Background: The occurrence of compound hot extreme (CHE) events in China is increasingly frequent. This study aimed to investigate the association between CHEs and all-cause mortality in Shandong Province and to estimate the attributable excess deaths. Methods: We collected daily data on weather, air pollution, and all-cause mortality at the subdistrict level in Shandong Province from 2013 to 2018. A CHE was defined as both daily maximum and minimum temperatures being higher than their historical 90th percentiles during 2013–2018 hot seasons. A case time-series analysis with a distributed lagged non-linear model was applied to analyze the subdistrict-specific association between different hot extremes and mortality risk, which were then pooled at the province level using meta-analysis. Results: Hot nights (RR = 1.44, 95%CI: 1.35–1.53) and CHEs (RR = 1.77, 95%CI: 1.64–1.90) were significantly associated with an increased mortality risk. CHEs had a greater effect for females (RR = 1.99, 95%CI: 1.81–2.19) and the elderly (>74 years) (RR = 2.14, 95%CI: 1.93–2.38) than their counterparts, respectively. Cardiovascular and respiratory deaths were more susceptible to CHEs than other deaths. Each year, 4888 (95%CI: 4133–5811) excess deaths in Shandong Province were attributable to CHEs, accounting for 2.60% (95%CI: 2.20–3.10%) of all-cause deaths and equating to 50 (95%CI: 42–58) deaths per 1,000,000 residents. The CHE-related mortality burden varied across subdistricts, with the highest occurring in the southeastern area and the lowest occurring in the northeastern and southwestern regions. Conclusion: CHEs and hot nights were substantially associated with excess deaths in Shandong Province, especially for females, the elderly, and residents living in the southeastern area. Our findings may facilitate the development of a heat alert warning system and preventive measures for vulnerable populations.

Background: To evaluate the effects of Urinary Sodium-to-Potassium Ratio Monitored Intensive Salt Reduction Intervention for Community Hypertensive Patients. Methods: This cluster randomized controlled trial was carried out between August 2023 and August 2024 in Yishui County, Shandong Province. All participants were asked to complete the blood and urine sample collection, anthropometric measurement, questionnaires at the baseline and one-year post-intervention survey, with dietary surveys conducted in a subset of participants. A total of 485 hypertensive patients aged 35 to 69 years from 15 villages were recruited at the baseline and randomly allocated in a 1:1:1 ratio to the control group, low-intensity intervention group, or high-intensity intervention group. The control group received management according to the Basic Public Health Service. The low-intensity intervention group received blood pressure monitoring, salt-restriction spoons, and health education. The high-intensity intervention group additionally received self-monitoring of salt intake and health lectures. Final survey was conducted after one year. Results: A total of 471 participants completed follow-up assessments. Compared with the control group, adjusted mixed linear model analysis showed that the systolic blood pressure decreased by 8.45 mmHg (95% confidence interval −13.57 to −3.33) in the low-intensity intervention group and 12.32 mmHg (−17.40 to −7.23) in the high-intensity intervention group. The effects of the high-intensity intervention were more pronounced, with salt intake decreasing by 2.98 g/d (−4.56 to −1.41) and spot urinary sodium-to-potassium ratio decreasing by 1.16 (−1.93 to −0.38). The knowledge and behaviors in intervention groups improved significantly. The intervention effect interacted with baseline hypertension grade (p for interaction = 0.017), with high-intensity intervention demonstrating greater blood pressure reductions in patients with grade 2 or 3 hypertension. Conclusions: The urinary sodium-to-potassium ratio monitored intensive salt reduction intervention was effective in lowering salt intake and blood pressure. Future efforts could integrate intensity salt reduction interventions and urinary sodium-to-potassium ratio monitoring into the Basic Public Health Service to improve health outcomes in hypertensive patients.

Objectives: This study aims to explore the association between the Mediterranean Diet (MD) pattern and the development of ischemic heart disease (IHD) in patients with diabetes mellitus (DM) to provide a scientific basis for the management of diabetic patients. Methods: Based on 7606 participants from the UK Biobank cohort, the adherence to the MD was assessed. The outcome indicator was the occurrence of IHD. Cox proportional hazards model was applied to estimate the Hazard ratios (HR) and 95% confidence interval (CI) of the Mediterranean Diet Score (MDS) and IHD, while trend analysis was performed using the Wald trend test. Subgroup and interaction analyses considered factors. Results: Among 7,606 diabetic patients with a mean follow-up of 13.04 years, a total of 1,173 new cases of IHD were reported. After multivariable adjustment, a higher MDS was negatively associated with the incidence of IHD in diabetic patients. Additionally, compared with the Q1 group, the Q4 group had a 18.5% lower risk of IHD occurrence. Trend tests were statistically significant ( P -values < 0.001 for all four models). Subgroup analyses showed benefits in white people, males, high-income earners, non smokers and previous smokers, but a positive association in current smokers. Only gender, income, and smoking showing multiplicative interactions with MDS. Sensitivity analysis demonstrated effect modification by physical activity and education level, which was not observed in the primary analysis. Conclusions: The MD pattern can effectively reduce the incidence of IHD in diabetic patients, and gender, income and smoking have modifying effects on the MD pattern.