (BDNF), N-methyl-D-aspartate (NMDA) 2A (NR2A) and 2B (NR2B) receptors in the hippocampus of the offspring rats when they were 2 months postnatally. Adult female Sprague-Dawley (SD) rats were divided randomly into two groups: control group (n = 8) and chronic unpredictable stress (CUS) group (n = 12). All rats were tested in the open field test and sucrose intake test before and after CUS. The memory function of their offspring were tested in the Morris water maze. Serum COR levels were determined by using a standard radioimmunoassay kit. The expression of BDNF, NR2A and NR2B in the hippocampus of the offspring rats were studied by immunoreactivity quantitative analysis and real-time RT-PCR. (1) Following CUS, reduced open field test activity and decreased sucrose consumption were observed relative to controls. (2) The Morris water maze task demonstrated increased escape latency in the offspring rats of CUS group relative to controls (P < 0.01). No-platform probe testing showed reduced crossings for offspring of CUS relative to controls (P < 0.05). (3) CUS induced a significant increase in serum COR levels of the offspring rats (P < 0.01), but no difference was observed in the body or brain weight between the offspring of the two groups. (4) Immunoreactivity quantitative analysis shows that BDNF and NR2B in the offspring of CUS group was decreased in the CA3 and DG regions of the hippocampus compared to the control group offspring, but NR2A levels were not altered between the offspring of the two groups. (5) Real-time RT-PCR demonstrated that BDNF and NR2B mRNAs were significantly decreased in the offspring of the CUS group compared with the control group (P < 0.01). No significant difference in the levels of NR2A mRNA was detected between offspring of CUS and offspring of control groups. In our study, pregestational stress can increase serum corticosterone levels and reduce the expression of BDNF and NR2B in the hippocampus of offspring. These alterations are associated with impairment of memory in the adult offspring. These data suggest that, stress before pregnancy might have a profound influence on brain development of offspring, that may persist into and be manifested in adulthood.

Objective: Our objective is to validate the effectiveness of the Global Leadership Initiative on Malnutrition (GLIM) criteria in malnutrition diagnosis compared with Patient-Generated Subjective Global Assessment (PG-SGA) and assess the impact of malnutrition diagnosed using GLIM criteria on the clinical outcomes of patients with GC. Methods:We retrospectively analyzed the data of 895 patients who underwent radical gastrectomy at the First Affiliated Hospital of Wenzhou Medical University. Nutrition assessment was performed on all patients according to the GLIM criteria and PG-SGA.The κ statistic was used to evaluate the agreement between two methods. Multivariate logistic regression and Cox regression based on single-factor analysis were used to predict postoperative complications and overall survival rates.Results: Based on the GLIM criteria, 38.3% of the patients were diagnosed as malnourished, including 21.7% Stage I (moderate malnutrition) and 16.6% Stage II (severe malnutrition). GLIM criteria had a moderate agreement with PG-SGA (κ = 0.548).Patients in the Stage II malnutrition group had a higher incidence of complications, a longer postoperative length of stay, and higher hospitalization costs. Logistic regression showed that Stage II malnutrition was an independent risk predictor of postoperative complications (odds ratio, 3.28; 95% confidence interval [CI], 2.18-4.94). Furthermore, Cox regression analysis showed that both Stage I (hazard ratio [HR], 1.52; 95% CI, 1.11-2.07; P = .009) and Stage II (HR, 1.85; 95% CI, 1.34-2.53; P < .001) malnutrition were independent risk predictors of overall survival. Conclusion:Diagnosis of malnutrition according to the GLIM criteria is useful in predicting the adverse postoperative clinical outcomes of patients with gastric cancer.

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