Lung function changes in children exposed to mine fire smoke in infancy.

BACKGROUND AND OBJECTIVE: Chronic, low-intensity air pollution exposure has been consistently associated with reduced lung function throughout childhood. However, there is limited research regarding the implications of acute, high-intensity air pollution exposure. We aimed to determine whether there were any associations between early life exposure to such an episode and lung growth trajectories. METHODS: We conducted a prospective cohort study of children who lived in the vicinity of the Hazelwood coalmine fire. Lung function was measured using respiratory oscillometry. Z-scores were calculated for resistance (R5 ) and reactance at 5 Hz (X5 ) and area under the reactance curve (AX). Two sets of analyses were conducted: (i) linear regression to assess the cross-sectional relationship between post-natal exposure to mine fire-related particulate matter with an aerodynamic diameter of less than 2.5 micrometres (PM2.5 ) and lung function at the 7-year follow-up and (ii) linear mixed-effects models to determine whether there was any association between exposure and changes in lung function between the 3- and 7-year follow-ups. RESULTS: There were no associations between mine fire-related PM2.5 and any of the lung function measures, 7-years later. There were moderate improvements in X5 (ß: -0.37 [-0.64, -0.10] p = 0.009) and AX (ß: -0.40 [-0.72, -0.08] p = 0.014), between the 3- and 7-year follow-ups that were associated with mean PM2.5 , in the unadjusted and covariance-adjusted models. Similar trends were observed with maximum PM2.5 . CONCLUSION: There was a moderate improvement in lung stiffness of children exposed to PM2.5 from a local coalmine fire in infancy, consistent with an early deficit in lung function at 3-years after the fire that had resolved by 7-years.

Pyrogeography in flux: Reorganization of Australian fire regimes in a hotter world.

Changes to the spatiotemporal patterns of wildfire are having profound implications for ecosystems and society globally, but we have limited understanding of the extent to which fire regimes will reorganize in a warming world. While predicting regime shifts remains challenging because of complex climate-vegetation-fire feedbacks, understanding the climate niches of fire regimes provides a simple way to identify locations most at risk of regime change. Using globally available satellite datasets, we constructed 14 metrics describing the spatiotemporal dimensions of fire and then delineated Australia's pyroregions-the geographic area encapsulating a broad fire regime. Cluster analysis revealed 18 pyroregions, notably including the (1) high-intensity, infrequent fires of the temperate forests, (2) high-frequency, smaller fires of the tropical savanna, and (3) low-intensity, diurnal, human-engineered fires of the agricultural zones. To inform the risk of regime shifts, we identified locations where the climate under three CMIP6 scenarios is projected to shift (i) beyond each pyroregion's historical climate niche, and (ii) into climate space that is novel to the Australian continent. Under middle-of-the-road climate projections (SSP2-4.5), an average of 65% of the extent of the pyroregions occurred beyond their historical climate niches by 2081-2100. Further, 52% of pyroregion extents, on average, were projected to occur in climate space without present-day analogues on the Australian continent, implying high risk of shifting to states that also lack present-day counterparts. Pyroregions in tropical and hot-arid climates were most at risk of shifting into both locally and continentally novel climate space because (i) their niches are narrower than southern temperate pyroregions, and (ii) their already-hot climates lead to earlier departure from present-day climate space. Such a shift implies widespread risk of regime shifts and the emergence of no-analogue fire regimes. Our approach can be applied to other regions to assess vulnerability to rapid fire regime change.

Understanding the perspectives and needs of multiple stakeholders: Identifying key elements of a digital health intervention to protect against environmental hazards.

AirRater is a free environmental health smartphone app developed and available in Australia that collects individual health data and disseminates environmental hazard information to populations. Following previous evaluations with app users, the aim of this study was to better understand how clinicians, government agency and non-government advocacy group representatives perceive an app designed to reduce the impacts of environmental hazards on individual and public health. Nine government agency and non-government advocacy group representatives, along with 11 clinicians based in Australia participated in a semi-structured interview or focus group to explore perspectives on AirRater. Interview and focus group data were transcribed and analysed using the qualitative data analysis software NVivo. Results indicate that for clinicians, apps like AirRater can add value as an educational, patient self-management and diagnostic tool. For government and peak bodies, apps can add value by addressing environmental health literacy and monitoring and forecasting gaps, as well as supporting advocacy efforts and public health surveillance. We conclude that environmental health smartphone apps can support a range of stakeholders to achieve shared goals and priorities related to individual and public health outcomes. Further research is needed to better understand how apps could be embedded into clinical practice and policy settings.

Exposure to air pollution concentrations of various intensities in early life and allergic sensitisation later in childhood.

BACKGROUND: Evidence on the relationship between air pollution and allergic sensitisation in childhood is inconsistent, and this relationship has not been investigated in the context of smoke events that are predicted to increase with climate change. Thus, we aimed to evaluate associations between exposure in two early life periods to severe levels of particulate matter with an aerodynamic diameter < 2.5 µm (PM2.5) from a mine fire, background PM2.5, and allergic sensitisation later in childhood. METHODS: We measured specific immunoglobulin E (IgE) levels for seven common aeroallergens as well as total IgE levels in a cohort of children who had been exposed to the Hazelwood coal mine fire, either in utero or during their first two years of life, in a regional area of Australia where ambient levels of PM2.5 are generally low. We estimated personal exposure to fire-specific emissions of PM2.5 based on a high-resolution meteorological and pollutant dispersion model and detailed reported movements of pregnant mothers and young children during the fire. We also estimated the usual background exposure to PM2.5 at the residential address at birth using a national satellite-based land-use regression model. Associations between both sources of PM2.5 and sensitisation to dust, cat, fungi, and grass seven years after the fire were estimated with logistic regression, while associations with total IgE levels were estimated with linear regression. RESULTS: No association was found between the levels of exposure at either developmental stage to fire-related PM2.5 and allergic sensitisation seven years after the event. However, levels of background exposure were positively associated with sensitisation to dust (OR = 1.90, 95%CI = 1.12,3.21 per 1 µg/m3). CONCLUSIONS: Chronic but low exposure to PM2.5 in early life could be more strongly associated with allergic sensitisation in childhood than time-limited high exposure levels, such as the ones experienced during landscape fires.

Wildfire national carbon accounting: how natural and anthropogenic landscape fires emissions are treated in the 2020 Australian government greenhouse gas accounts report to the UNFCCC.

Greenhouse gas (GHG) accounting of emissions from land use, land-use change, and forestry necessarily involves consideration of landscape fire. This is of particular importance for Australia given that natural and human fire is a common occurrence, and many ecosystems are adapted to fire, and require periodic burning for plant regeneration and ecological health. Landscape fire takes many forms, can be started by humans or by lightning, and can be managed or uncontrolled. We briefly review the underlying logic of greenhouse gas accounting involving landscape fire in the 2020 Australian Government GHG inventory report. The treatment of wildfire that Australia chooses to enact under the internationally agreed guidelines is based on two core assumptions (a) that effects of natural and anthropogenic fire in Australian vegetation carbon stocks are transient and they return to the pre-fire level relatively quickly, and (b) that historically and geographically anomalous wildfires in forests should be excluded from national anthropogenic emission estimates because they are beyond human control. It is now widely accepted that anthropogenic climate change is contributing to increased frequency and severity of forest fires in Australia, therefore challenging assumptions about the human agency in fire-related GHG emissions and carbon balance. Currently, the national inventory focuses on forest fires; we suggest national greenhouse gas accounting needs to provide a more detailed reporting of vegetation fires including: (a) more detailed mapping of fire severity patterns; (b) more comprehensive emission factors; (c) better growth and recovery models from different vegetation types; (d) improved understanding how fires of different severities affect carbon stocks; and (e) improved analysis of the human agency behind the causes of emissions, including ignition types and fire-weather conditions. This more comprehensive accounting of carbon emissions would provide greater incentives to improve fire management practices that reduce the frequency, severity, and extent of uncontrolled landscape fires.

Mechanical treatments and prescribed burning can reintroduce low-severity fire in southern Australian temperate sclerophyll forests.

The establishment of sustainable, low-intensity fire regimes is a pressing global challenge given escalating risk of wildfire driven by climate change. Globally, colonialism and industrialisation have disrupted traditional fire management, such as Indigenous patch burning and silvo-pastoral practices, leading to substantial build-up of fuel and increased fire risk. The disruption of fire regimes in southeastern Tasmania has led to dense even-aged regrowth in wet forests that are prone to crown fires, and dense Allocasuarina-dominated understoreys in dry forests that burn at high intensities. Here, we investigated the effectiveness of several fire management interventions at reducing fire risk. These interventions involved prescribed burning or mechanical understorey removal techniques. We focused on wet and dry Eucalyptus-dominated sclerophyll forests on the slopes of kunanyi/Mt. Wellington in Hobart, Tasmania, Australia. We modelled potential fire behaviour in these treated wet and dry forests using fire behaviour equations based on measurements of fuel load, vegetation structure, understorey microclimate and regional meteorological data. We found that (a) fuel treatments were effective in wet and dry forests in reducing fuel load, though each targeted different layers, (b) both mechanical treatments and prescribed burning resulted in slightly drier, and hence more fire prone understorey microclimate, and (c) all treatments reduced predicted subsequent fire severity by roughly 2-4 fold. Our results highlight the importance of reducing fuel loads, even though fuel treatments make forest microclimates drier, and hence fuel more flammable. Our finding of the effectiveness of mechanical treatments in lowering fire risk enables managers to reduce fuels without the risk of uncontrolled fires and smoke pollution that is associated with prescribed burning. Understanding the economic and ecological costs and benefits of mechanic treatment compared to prescribed burning requires further research.

No association between in utero exposure to emissions from a coalmine fire and post-natal lung function.

BACKGROUND AND OBJECTIVE: Studies linking early life exposure to air pollution and subsequent impaired lung health have focused on chronic, low-level exposures in urban settings. We aimed to determine whether in utero exposure to an acute, high-intensity air pollution episode impaired lung function 7-years later. METHOD: We conducted a prospective cohort study of children who lived in the vicinity of a coalmine fire. Respiratory function was measured using the forced oscillation technique (FOT). Z-scores for resistance at 5 Hz (R5), reactance at 5 Hz (X5) and area under the reactance curve (AX) were calculated. Two sets of analyses were conducted to address two separate questions: (1) whether mine fire exposure (a binary indicator; conceived after the mine fire vs in utero exposed) was associated with the respiratory Z-scores; (2) whether there was any dose-response relationship between fire-related PM2.5 exposure and respiratory outcomes among those exposed. RESULTS: Acceptable lung function measurements were obtained from 79 children; 25 unexposed and 54 exposed in utero. Median (interquartile range) for daily average and peak PM2.5 for the exposed children were 4.2 (2.6 - 14.2) and 88 (52-225) µg/m3 respectively. There were no detectable differences in Z-scores between unexposed and exposed children. There were no associations between respiratory Z-scores and in utero exposure to PM2.5 (daily average or peak). CONCLUSION: There was no detectable effect of in utero exposure to PM2.5 from a local coalmine fire on post-natal lung function 7-years later. However, statistical power was limited.

Primary and pharmaceutical care usage concurrent associations with a severe smoke episode and low ambient air pollution in early life.

BACKGROUND: Due to climate change, landscape fires account for an increasing proportion of air pollution emissions, and their impacts on primary and pharmaceutical care are little understood. OBJECTIVES: To evaluate associations between exposure in two early life periods to severe levels of PM2.5 from a mine fire, background PM2.5, and primary and pharmaceutical care. METHODS: We linked records of births, general practitioner (GP) presentations and prescription dispensing for children born in the Latrobe Valley, Australia, 2012-2014, where a severe mine fire occurred in February-March 2014 in an area with otherwise low levels of ambient PM2.5. We assigned modelled exposure estimates for fire-related (cumulative over the fire and peak 24-hour average) and annual ambient PM2.5 to residential address. Associations with GP presentations and dispensing of prescribed medications in the first two years of life (exposure in utero) and in the two years post-fire (exposure in infancy) were estimated using two-pollutant quasi-Poisson regression models. RESULTS: Exposure in utero to fire-related PM2.5 was associated with an increase in systemic steroid dispensing (Cumulative: IRR = 1.11, 95%CI = 1.00-1.24 per 240 µg/m3; Peak: IRR = 1.15, 95%CI = 1.00-1.32 per 45 µg/m3), while exposure in infancy was associated with antibiotic dispensing (Cumulative: IRR = 1.05, 95%CI = 1.00-1.09; Peak: IRR = 1.06, 95%CI = 1.00-1.12). Exposure in infancy to ambient PM2.5, despite relatively low levels from a global perspective (Median = 6.1 µg/m3), was associated with an increase in antibiotics (IRR = 1.10, 95%CI = 1.01-1.19 per 1.4 µg/m3) and in GP presentations (IRR = 1.05, 95%CI = 1.00-1.11), independently from exposure to the fire. We also observed differences in associations between sexes with GP presentations (stronger in girls) and steroid skin cream dispensing (stronger in boys). DISCUSSION: Severe medium-term concentrations of PM2.5 were linked with increased pharmaceutical treatment for infections, while chronic low levels were associated with increased prescriptions dispensed for infections and primary care usage. Our findings also indicated differences between sexes.

Evaluating User Preferences, Comprehension, and Trust in Apps for Environmental Health Hazards: Qualitative Case Study.

BACKGROUND: Climate change is projected to increase environmental health hazard risks through fire-related air pollution and increased airborne pollen levels. To protect vulnerable populations, it is imperative that evidence-based and accessible interventions are available. The environmental health app, AirRater, was developed in 2015 in Australia to provide information on multiple atmospheric health hazards in near real time. The app allows users to view local environmental conditions, and input and track their personal symptoms to enable behaviors that protect health in response to environmental hazards. OBJECTIVE: This study aimed to develop insights into users' perceptions of engagement, comprehension, and trust in AirRater to inform the future development of environmental health apps. Specifically, this study explored which AirRater features users engaged with, what additional features or functionality needs users felt they required, users' self-perception of understanding app information, and their level of trust in the information provided. METHODS: A total of 42 adult AirRater users were recruited from 3 locations in Australia to participate in semistructured interviews to capture location- or context-specific experiences. Participants were notified of the recruitment opportunity through multiple avenues including newsletter articles and social media. Informed consent was obtained before participation, and the participants were remunerated for their time and perspectives. A preinterview questionnaire collected data including age range, any preexisting conditions, and location (postcode). All participant data were deidentified. Interviews were recorded, transcribed, and analyzed using thematic analysis in NVivo 12 (QSR International). RESULTS: Participants discussed app features and functionality, as well as their understanding of, and trust in, the information provided by the app. Most (26/42, 62%) participants used and valued visual environmental hazard features, especially maps, location settings, and hazard alerts. Most (33/42, 78%) found information in the app easy to understand and support their needs, irrespective of their self-reported literacy levels. Many (21/42, 50%) users reported that they did not question the accuracy of the data presented in the app. Suggested enhancements include the provision of meteorological information (eg, wind speed or direction, air pressure, UV rating, and humidity), functionality enhancements (eg, forecasting, additional alerts, and the inclusion of health advice), and clarification of existing information (eg, symptom triggers), including the capacity to download personal summary data for a specified period. CONCLUSIONS: Participants' perspectives can inform the future development of environmental health apps. Specifically, participants' insights support the identification of key elements for the optimal development of environmental health app design, including streamlining, capacity for users to customize, use of real time data, visual cues, credibility, and accuracy of data. The results also suggest that, in the future, iterative collaboration between developers, environmental agencies, and users will likely promote better functional design, user trust in the data, and ultimately better population health outcomes.

Exposure to fine particulate matter (PM2.5) during landscape fire events and the risk of cardiorespiratory emergency department attendances: a time-series study in Perth, Western Australia.

BACKGROUND: Landscape fires (LFs) are the main source of elevated particulate matter (PM2.5) in Australian cities and towns. This study examined the associations between daily exposure to fine PM2.5 during LF events and daily emergency department attendances (EDA) for all causes, respiratory and cardiovascular outcomes. METHODS: Daily PM2.5 was estimated using a model that included PM2.5 measurements on the previous day, remotely sensed aerosols and fires, hand-drawn tracing of smoke plumes from satellite images, fire danger ratings and the atmosphere venting index. Daily PM2.5 was then categorised as high (≥99th percentile), medium (96th-98th percentile) and low (≤95th percentile). Daily EDA for all-cause and cardiorespiratory conditions were obtained from the Western Australian Emergency Department Data Collection. We used population-based cohort time-series multivariate regressions with 95% CIs to assess modelled daily PM2.5 and EDA associations from 2015 to 2017. We estimated the lag-specific associations and cumulative risk ratios (RR) at lags of 0-3 days, adjusted for sociodemographic factors, weather and time. RESULTS: All-cause EDA and overall cardiovascular presentations increased on all lagged days and up to 5% (RR 1.05, 95% CI 1.03 to 1.06) and 7% (RR 1.07, 95% CI 1.01 to 1.12), respectively, at the high level. High-level exposure was also associated with increased acute lower respiratory tract infections at 1 (RR 1.19, 95% CI 1.10 to 1.29) and 3 (RR 1.17, 95% CI 1.10 to 1.23) days lags and transient ischaemic attacks at 1 day (RR 1.25, 95% CI 1.02 to 1.53) and 2 (RR 1.20, 95% CI 1.01 to 1.42) days lag. CONCLUSIONS: Exposure to PM2.5 concentrations during LFs was associated with an increased risk of all-cause EDA, overall EDA cardiovascular diseases, acute respiratory tract infections and transient ischaemic attacks.

Carbon dioxide and particulate emissions from the 2013 Tasmanian firestorm: implications for Australian carbon accounting.

BACKGROUND: Uncontrolled wildfires in Australian temperate Eucalyptus forests produce significant smoke emissions, particularly carbon dioxide (CO2) and particulates. Emissions from fires in these ecosystems, however, have received less research attention than the fires in North American conifer forests or frequently burned Australian tropical savannas. Here, we use the 2013 Forcett-Dunalley fire that caused the first recorded pyrocumulonimbus event in Tasmania, to understand CO2 and particulate matter (PM2.5) emissions from a severe Eucalyptus forest fire. We investigate the spatial patterns of the two emissions using a fine scale mapping of vegetation and fire severity (50 m resolution), and utilising available emission factors suitable for Australian vegetation types. We compare the results with coarse-scale (28 km resolution) emissions estimates from Global Fire Emissions Database (GFED) to determine the reliability of the global model in emissions estimation. RESULTS: The fine scale inventory yielded total CO2 emission of 1.125 ± 0.232 Tg and PM2.5 emission of 0.022 ± 0.006 Tg, representing a loss of 56 t CO2 ha-1 and 1 t PM2.5 ha-1. The CO2 emissions were comparable to GFED estimates, but GFED PM2.5 estimates were lower by a factor of three. This study highlights the reliability of GFED for CO2 but not PM2.5 for estimating emissions from Eucalyptus forest fires. Our fine scale and GFED estimates showed that the Forcett-Dunalley fire produced 30% of 2013 fire carbon emissions in Tasmania, and 26-36% of mean annual fire emissions for the State, representing a significant single source of emissions. CONCLUSIONS: Our analyses highlight the need for improved PM2.5 emission factors specific to Australian vegetation, and better characterisation of fuel loads, particularly coarse fuel loads, to quantify wildfire particulate and greenhouse gas emissions more accurately. Current Australian carbon accountancy approach of excluding large wildfires from final GHG accounts likely exaggerates Tasmania's claim to carbon neutrality; we therefore recommend that planned and unplanned emissions are included in the final national and state greenhouse gas accounting to international conventions. Advancing these issues is important given the trajectory of more frequent large fires driven by anthropogenic climate change.

Smoke pollution must be part of the savanna fire management equation: A case study from Darwin, Australia.

Savanna fire management is a topic of global debate, with early dry season burning promoted as a large-scale emissions reduction opportunity. To date, discussions have centred on carbon abatement efficacy, biodiversity and cultural benefits and/or risks. Here we use a case study of Darwin, Australia to highlight smoke pollution as another critical consideration. Smoke pollution from savanna fires is a major public health issue, yet absent so far from discussions of program design. Here, we assess the likely impacts of increased early dry season burning on smoke pollution in Darwin between 2004 and 2019, spanning the introduction and expansion of carbon abatement programs. We found increased smoke pollution in the early dry season but little change in the late dry season, contributing to a net annual increase in air quality standard exceedances. Geospatial analysis suggests this relates to increased burning in the path of early dry season trade winds. This study highlights the complex health trade-offs involved with any large-scale prescribed burning, including for carbon abatement.

Population collapse of a Gondwanan conifer follows the loss of Indigenous fire regimes in a northern Australian savanna.

Colonialism has disrupted Indigenous socioecological systems around the globe, including those supported by intentional landscape burning. Because most disruptions happened centuries ago, our understanding of Indigenous fire management is largely inferential and open to debate. Here, we investigate the ecological consequences of the loss of traditional Aboriginal fire management on fire-exposed savannas on the Arnhem Plateau, northern Australia, using the fire-sensitive conifer Callitris intratropica as a bio-indicator. We contrast Kakadu National Park, where traditional Aboriginal fire management was severely disrupted during the early twentieth century following Aboriginal relocation to surrounding settlements, and an adjacent Aboriginal estate where traditional Aboriginal fire management endures. Since 2006, traditional Aboriginal fire management at this site has been overlaid by a program of broad-scale institutionalized burning in the early dry season, designed to reduce greenhouse emissions. Using remote sensing, field survey, and dendrochronology, we show that on the Aboriginal estate, C. intratropica populations depend on the creation of a shifting patch mosaic of long unburned areas necessary for the recruitment of C. intratropica. However, the imposition of broad-scale fire management is disrupting this population patch dynamic. In Kakadu, there have been extreme declines of C. intratropica associated with widespread fires since the mid twentieth century and consequent proliferation of grass fuels. Fire management in Kakadu since 2007, designed to increase the size and abundance of patches of unburned vegetation, has not been able to reverse the population collapse of C. intratropica. Our study demonstrates that colonial processes including relocation of Indigenous people and institutional fire management can have deleterious consequences that are nearly irreversible because of hysteresis in C. intratropica population dynamics.

Global increase in wildfire risk due to climate-driven declines in fuel moisture.

There is mounting concern that global wildfire activity is shifting in frequency, intensity, and seasonality in response to climate change. Fuel moisture provides a powerful means of detecting changing fire potential. Here, we use global burned area, weather reanalysis data, and the Canadian fire weather index system to calculate fuel moisture trends for multiscale biogeographic regions across a gradient in vegetation productivity. We quantify the proportion of days in the local fire season between 1979 and 2019, where fuel moisture content is below a critical threshold indicating extreme fire potential. We then associate fuel moisture trends over that period to vegetation productivity and comment on its implications for projected anthropogenic climate change. Overall, there is a strong drying trend across realms, biomes, and the productivity gradient. Even where a wetting trend is observed, this often indicates a trend toward increasing fire activity due to an expected increase in fuel production. The detected trends across the productivity gradient lead us to conclude global fire activity will increase with anthropogenic climate change.

Associations between respiratory and vascular function in early childhood.

BACKGROUND AND OBJECTIVE: The link between respiratory and vascular health is well documented in adult populations. Impaired lung function is consistently associated with thicker arteries and higher incidence of cardiovascular disease. However, there are limited data on this relationship in young children and the studies that exist have focussed on populations at high risk of cardiorespiratory morbidity. We determined if an association exists between respiratory and cardiovascular function in young children and, if so, whether it is confounded by known cardiorespiratory risk factors. METHODS: Respiratory and vascular data from a prospective cohort study established to evaluate the health implications 3 years after coal mine fire smoke exposure in children aged 3-5 years were used. Respiratory function was measured using the forced oscillation technique and included resistance at 5 Hz (R5 ), reactance at 5 Hz (X5 ) and area under the reactance curve (AX). Vascular health was measured by carotid intima-media thickness (ultrasound) and pulse wave velocity (arterial tonometry). Regression analyses were used to examine the relationship between the respiratory Z-scores and cardiovascular measures. Subsequent analyses were adjusted for potential confounding by maternal smoking during pregnancy, maternal education and exposure to fine particulate matter <2.5 µm in aerodynamic diameter (PM2.5 ). RESULTS: Peripheral lung function (X5 and AX), but not respiratory system resistance (R5 ), was associated with vascular function. Adjustment for maternal smoking, maternal education and early life exposure to PM2.5 had minimal effect on these associations. CONCLUSION: These observations suggest that peripheral lung stiffness is associated with vascular stiffness and that this relationship is established early in life.

Ambulance dispatches and heatwaves in Tasmania, Australia: A case-crossover analysis.

BACKGROUND: Climate change is causing an increase in the frequency and severity of heatwave events, with a corresponding negative impact on human health. Health service utilisation during a heatwave is increased, with a greater risk of poor health outcomes identified for specific population groups. In this study, we examined the impact of heatwave events on ambulance dispatches in Tasmania, Australia from 2008 to 2019 to explore health service utilisation and identify the most vulnerable populations at a local level. METHODS: We used a time-stratified case-crossover analysis with conditional logistic regression to examine the association between ambulance dispatches and three levels of heatwave events (extreme, severe, and low-intensity). We examined the relationship for the whole study population, and by age, gender, socio-economic advantage and clinical diagnostic group. RESULTS: We found that ambulance dispatches increase by 34% (OR 1.34, 95% CI 1.18-1.52) during extreme heatwaves, by 10% (OR 1.10, 95% CI 1.05-1.15) during severe heatwaves and by 4% (OR 1.04, 95% CI 1.02-1.06) during low-intensity heatwaves. We found significant associations for the elderly (over 65), the young (5 and under) and for regions with the greatest socio-economic disadvantage. CONCLUSION: Heatwaves were associated with increased demands on ambulance services in Tasmania. In subgroups of people aged over 65 or under 5 years of age, and those from areas of higher disadvantage, we generally observed greater effect sizes than for the population as a whole.

Characterising non-linear associations between airborne pollen counts and respiratory symptoms from the AirRater smartphone app in Tasmania, Australia: A case time series approach.

Pollen is a well-established trigger of asthma and allergic rhinitis, yet concentration-response relationships, lagged effects, and interactions with other environmental factors remain poorly understood. Smartphone technology offers an opportunity to address these challenges using large, multi-year datasets that capture individual symptoms and exposures in real time. We aimed to characterise associations between six pollen types and respiratory symptoms logged by users of the AirRater smartphone app in Tasmania, Australia. We analyzed 44,820 symptom reports logged by 2272 AirRater app users in Tasmania over four years (2015-2019). With these data we evaluated associations between daily respiratory symptoms and atmospheric pollen concentrations. We implemented Poisson regression models, using the case time series approach designed for app-sourced data. We assessed potentially non-linear and lagged associations with (a) total pollen and (b) six individual pollen taxa. We adjusted for seasonality and meteorology and tested for interactions with particulate air pollution (PM2.5). We found evidence of non-linear associations between total pollen and respiratory symptoms for up to three days following exposure. For total pollen, the same-day relative risk (RR) increased to 1.31 (95% CI: 1.26-1.37) at a concentration of 50 grains/m3 before plateauing. Associations with individual pollen taxa were also non-linear with some diversity in shapes. For all pollen taxa the same-day RR was highest. The interaction between total pollen and PM2.5 was positive, with risks associated with pollen significantly higher in the presence of high concentrations of PM2.5. Our results support a non-linear response between airborne pollen and respiratory symptoms. The association was strongest on the day of exposure and synergistic with particulate air pollution. The associations found with Dodonaea and Myrtaceae highlight the need to further investigate the role of Australian native pollen types in allergic respiratory disease.

The severity and extent of the Australia 2019-20 Eucalyptus forest fires are not the legacy of forest management.

The 2019-20 wildfires in eastern Australia presented a globally important opportunity to evaluate the respective roles of climatic drivers and natural and anthropogenic disturbances in causing high-severity fires. Here, we show the overwhelming dominance of fire weather in causing complete scorch or consumption of forest canopies in natural and plantation forests in three regions across the geographic range of these fires. Sampling 32% (2.35 Mha) of the area burnt we found that >44% of the native forests suffered severe canopy damage. Past logging and wildfire disturbance in natural forests had a very low effect on severe canopy damage, reflecting the limited extent logged in the last 25 years (4.5% in eastern Victoria, 5.3% in southern New South Wales (NSW) and 7.8% in northern NSW). The most important variables determining severe canopy damage were broad spatial factors (mostly topographic) followed by fire weather. Timber plantations affected by fire were concentrated in NSW and 26% were burnt by the fires and >70% of the NSW plantations suffered severe canopy damage showing that this intensive means of wood production is extremely vulnerable to wildfire. The massive geographic scale and severity of these Australian fires is best explained by extrinsic factors: an historically anomalous drought coupled with strong, hot dry westerly winds that caused uninterrupted, and often dangerous, fire weather over the entire fire season.