A Research Translation, Implementation and Impact Strategy for the Australian Healthy Environments and Lives (HEAL) Research Network.

Healthy Environments And Lives (HEAL) is the Australian national research network established to support improvements to health, the Australian health system, and the environment in response to the unfolding climate crisis. The HEAL Network comprises researchers, community members and organisations, policymakers, practitioners, service providers, and other stakeholders from diverse backgrounds and sectors. HEAL seeks to protect and improve public health, reduce health inequities and inequalities, and strengthen health system sustainability and resilience in the face of environmental and climate change, all with a commitment to building on the strengths, knowledge, wisdom, and experience of Aboriginal and Torres Strait Islander people, culture, and communities. Supporting applied research that can inform policy and practice, and effective research translation, implementation, and impact are important goals across the HEAL Network and essential to achieve its intended outcomes. To aid translation approaches, a research translation, implementation, and impact strategy for the HEAL Network was developed. The strategy has been created to inform and guide research translation across HEAL, emphasising communication, trust, partnerships, and co-design with communities and community organisations as well as the decision-makers responsible for public policies and programs. Development of the strategy was guided by research translation theory and practice and the Health in All Policies and Environment in All Policies frameworks. As described in this paper, the strategy is underpinned by a set of principles and outlines preliminary actions which will be further expanded over the course of the HEAL Network's activities. Through these actions, the HEAL Network is well-positioned to ensure successful research translation and implementation across its program of work.

Treatment cost assessment for COVID-19 inpatients in Shenzhen, China 2020-2021: facts and suggestions.

Background: Knowledge regarding the treatment cost of coronavirus disease 2019 (COVID-19) in the real world is vital for disease burden forecasts and health resources planning. However, it is greatly hindered by obtaining reliable cost data from actual patients. To address this knowledge gap, this study aims to estimate the treatment cost and specific cost components for COVID-19 inpatients in Shenzhen city, China in 2020-2021. Methods: It is a 2 years' cross-sectional study. The de-identified discharge claims were collected from the hospital information system (HIS) of COVID-19 designated hospital in Shenzhen, China. One thousand three hundred ninety-eight inpatients with a discharge diagnosis for COVID-19 from January 10, 2020 (the first COVID-19 case admitted in the hospital in Shenzhen) to December 31, 2021. A comparison was made of treatment cost and cost components of COVID-19 inpatients among seven COVID-19 clinical classifications (asymptomatic, mild, moderate, severe, critical, convalescent and re-positive cases) and three admission stages (divided by the implementation of different treatment guidelines). The multi-variable linear regression models were used to conduct the analysis. Results: The treatment cost for included COVID-19 inpatients was USD 3,328.8. The number of convalescent cases accounted for the largest proportion of all COVID-19 inpatients (42.7%). The severe and critical cases incurred more than 40% of treatment cost on western medicine, while the other five COVID-19 clinical classifications spent the largest proportion (32%-51%) on lab testing. Compared with asymptomatic cases, significant increases of treatment cost were observed in mild cases (by 30.0%), moderate cases (by 49.2%), severe cases (by 228.7%) and critical cases (by 680.7%), while reductions were shown in re-positive cases (by 43.1%) and convalescent cases (by 38.6%). The decreasing trend of treatment cost was observed during the latter two stages by 7.6 and 17.9%, respectively. Conclusions: Our findings identified the difference of inpatient treatment cost across seven COVID-19 clinical classifications and the changes at three admission stages. It is highly suggestive to inform the financial burden experienced by the health insurance fund and the Government, to emphasize the rational use of lab tests and western medicine in the COVID-19 treatment guideline, and to design suitable treatment and control policy for convalescent cases.

Association Between Hydrological Conditions and Dengue Fever Incidence in Coastal Southeastern China From 2013 to 2019.

Importance: Dengue fever is a climate-sensitive infectious disease. However, its association with local hydrological conditions and the role of city development remain unclear. Objective: To quantify the association between hydrological conditions and dengue fever incidence in China and to explore the modification role of city development in this association. Design, Setting, and Participants: This cross-sectional study collected data between January 1, 2013, and December 31, 2019, from 54 cities in 4 coastal provinces in southeast China. The Standardized Precipitation Evapotranspiration Index (SPEI) was calculated from ambient temperature and precipitation, with SPEI thresholds of 2 for extreme wet conditions and -2 for extreme dry conditions. The SPEI-dengue fever incidence association was examined over a 6-month lag, and the modification roles of 5 city development dimensions were assessed. Data were analyzed in May 2022. Exposures: City-level monthly temperature, precipitation, SPEI, and annual city development indicators from 2013 to 2019. Main Outcomes and Measures: The primary outcome was city-level monthly dengue fever incidence. Spatiotemporal bayesian hierarchal models were used to examine the SPEI-dengue fever incidence association over a 6-month lag period. An interaction term between SPEI and each city development indicator was added into the model to assess the modification role of city development. Results: Included in the analysis were 70 006 dengue fever cases reported in 54 cities in 4 provinces in China from 2013 to 2019. Overall, a U-shaped cumulative curve was observed, with wet and dry conditions both associated with increased dengue fever risk. The relative risk [RR] peaked at a 1-month lag for extreme wet conditions (1.27; 95% credible interval [CrI], 1.05-1.53) and at a 6-month lag for extreme dry conditions (1.63; 95% CrI, 1.29-2.05). The RRs of extreme wet and dry conditions were greater in areas with limited economic development, health care resources, and income per capita. Extreme dry conditions were higher and prolonged in areas with more green space per capita (RR, 1.84; 95% CrI, 1.37-2.46). Highly urbanized areas had a higher risk of dengue fever after extreme wet conditions (RR, 1.80; 95% CrI, 1.26-2.56), while less urbanized areas had the highest risk of dengue fever in extreme dry conditions (RR, 1.70; 95% CrI, 1.11-2.60). Conclusions and Relevance: Results of this study showed that extreme hydrological conditions were associated with increased dengue fever incidence within a 6-month lag period, with different dimensions of city development playing various modification roles in this association. These findings may help in developing climate change adaptation strategies and public health interventions against dengue fever.

Study on the death and disease burden caused by high sugar-sweetened beverages intake in China from 1990 to 2019.

BACKGROUND: To analysis the death and disease burden caused by high sugar-sweetened beverages intake in China from 1990 to 2019. METHODS: Data were obtained from the 2019 Global Burden of Disease Study. We analyzed the death cases caused by high sugar-sweetened beverages intake in China and provinces from 1990 to 2019, as well as the disease burden (including disability-adjusted of life year), years of life lost and years lived with disability, and compared the changes of death in 1990 and 2019. RESULTS: In 2019, the number of deaths attributed to sugar-sweetened beverages in China reached 46 633 with an increase of 95% compared with 1990. The proportion of deaths caused by excessive consumption of carbon-containing beverages increased from 0.34% in 1990 to 0.46% in 2019, an increase of 35%. In 2019, the top five provinces in China with more deaths caused by excessive intake of sugary beverages were Shandong, Henan, Hebei, Hunan and Guangdong, with the number of death cases 4337, 3881, 3010, 2762 and 2611, respectively. CONCLUSIONS: The number of deaths and disease burdens caused by high sugar-sweetened beverages intake in China has increased significantly over the past three decades. The burden of disease due to high intake of sugary beverages varies widely from province to province. We suggest that attention should be paid to the problem of excessive intake of high sugar-sweetened beverages for Chinese population. In addition to regular monitoring and investigation of sugar-sweetened beverage intake, comprehensive measures should be taken in China's sugar control work.

Sociodemographic, lifestyle, behavioral, and parental factors associated with sugar-sweetened beverage consumption in children in China.

OBJECTIVE: Evidence shows sugar-sweetened beverage (SSB) consumption is a risk factor for obesity and non-communicable diseases (NCDs) in children. Investigating the influential profiles, which have been examined insufficiently, will help to inform the reduction of SSB consumption. The present research examines the current trend in SSB consumption and associated factors among children in China, in order to inform policy development. METHODS: Secondary data was extracted from China's Health and Nutrition Survey (CHNS; 2004, 2006, 2009, and 2011), a repeated cross-sectional research, and a Chi-squared test was applied to compare SSB consumption in the last year, queried by social demographical, `environmental, behavioral, and parental factors. Multilevel mixed-effects logistic regression was employed to examine the trend and effects of the multiple factors. RESULTS: A total of 6015 Chinese children aged 6-17 years were investigated. From 2004 to 2011, the percentage of SSB consumption in children increased from 72.6% to 90.3%. The prevalence in urban areas was higher than the prevalence in rural areas, higher in high schools than primary and middle schools, higher in east coast affluent provinces than other provinces, and higher in high-income households than low-income households. Other associated factors include children's fast food and salty snacks preference, level of physical activity, sedentariness, and parental education. The strongest association with SSB consumption in children was the mother's SSB consumption (adjusted odds ratio: 5.54, 95% CI: 3.17-9.67). CONCLUSION: Children's SSB consumption has increased significantly in China, and is associated with socio-economic, demographic, level of physical activity, food preference, and parental factors. Future strategies aimed at reducing SSB consumption among children need to consider these factors.

Probabilistic health risk assessment of chlorpyrifos exposure among applicators on rice farms in Ghana.

Human health risk assessments of exposures to non-carcinogenic occupational and environmental toxicants have mostly been undertaken using the Hazard Quotient (HQ) approach, which largely ignores variabilities in both exposures and associated adverse health outcomes, unlike probabilistic approaches. Chlorpyrifos is a neurotoxic insecticide that is commonly applied by farmers in Ghana with limited research on associated health risks among applicators. The objective of this study was to assess health risks associated with chlorpyrifos exposure among applicators on rice farms in Ghana, using advanced probabilistic approaches that incorporate variability in both exposure doses and adverse response doses obtained from human epidemiological studies. Urine samples obtained from the applicators were analyzed for 3,5,6-trichloro-2-pyridinol (TCP)from which Absorbed Daily Dose (ADD) and Lifetime Average Daily Dose (LADD) levels of chlorpyrifos were estimated. The scientific literature was searched to identify human epidemiological data from studies that have reported chlorpyrifos adverse effects and their corresponding exposure levels. Equivalent ADD and LADD of chlorpyrifos were estimated from the human epidemiological data to obtain chlorpyrifos Toxicant Sensitivity Distributions (TSDs). Using the applicators' chlorpyrifos dose distribution and TSDs, adverse health risks among the applicators were characterized using the probabilistic approaches, Overall Risk Probability (ORP) and Monte Carlo Simulation (MCS). The probabilities of chlorpyrifos adverse health effects occurring under the chronic exposure scenarios ranged from 1 to 8%, while those for acute exposure scenarios ranged from 31 to 34%. This study indicates that while the risks of chronic adverse health effects from chlorpyrifos exposure among the applicators were low, acute health risks were high.

Understanding the Operational Concept of a Flood-Resilient Urban Community in Jakarta, Indonesia, from the Perspectives of Disaster Risk Reduction, Climate Change Adaptation and Development Agencies.

Climate change-related extreme events such as floods have and will continue to present a great challenge to disaster risk management. There is a pressing need to develop a robust management strategy via enhancing the resiliency of the community, particularly in the context of complex urban environments, like Jakarta. Resilience is conceptualized within specific contexts and uniquely tailored to the targeted setting, yet research regarding the operational concept of a flood-resilient community in the context of Jakarta remains limited. This paper will elaborate this operational concept through understanding the desirable features and influential barriers of a flood-resilient community through the lenses of three main stakeholder groups: disaster risk reduction (DRR), climate change adaptation (CCA), and development. It will also discuss the ways in which the synergies that exist across these groups can be enhanced. Both quantitative and qualitative approaches were applied in this study, and multiple sources of data were used. The findings indicate that these groups share common views regarding the importance of human aspects being central to resilience building efforts. We argue there is an urgent need to shift the flood resilience building paradigm towards building community resilience from the people and to apply a collaborative governance approach to facilitate effective partnership between the actors involved.

Development and Validation of a Self-Assessment Tool for an Integrative Model of Health Promotion in Hospitals: Taiwan's Experience.

The Health Promotion Administration of Taiwan launched an integrative certification initiative in 2016 to streamline a plural system of certifications of health promotion in hospitals. It endeavored to replace original certifications, thereby establishing the proposal of a self-assessment instrument to aid in this integration. This study aimed to verify the robustness of this self-assessment tool by conducting exploratory factor analyses through stratification, reliability tests, content and construct validity tests, and specialist evaluations, which were convened to judge the comprehensibility, applicability, and importance of the standards and measures of this tool. A stratified random sampling of 46 hospitals was performed to confirm the validity of this tool. The tool rendered a floor effect of 0% and a ceiling effect of 13%. A valid factor structure and internal consistency (α ranged from 0.88 to 0.96) in each standard were verified. Hospitals with previous certificates or with 300+ beds achieved high compliance scores. A majority of experts agreed that the sub-standards were comprehensible (≥80%), applicable (≥70%), and important (≥70%). Finally, we conclude that the self-assessment tool is valid and can serve as a reference for other countries with hospitals committed to health promotion in hospital settings.

Exploring the system capacity to meet occupational health and safety needs: the case of the ready-made garment industry in Bangladesh.

BACKGROUND: Since the 2013 Rana Plaza incident in Bangladesh, the government of Bangladesh has been under pressure to improve health and safety conditions for workers in the ready-made garment industry. Its efforts have focused heavily on structural safety of the buildings but have largely ignored broader occupational health system issues. This qualitative study explores contextual factors and system challenges that create barriers for ensuring a healthy and safe workplace in the ready-made garment industry in Bangladesh. METHODS: Data were collected through key informant interviews (n = 14) with government officials from the Department of Inspection for Factories and Establishments (DIFE), factory employers, factory doctors and representatives from the Bangladesh Garment Manufacturers and Exporters Association (BGMEA). A thematic analysis was conducted using Atlas-ti v 5.2. RESULTS: A thematic analysis suggests that the capacity of the DIFE to provide adequate occupational health services remains a problem. There is a shortage of both appropriately trained staff and equipment to monitor occupational health and safety in factories and to gather useful data for evidence-based decision-making. Another barrier to effective occupational health and safety of workers is the lack of cooperation by employers in recording data on workers' health and safety problems. Finally, government officials have limited resources and power to enforce compliance with regulations. Such deficiencies threaten the health and safety of this important, largely female, working population. CONCLUSION: This case example focused on the valuable ready-made garment industry sector of Bangladesh's economy. It identifies the critical need for occupational health system strengthening. Specifically system capacity needs to be improved by both increasing human resources for in-factory hazards and health monitoring, regulatory inspection, enforcement, and improved training of government officials around monitoring and reporting.

Clarification of the Concept of Risk Communication and its Role in Public Health Crisis Management in China.

Risk communication plays a very important role in the prevention of public health crisis events and has been considered by the World Health Organization (WHO) to be 1 of the main functions of an emergency public health crisis. However, it is a relatively new research field in China, so many people have mistaken understandings of risk communication. This article will describe the concept and importance of risk communication and briefly introduce the role of risk communication in public health crisis management. It also provides information for the prevention of public health crisis events in the future.

Sewing shirts with injured fingers and tears: exploring the experience of female garment workers health problems in Bangladesh.

BACKGROUND: The ready-made garment industry in Bangladesh not only contributes to the nation's economic development, but has created income opportunities for women, benefiting their whole family. However, these benefits come at considerable cost to the women. This research examines how the work environment and gendered family role in this conservative society affect the health of the female industrial workers. METHODS: A qualitative study employed in-depth interviews (n-20) and focus group discussions with female garment workers (n-4) in two cities of Dhaka district. Further, key informant interviews (n = 4) with factory doctors, along with eight workplace observations were conducted to explore the lived experience of female workers' health issues. Interview transcripts were coded in Atlas-ti, 5.2. The data were analysed using thematic analysis approach. The themes are illustrated with case narratives. RESULTS: The female workers reported that their work has led to back and joint pain, continuous headache, eye pain and difficulty in breathing associated with inhaling fabric dust. Inadequate lighting, constantly sitting in one position without back rest and continuous noise from hundreds of machines makes them feel permanently tired. Further, the female workers reported that working in the factory and meeting the expectations of the families at home has doubled their workload. The doctors indicated that the physical work environment, their low job status and the nature of the job affect the health of female workers. CONCLUSION: This study found that female workers in the ready-made garment industry face a high risk of health problems. Both government and non-government organizations need to be better involved in designing interventions targeting these women, to protect them from such health risks. In addition, recognition by the whole society of the important role the women play in the economy is needed, so that support by both family and society can be improved.

Hospital climate actions and assessment tools: a scoping review protocol.

INTRODUCTION: Health and climate change are inexorably linked through the exacerbation of health risks and the contribution of the health sector to greenhouse gas emissions. Climate action in healthcare settings is critical to reduce risks and impacts of climate change through the smarter use of energy, minimising waste and enhancing disaster preparedness. Globally, hospital climate action is growing; however, the potential for further progress and impacts remains. The literature on this topic lacks synthesis, and this poses challenges for hospital leadership in tracking the impact of climate action. This scoping review will summarise the current knowledge about hospital climate action and existing tools to measure progress in this area. METHODS AND ANALYSIS: This scoping review will be conducted applying the six-stage protocol proposed by Arksey and O'Malley. The study includes literature of how hospitals have addressed climate change (mitigation and adaptation) since the Kyoto Protocol was signed in 1997. All identified studies indexed in Medline, Scopus, Embase and CINAHL will be examined. The search strategy will also include Google Scholar to capture relevant grey literature. Quantitative and thematic analysis will be used to evaluate and categorise the study results. ETHICS AND DISSEMINATION: This scoping review is part of the climate-smart healthcare initiative which will provide a valuable synthesis to aid understanding of hospitals' climate actions, and tools used to measure its implementation. As such it will contribute to mobilising and accelerating the implementation of climate action in hospitals. The findings will be disseminated with all members of the International Health Promoting Hospital and Health Services (HPH) and the Global Green and Healthy Hospital network. Dissemination will occur through peer-reviewed publications; and with the HPH and GGHH members through its annual conference and newsletter.

Is the World Health Organization predicted exposure assessment model for space spraying of insecticides applicable to agricultural farmers?

Agricultural farmers in developing countries are at high risk of pesticide exposure and adverse effects because of unsafe practices and inappropriate legislation. Biological monitoring is considered a useful tool for pesticide exposure assessment; however, its use is limited in developing countries due to a lack of techniques and resources such as laboratory analysis, trained staff and budgets. This study examines whether the World Health Organization predicted exposure assessment model (WHO-PEAM) is a suitable alternative tool for assessing insecticide exposure among agricultural farmers. WHO-PEAM was used to predict daily doses (PDD) of chlorpyrifos for a group of Vietnamese rice farmers using a set of exposure parameters obtained from a questionnaire survey of participant famers during a field study. These results were compared to absorbed daily doses (ADD) of chlorpyrifos for the farmers measured using a biological monitoring program, in which 24-h urine samples were collected and analysed for the chlorpyrifos metabolite, 3,5,6-trichloro-2-pyridinol (TCP) using LC/MS. Validation of the model results was tested using the Wilcoxon signed-rank test (WSR) and two-way mixed-model intraclass correlation coefficient (ICC). The mean of total ADD was 20 µg/kg/day while that of total PDD was 22 µg/kg/day. The WSR test revealed no statistically significant difference in the average values of ADDT and PDDT. ICC indicated substantial agreement for both single and average measures between ADDT and PDDT (ICC, 0.62 and 0.77, respectively). The results demonstrate that a refined WHO-PEAM model can be readily used as a field method, without biological monitoring, to evaluate chlorpyrifos exposure among agricultural farmers in Vietnam and similar developing countries.

The Impacts on Health, Society, and Economy of SARS and H7N9 Outbreaks in China: A Case Comparison Study.

Background: Epidemics such as SARS and H7N9 have caused huge negative impacts on population health and the economy in China. Aims: This article discusses the impacts of SARS in 2003 and H7N9 in 2013 in China, in order to provide a better understanding to government and practitioners of why improving management of response to infectious disease outbreaks is so critical for a country's economy, its society, and its place in the global community. Methods: To provide the results of an analysis of impacts of SARS and H7N9 based on feedback from documents, informants, and focus groups on events during the SARS and H7N9 outbreaks. Results: Both outbreaks of SARS and H7N9 have had an impact on China, causing significant negative impacts on health, the economy, and even national and even international security. Conclusions: Both SARS coronavirus and H7N9 viruses presented a global epidemic threat, but the social and economic impacts of H7N9 were not as serious as in the case of SARS because the response to H7N9 was more effective.

Biomonitoring of chlorpyrifos exposure and health risk assessment among applicators on rice farms in Ghana.

Chlorpyrifos is a neurotoxic insecticide that is widely used in the agricultural sector of Ghana. The main objective of this study was to evaluate the levels of chlorpyrifos exposure and health risk among applicators (n = 21) on irrigated rice farms in Ghana, based on a typical application event. Pre- and post-application urine samples (24-h) were collected from the applicators and analysed for 3,5,6-trichloro-2-pyridinol (TCP), using LC-MS/MS. The levels of chlorpyrifos-absorbed dose with the applicators were estimated from the urinary TCP levels. Prior to application, the median absorbed dose of chlorpyrifos (background exposure) with the applicators was 0.2 µg/kg/day (range 0.05 to 2 µg/kg/day). Following application, the median absorbed dose of chlorpyrifos (application exposure) increased 30-fold to 6 µg/kg/day (range 0.7 to 74 µg/kg/day). The mean elimination half-life (t1/2) of chlorpyrifos was calculated to be 50 h. Hazard quotient (HQ) values (HQ > 1) obtained with the chronic (10 µg/kg/day) and acute (100 µg/kg/day) guideline values of the WHO suggested no risk of chronic or acute health effects, respectively, among both the median and 5% highly exposed groups. However, HQ values (HQ > 1) obtained with the chronic (0.3 µg/kg/day) and acute (5 µg/kg/day) guideline values of the USEPA suggested risk of chronic and acute health effects, respectively, among both the median and 5% highly exposed groups. The quantity of chlorpyrifos formulation applied, spraying duration, and the number of spray tanks applied significantly correlated with the absorbed dose levels of chlorpyrifos from application exposure. Therefore, these factors suggest means to reduce exposure and consequent health risk among the applicators.

Health risk assessment of dermal exposure to chlorpyrifos among applicators on rice farms in Ghana.

Generally, there is limited information on pesticide absorbed dose levels and health risk attributable to the dermal route of exposure among applicators. The objective of this study was to evaluate the absorbed dose levels and consequent health risk from dermal exposure to chlorpyrifos among applicators on rice farms in Ghana. The whole-body dosimetry technique was used to capture chlorpyrifos residues penetrating the applicators' clothing and reaching their skin, as well as residues reaching uncovered body areas of the applicators. Acute (ADDD) and chronic (LADDD) absorbed dose levels of chlorpyrifos were estimated from the residues and plotted as cumulative probability distributions. Health risk from chlorpyrifos exposure was characterized using the Hazard Quotient (HQ) technique. Three of the four acute exposure guideline values used in the study indicated that applicators, represented by the median-exposed (ADDD, 15 µg/kg/day) and the 5% - highly exposed (ADDD, 27 µg/kg/day) groups were at high risk of acute adverse health effects due to chlorpyrifos exposure, with HQ values ranging from 1.5 to 5 and 2.7 to 9, respectively. Regarding chronic adverse health effects, none of the guideline values suggested risk among the median-exposed group (LADDD, 0.3 µg/kg/day), with HQ values ranging from 0.03 to 1. However, two of the chronic exposure guideline values suggested that the 5%- highly exposed group (LADDD, 0.6 µg/kg/day) may be adversely affected, with HQ values ranging from 1.2 to 2. These findings highlight the importance of the dermal route as a major pesticide exposure pathway and suggest possible exposure minimization strategies.

The effects of socioecological factors on variation of communicable diseases: A multiple-disease study at the national scale of Vietnam.

OBJECTIVE: To examine the effects of socioecological factors on multiple communicable diseases across Vietnam. METHODS: We used the Moran's I tests to evaluate spatial clusters of diseases and applied multilevel negative binomial regression models using the Bayesian framework to analyse the association between socioecological factors and the diseases queried by oral, airborne, vector-borne, and animal transmission diseases. RESULTS AND SIGNIFICANCE: The study found that oral-transmission diseases were spatially distributed across the country; whereas, the airborne-transmission diseases were more clustered in the Northwest and vector-borne transmission diseases were more clustered in the South. Most of diseases were sensitive with climatic factors. For instance, a 1°C increase in average temperature is significantly associated with 0.4% (95CI, 0.3-0.5), 2.5% (95%CI, 1.4-3.6), 0.9% (95%CI, 0.6-1.4), 1.1% (95%CI), 5% (95%CI, 3-.7.4), 0.4% (95%CI, 0.2-0.7), and 2% (95%CI, 1.5-2.8) increase in risk of diarrhoea, shigellosis, mumps, influenza, dengue, malaria, and rabies respectively. The influences of socio-economic factors on risk of communicable diseases are varied by factors with the biggest influence of population density. The research findings reflect an important implication for the climate change adaptation strategies of health sectors. A development of weather-based early warning systems should be considered to strengthen communicable disease prevention in Vietnam.

Association between salinity and hospital admission for hypertension: an ecological case-control study in the Mekong Delta Region in Vietnam.

Background: Drinking water in the Mekong Delta Region (MDR) is highly vulnerable to salinity intrusion and this problem is expected to increase with the projected climate change and sea level rise. Despite this, research on health effects of saline contaminated water is scarce in this region. This study examines the risk of hospital admission for hypertension in salinity-affected areas of the MDR. Methods: Cases and controls were obtained from national/provincial hospital admission records for 2013. The cases were adult patients whom hypertension (ICD10-code: I10-I15) was primary diagnosis for admission. Of the 13 provinces in the MDR, we identified seven as 'salinity exposed' and the remaining as 'non-exposed' areas. A multi-level logistic regression model was used to examine the association between salinity exposure and hypertension outcome. Results: Of the total 573 650 hospital admissions, 22 382 (~3.9%) were hypertensive cases. The multi-level logistic model combining both individual and ecological factors showed a 9% increase in risk (95% CI: 3-14%) of hypertension admission among individuals in exposed areas compared to those in non-exposed areas. Conclusion: In order to develop and promote appropriate adaptation strategies, further research is recommended to identify the salt exposure pathways and consumption behaviours in the salinity exposed areas.

A Comparison of China's Risk Communication in Response to SARS and H7N9 Using Principles Drawn From International Practice.

BACKGROUND: China's emergency management of severe acute respiratory syndrome (SARS) was heavily criticized, whereas the H7N9 response was praised by the international community.AimsThe aims of this study were to examine and compare the strengths and weaknesses of risk communication conducted in response to SARS and H7N9 and their associated social impacts on affected communities in China. METHOD: A qualitative comparative case study approach was employed in the present study, using a set of 8 risk communication principles selected from international literature to suit the Chinese context for the comparative analysis of emergency responses of SARS and H7N9. RESULTS: The study found significant differences in the risk communication conducted in the 2 cases. The SARS outbreak fully exposed China's lack of experience in public health risk communication. By contrast, the Chinese government's risk communication strategies had improved significantly during the H7N9 outbreak.DiscussionTrust is the basis for communication. Maintaining an open and honest attitude and actively engaging stakeholders to address their risk information needs will serve to build trust and facilitate multi-sector collaborations in dealing with a public health crisis. CONCLUSIONS: From SARS to H7N9, risk communication practices in China greatly improved, which, in turn, lessened adverse social impacts and improved outcomes in emergency management of public health crises. (Disaster Med Public Health Preparedness. 2018;12:587-598).

What makes pregnant workers sick: why, when, where and how? An exploratory study in the ready-made garment industry in Bangladesh.

BACKGROUND: Bangladesh has made significant progress in reducing maternal mortality. Many factors have contributed to this; one is the socio-economic development of the country. The ready-made garment industry is at the forefront of this development creating employment for many women. However, the work environment has the potential to create health problems, particularly for vulnerable groups such as pregnant women. This paper explores perceptions of health problems during pregnancy of factory workers, in this important industry in Bangladesh. METHODS: This study was conducted in four factories using qualitative research methods to provide a view of pregnant workers' health risks beyond a bio-medical approach. Data was collected through in-depth interviews of pregnant workers and observations of their homes and workplaces. Further, key informant interviews with factory health care providers, government officials and employers revealed different perspectives and experiences. Data was collected in the local language (Bengali), then transcribed and analysed using a framework analysis approach. RESULTS: Female workers reported that participation in paid work created an opportunity for them to earn money but pregnancy and the nature of the job, including being pressured to meet the production quota, pressure to leave the job because of their pregnancy and withholding of maternity benefits, cause stress, anxiety and may contribute to hypertensive disorders of pregnancy. This was confirmed by factory doctors who suggested that developing hypertensive disorders during pregnancy was influenced by the nature of work and stress. The employers seemed focused on profit and meeting quotas and the health of pregnant workers appeared to be a lower priority. This study found that the government lacks the resources to understand the extent of the problem or the level of compliance with maternity related regulations. CONCLUSIONS: These results indicate the vulnerability of female workers to physical and mental stress at work and associations with their health problems during pregnancy. It identifies the deficiencies of family, workplace and health service support for these pregnant workers, highlighting the urgent need for government and non-government organisations to work with this important export industry to improve health surveillance and monitoring and the enforcement of existing laws to protect the rights and conditions of pregnant women.