Q fever prevention: Perspectives from university animal science and veterinary students and livestock farmers.

OBJECTIVE: To explore animal science and veterinary students' and livestock farmers' perceptions concerning Q fever prevention. DESIGN: An online survey with an open-ended question seeking knowledge and perceptions about Q fever prevention was distributed among participants during March-September 2019. We applied thematic analysis to identify emerging themes. SETTING: Animal science and veterinary students enrolled at the University of Adelaide and members of Livestock South Australia representing cattle, sheep and goat farmers in South Australia. PARTICIPANTS: A total of56 animal science and veterinary students and 154 livestock farmers responded to the open-ended question. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Perceived challenges and opportunities for a coordinated Q fever prevention approach including human vaccination reported by the participants. RESULTS: Two major themes arose in each group. Students and farmers viewed Q fever vaccination as important. However, excessive cost for students was a barrier and for farmers, it was general practitioners' lack of knowledge of Q fever and access to an accredited immunisation provider. Similarly, both groups highlighted the need for education and increasing public and community awareness of Q fever. CONCLUSION: Our findings underscore that a sector-wide approach involving community awareness programmes, education and training for general practitioners, and subsidised vaccination as well as commitment from government and industry partners may contribute to reducing the burden of Q fever among at-risk populations.

Public health professionals' perceptions of the capacity of China's CDCs to address emerging and re-emerging infectious diseases.

BACKGROUND: China's capacity to control and prevent emerging and re-emerging infectious diseases is critical to the nation's population health. This study aimed to explore the capacity of Centers for Disease Control and Prevention (CDCs) in China to deal with infectious diseases now and in the future. METHODS: A survey was conducted in 2015 among 973 public health professionals at CDCs in Beijing and four provinces, to assess their capacity to deal with emerging and re-emerging infectious diseases. RESULTS: Although most professionals were confident with the current capacity of CDCs to cope with outbreaks, nearly all indicated more funding was required to meet future challenges. Responses indicated that Yunnan Province faced more challenges than Anhui, Henan and Liaoning Provinces in being completely prepared and able to deal with outbreaks. Participants aged 20-39 years were more likely than those aged 40 and over to believe strategies such as interdisciplinary and international collaborations for disease surveillance and control, would assist capacity building. CONCLUSION: The capacity of China's CDCs to deal with infectious diseases was excellent. However, findings suggest it is imperative to increase the number of skilled CDC staff, financial support, and strengthen county level staff training and health education programs.

The 2019 report of the MJA-Lancet Countdown on health and climate change: a turbulent year with mixed progress.

The MJA-Lancet Countdown on health and climate change was established in 2017 and produced its first Australian national assessment in 2018. It examined 41 indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. It found that, overall, Australia is vulnerable to the impacts of climate change on health, and that policy inaction in this regard threatens Australian lives. In this report we present the 2019 update. We track progress on health and climate change in Australia across the same five broad domains and many of the same indicators as in 2018. A number of new indicators are introduced this year, including one focused on wildfire exposure, and another on engagement in health and climate change in the corporate sector. Several of the previously reported indicators are not included this year, either due to their discontinuation by the parent project, the Lancet Countdown, or because insufficient new data were available for us to meaningfully provide an update to the indicator. In a year marked by an Australian federal election in which climate change featured prominently, we find mixed progress on health and climate change in this country. There has been progress in renewable energy generation, including substantial employment increases in this sector. There has also been some progress at state and local government level. However, there continues to be no engagement on health and climate change in the Australian federal Parliament, and Australia performs poorly across many of the indicators in comparison to other developed countries; for example, it is one of the world's largest net exporters of coal and its electricity generation from low carbon sources is low. We also find significantly increasing exposure of Australians to heatwaves and, in most states and territories, continuing elevated suicide rates at higher temperatures. We conclude that Australia remains at significant risk of declines in health due to climate change, and that substantial and sustained national action is urgently required in order to prevent this.

The MJA-Lancet Countdown on health and climate change: Australian policy inaction threatens lives.

Climate plays an important role in human health and it is well established that climate change can have very significant impacts in this regard. In partnership with The Lancet and the MJA, we present the inaugural Australian Countdown assessment of progress on climate change and health. This comprehensive assessment examines 41 indicators across five broad sections: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. These indicators and the methods used for each are largely consistent with those of the Lancet Countdown global assessment published in October 2017, but with an Australian focus. Significant developments include the addition of a new indicator on mental health. Overall, we find that Australia is vulnerable to the impacts of climate change on health, and that policy inaction in this regard threatens Australian lives. In a number of respects, Australia has gone backwards and now lags behind other high income countries such as Germany and the United Kingdom. Examples include the persistence of a very high carbon-intensive energy system in Australia, and its slow transition to renewables and low carbon electricity generation. However, we also find some examples of good progress, such as heatwave response planning. Given the overall poor state of progress on climate change and health in Australia, this country now has an enormous opportunity to take action and protect human health and lives. Australia has the technical knowhow and intellect to do this, and our annual updates of this assessment will track Australia's engagement with and progress on this vitally important issue.

Heatwave and urinary hospital admissions in China: Disease burden and associated economic loss, 2014 to 2019.

BACKGROUND: Many studies have shown that heatwaves are associated with an increased prevalence of urinary diseases. However, few national studies have been undertaken in China, and none have considered the associated economic losses. Such information would be useful for health authorities and medical service providers to improve their policy-making and medical resource allocation decisions. OBJECTIVES: To explore the association between heatwaves and hospital admissions for urinary diseases and assess the related medical costs and indirect economic losses in China from 2014 to 2019. METHODS: Daily meteorological and hospital admission data from 2014 to 2019 were collected from 23 study sites with different climatic characteristics in China. We assessed the heatwave-hospitalization associations and evaluated the location-specific attributable fractions (AFs) of urinary-related hospital admissions due to heatwaves by using a time-stratified case-crossover method with a distributed lag nonlinear model. We then pooled the AFs in a meta-analysis and estimated the national excess disease burden and associated economic losses. We also performed stratified analyses by sex, age, climate zone, and urinary disease subtype. RESULTS: A significant association between heatwaves and urinary-related hospital admissions was found with a relative risk of 1.090 (95 % confidence interval (CI): 1.050, 1.132). The pooled AF was 8.27 % (95%CI: 4.77 %, 11.63 %), indicating that heatwaves during the warm season (May to September) caused 248,364 urinary-related hospital admissions per year, with 2.42 (95%CI: 1.35, 3.45) billion CNY in economic losses, including 2.23 (95%CI: 1.29, 3.14) billion in direct losses and 0.19 (95%CI, 0.06, 0.31) billion in indirect losses, males, people aged 15-64 years, residents of temperate continental climate zones, and patients with urolithiasis were at higher risk. CONCLUSION: Tailored community health campaigns should be developed and implemented to reduce the adverse health effects and economic losses of heatwave-related urinary diseases, especially in the context of climate change.

Q fever prevention in Australia: general practitioner and stakeholder perspectives on preparedness and the potential of a One Health approach.

OBJECTIVE: To examine stakeholder perspectives on the factors of an effective approach to reduce Q fever risk including disease prevention, and the perceived potential benefits of a One Health framework. METHODS: Semi-structured interviews were conducted with general practitioners (GPs), veterinarians, government authorities, researchers, and representatives from the farming industry. Transcripts were thematically analysed. RESULTS: Six major themes were identified as key factors underpinning an effective approach to Q fever: understanding Q fever burden; effective surveillance; the role of general practitioners and other stakeholders; barriers and enablers of vaccination; an integrated approach; and increased Q fever awareness. Most participants perceived GPs to play a central role in disease detection, notification, treatment and prevention through health promotion and vaccination, despite GPs acknowledging limited awareness of Q fever. Participants suggested leadership is required from the Department of Health (DoH) to foster inter-sectoral communication and collaboration. CONCLUSIONS: A One Health approach holds opportunities for zoonosis prevention. We recommend that medical curricula and professional development be enhanced, zoonosis working group networks strengthened, government-industry partnerships established, and relevant stakeholders included within an integrated program. IMPLICATIONS FOR PUBLIC HEALTH: Updating medical curricula, GP professional development programs and inter-sectoral collaboration led by health departments may reduce Q fever burden.

Evaluating cost benefits from a heat health warning system in Adelaide, South Australia.

OBJECTIVE: To examine the cost benefits of a heat health warning system (HHWS) in South Australia. METHODS: Information from key agencies was used to estimate the costs associated with the South Australian HHWS, including for three targeted public health interventions. Health cost savings were estimated based on previously reported HHWS-attributable reductions in hospital and emergency department (ED) admissions and ambulance callouts. RESULTS: The estimated cost for a one-week activation of the HHWS was AU$593,000. Activation costs compare favourably with the potential costs averted through HHWS-attributable reductions in hospital admissions and ambulance callouts with an estimated benefit-cost ratio of 2.0-3.3. CONCLUSIONS: On the basis of estimated cost benefit, the South Australian HHWS is a no-regret public health response to heatwaves. IMPLICATIONS FOR PUBLIC HEALTH: As global temperatures rise there are likely to be significant health impacts from more frequent and intense heatwaves. This study indicates that HHWSs incorporating targeted supports for vulnerable groups are likely to be cost-effective public health interventions.

Extreme heat arrangements in South Australia: an assessment of trigger temperatures.

ISSUE ADDRESSED: The high mortality and morbidity associated with the 2009 heat wave across South Eastern Australia highlighted the need for effective heat-related health promotion and preventive strategies. The adverse health effects of extreme heat are largely preventable, and heat-related health promotion can advise the public about the dangers of hot weather and how to reduce health risks. The South Australian State Emergency Service has outlined a co-ordinated response system in their Extreme Heat Arrangements for South Australia. This paper evaluates the health impacts at the temperature trigger levels incorporated in this plan. METHODS: Heat events in Adelaide between 1994 and 2009 were compared in terms of heat duration, heat intensity and their impact on mortality and ambulance call-outs.The health impacts for events meeting specific temperature triggers were estimated. RESULTS: Individual heat events varied in terms of estimated excess mortality and ambulance call-outs. Increased mortality was associated with heat events of 3 or more consecutive days with maximum temperature (T(max)) > or = 43 degrees C or average daily temperature (ADT) > or = 34 degrees C, while ambulance call-outs increased significantly at lower T(max) levels.The two events reaching the temperature triggers for an extreme heat warning were associated with a 44% (95% CI 26-63%) increase in mortality. CONCLUSIONS: The results support the temperature trigger for an extreme heat warning within the Extreme Heat Arrangements for Adelaide, and indicate a limited health impact at lower temperature triggers.

Climate change and infectious disease research in Nepal: Are the available prerequisites supportive enough to researchers?

Although Nepal has been identified as a country highly vulnerable to adverse health and socioeconomic impacts arising from climate change, extant research on climate sensitive infectious diseases has yet to develop the evidence base to adequately address these threats. In this opinion paper we identify and characterise basic requirements that are hindering the progress of climate change and infectious disease research in Nepal. Our opinion is that immediate attention should be given to strengthening Nepal's public health surveillance system, promoting inter-sectoral collaboration, improving public health capacity, and enhancing community engagement in disease surveillance. Moreover, we advocate for greater technical support of public health researchers, and data sharing among data custodians and epidemiologists/researchers, to generate salient evidence to guide relevant public health policy formulation aimed at addressing the impacts of climate change on human health in Nepal. International studies on climate variability and infectious diseases have clearly demonstrated that climate sensitive diseases, namely vector-borne and food/water-borne diseases, are sensitive to climate variation and climate change. This research has driven the development and implementation of climate-based early warning systems for preventing potential outbreaks of climate-sensitive infectious diseases across many European and African countries. Similarly, we postulate that Nepal would greatly benefit from a climate-based early warning system, which would assist in identification or prediction of conditions suitable for disease emergence and facilitate a timely response to reduce mortality and morbidity during epidemics.

Using a Qualitative Phenomenological Approach to Inform the Etiology and Prevention of Occupational Heat-Related Injuries in Australia.

Epidemiological evidence has shown an association between exposure to high temperatures and occupational injuries, an issue gaining importance with environmental change. The aim of this study was to better understand contributing risk factors and preventive actions based on personal experiences. Interviews were conducted with 21 workers from five Australian states using a critical phenomenological approach to capture the lived experiences of participants, whilst exploring contextual factors that surround these experiences. Two case studies are presented: a cerebrovascular injury and injuries among seasonal horticulture workers. Other accounts of heat-related injuries and heat stress are also presented. Risk factors were classified as individual, interpersonal and organizational. In terms of prevention, participants recommended greater awareness of heat risks and peer-support for co-workers. Adding value to current evidence, we have provided new insights into the etiology of the health consequences of workplace heat exposure with workers identifying a range of influencing factors, prevention measures and adaptation strategies. Underpinning the importance of these are future climate change scenarios, suggesting that extended hot seasons will lead to increasing numbers of workers at risk of heat-stress and associated occupational injuries.

Global warming and Australian public health: reasons to be concerned.

Studies in global warming and climate change indicate that human populations will be deleteriously affected in the future. Studies forecast that Australia will experience increasing heat waves and droughts. Heat stress caused by frequent heat waves will have a marked effect on older Australians due to physiological and pharmacological factors. In this paper we present an overview of some of the foreseeable issues which older Australians will face from a public health perspective.

Is a One Health Approach Utilized for Q Fever Control? A Comprehensive Literature Review.

Q fever, a zoonotic disease transmitted from animals to humans, is a significant public health problem with a potential for outbreaks to occur. Q fever prevention strategies should incorporate human, animal, and environmental domains. A One Health approach, which engages cross-sectoral collaboration among multiple stakeholders, may be an appropriate framework and has the underlying principles to control Q fever holistically. To assess whether components of One Health for Q fever prevention and control have been applied, a comprehensive literature review was undertaken. We found 16 studies that had practiced or recommended a One Health approach. Seven emerging themes were identified: Human risk assessment, human and animal serology, integrated human⁻animal surveillance, vaccination for at-risk groups, environmental management, multi-sectoral collaboration, and education and training. Within the multi-sectoral theme, we identified five subthemes: Policy and practice guidelines, information sharing and intelligence exchange, risk communication, joint intervention, and evaluation. One Health practices varied between studies possibly due to differences in intercountry policy, practice, and feasibility. However, the key issue of the need for multi-sectoral collaboration was highlighted across most of the studies. Further research is warranted to explore the barriers and opportunities of adopting a One Health approach in Q fever prevention and control.

Heat Health Messages: A Randomized Controlled Trial of a Preventative Messages Tool in the Older Population of South Australia.

This study explores the efficacy of providing targeted information to older individuals to prevent adverse health outcomes during extreme heat. Participants ≥65 years of age (n = 637) were recruited from previous population-based studies and randomized into intervention and control groups. The intervention group received evidence-based information leaflets and summarised "Beat the Heat" tips. Post summer 2013-2014, participants responded to questions about their behaviours and their health experiences. Chi square analysis and risk ratios (RR) were used to determine the difference in effects. Responses were received from 216 intervention subjects and 218 controls. Behaviour modification during extreme heat was similar in both groups except for significant increases in the use of cooling systems and the use of a wet cloth to cool the skin in the intervention group. Both actions were recommended in the information package. More people in the intervention group also claimed to have had adequate heat health information. After adjusting for confounders, the RR for self-reported heat stress experienced during summer 2014 indicated a 63% (RR 0.37; 95% CI: 0.22-0.63) reduction in the intervention group compared to the control group. Access to intensive prevention information may have contributed to this positive outcome, indicating the potential usefulness of targeted heat-health information for seniors.

Health impacts of workplace heat exposure: an epidemiological review.

With predicted increasing frequency and intensity of extremely hot weather due to changing climate, workplace heat exposure is presenting an increasing challenge to occupational health and safety. This article aims to review the characteristics of workplace heat exposure in selected relatively high risk occupations, to summarize findings from published studies, and ultimately to provide suggestions for workplace heat exposure reduction, adaptations, and further research directions. All published epidemiological studies in the field of health impacts of workplace heat exposure for the period of January 1997 to April 2012 were reviewed. Finally, 55 original articles were identified. Manual workers who are exposed to extreme heat or work in hot environments may be at risk of heat stress, especially those in low-middle income countries in tropical regions. At risk workers include farmers, construction workers, fire-fighters, miners, soldiers, and manufacturing workers working around process-generated heat. The potential impacts of workplace heat exposure are to some extent underestimated due to the underreporting of heat illnesses. More studies are needed to quantify the extent to which high-risk manual workers are physiologically and psychologically affected by or behaviourally adapt to workplace heat exposure exacerbated by climate change.

Projected burden of disease for Salmonella infection due to increased temperature in Australian temperate and subtropical regions.

OBJECTIVE: This study aimed to project the future disability burden of Salmonella infection associated with increased temperature in future in temperate and subtropical regions of Australia in order to provide recommendations for public health policy to respond to climate change. METHODS: Years Lost due to Disabilities (YLDs) were used as the measure of the burden of disease in this study. Regions in temperate and subtropical Australia were selected for this study. Future temperature change scenarios in the study were based on Australian projections, developed by the Commonwealth Scientific and Industrial Research Organization (CSIRO). YLDs for Salmonella infection in 2000 were calculated as the baseline data. YLDs for Salmonella infection in 2030 and 2050 under future temperature change scenarios were projected based on the quantitative relationship between temperature and disease examined in previously published regression models. Future demographic change was also considered in this analysis. RESULTS: Compared with the YLDs in 2000, increasing temperature and demographic changes may lead to a 9%-48% increase in the YLDs for Salmonella infection by 2030 and a 31%-87% increase by 2050 in the temperate region, and a 51%-100% increase by 2030 and an 87%-143% increase by 2050 in the subtropical region, if other factors remain constant. CONCLUSION: Temperature-related health burden of Salmonella infection in Australia may increase in the future due to change in climate and demography in the absence of effective public health interventions. Relevant public health strategies should be developed at an early stage to prevent and reduce the health burden of climate change.

Climate change and infectious diseases in Australia: future prospects, adaptation options, and research priorities.

Climate change will have significant and diverse impacts on human health. These impacts will include changes in infectious disease incidence. In this article, the authors review the current situation and potential future climate change impacts for respiratory, diarrheal, and vector-borne diseases in Australia. Based on this review, the authors suggest adaptive strategies within the health sector and also recommend future research priorities.

Preparing health services for climate change in Australia.

Although the implications of climate change for public health continue to be elucidated, we still require much work to guide the development of a comprehensive strategy to underpin the adaptation of the health system. Adaptation will be an evolving process as impacts emerge. The authors aim is to focus on the responses of the Australian health system to health risks from climate change, and in particular how best to prepare health services for predicted health risks from heat waves, bushfires, infectious diseases, diminished air quality, and the mental health impacts of climate change. In addition, the authors aim to provide some general principles for health system adaptation to climate change that may be applicable beyond the Australian setting. They present some guiding principles for preparing health systems and also overview some specific preparatory activities in relation to personnel, infrastructure, and coordination. Increases in extreme weather-related events superimposed on health effects arising from a gradually changing climate will place additional burdens on the health system and challenge existing capacity. Key characteristics of a climate change-prepared health system are that it should be flexible, strategically allocated, and robust. Long-term planning will also require close collaboration with the nonhealth sectors as part of a nationwide adaptive response.

Effect of climate change on Australian rural and remote regions: what do we know and what do we need to know?

This paper addresses a very important issue in Australian rural and remote regions: the effects of climate change on various aspects including natural resources, agricultural activity, population health, and social and economic development. The objective is to briefly characterise the consequences of climate change in rural Australia and what we can do to prevent further impact in our rural communities.