RESUMEN
The MJA-Lancet Countdown on health and climate change in Australia was established in 2017 and produced its first national assessment in 2018 and annual updates in 2019, 2020, 2021 and 2022. It examines five broad domains: health hazards, exposures and impacts; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. In this, the sixth report of the MJA-Lancet Countdown, we track progress on an extensive suite of indicators across these five domains, accessing and presenting the latest data and further refining and developing our analyses. Our results highlight the health and economic costs of inaction on health and climate change. A series of major flood events across the four eastern states of Australia in 2022 was the main contributor to insured losses from climate-related catastrophes of $7.168 billion - the highest amount on record. The floods also directly caused 23 deaths and resulted in the displacement of tens of thousands of people. High red meat and processed meat consumption and insufficient consumption of fruit and vegetables accounted for about half of the 87 166 diet-related deaths in Australia in 2021. Correction of this imbalance would both save lives and reduce the heavy carbon footprint associated with meat production. We find signs of progress on health and climate change. Importantly, the Australian Government released Australia's first National Health and Climate Strategy, and the Government of Western Australia is preparing a Health Sector Adaptation Plan. We also find increasing action on, and engagement with, health and climate change at a community level, with the number of electric vehicle sales almost doubling in 2022 compared with 2021, and with a 65% increase in coverage of health and climate change in the media in 2022 compared with 2021. Overall, the urgency of substantial enhancements in Australia's mitigation and adaptation responses to the enormous health and climate change challenge cannot be overstated. Australia's energy system, and its health care sector, currently emit an unreasonable and unjust proportion of greenhouse gases into the atmosphere. As the Lancet Countdown enters its second and most critical phase in the leadup to 2030, the depth and breadth of our assessment of health and climate change will be augmented to increasingly examine Australia in its regional context, and to better measure and track key issues in Australia such as mental health and Aboriginal and Torres Strait Islander health and wellbeing.
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Cambio Climático , Sector de Atención de Salud , Humanos , Australia , Salud Mental , Planificación en SaludRESUMEN
BACKGROUND: Physical inactivity is a global public health problem. A practical solution would be to build physical activity into the daily routine by using active modes of transport. Choice of transport mode can influence cancer risk through their effects on levels of physical activity, sedentary time, and environmental pollution. This review synthesizes existing evidence on the associations of specific transport modes with risks of site-specific cancers. METHODS: Relevant literature was searched in PubMed, Embase, and Scopus from 1914 to 17th February 2023. For cancer sites with effect measures available for a specific transport mode from two or more studies, random effects meta-analyses were performed to pool relative risks (RR) comparing the highest vs. lowest activity group as well as per 10 Metabolic Equivalent of Task (MET) hour increment in transport-related physical activity per week (â¼150 min of walking or 90 min of cycling). RESULTS: 27 eligible studies (11 cohort, 15 case-control, and 1 case-cohort) were identified, which reported the associations of transport modes with 10 site-specific cancers. In the meta-analysis, 10 MET hour increment in transport-related physical activity per week was associated with a reduction in risk for endometrial cancer (RR: 0.91, 95% CI: 0.83-0.997), colorectal cancer (RR: 0.95, 95% CI: 0.91-0.99) and breast cancer (RR: 0.99, 95% CI: 0.89-0.996). The highest level of walking only or walking and cycling combined modes, compared to the lowest level, were significantly associated with a 12% and 30% reduced risk of breast and endometrial cancers respectively. Cycling, compared to motorized modes, was associated with a lower risk of overall cancer incidence and mortality. CONCLUSION: Active transport appears to reduce cancer risk, but evidence for cancer sites other than colorectum, breast, and endometrium is currently limited.
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Neoplasias , Humanos , Neoplasias/epidemiología , Transportes , Ejercicio Físico , CaminataRESUMEN
We investigated the association of allergic diseases and epilepsy with risk of brain tumours, in Interphone, a 13-country case-control study. Data were obtained from 2693 glioma cases, 2396 meningioma cases, and 1102 acoustic neuroma cases and their 6321 controls. Conditional logistic regression models were used to estimate pooled odds ratios (ORs) and their respective 95% confidence intervals (CIs), adjusted for education and time at interview. Reduced ORs were observed for glioma in relation to physician-diagnosed asthma (OR = 0.73; CI 0.58-0.92), hay fever (OR 0.72; CI 0.61-0.86), and eczema (OR 0.78, CI 0.64-0.94), but not for meningioma or acoustic neuroma. Previous diagnosis of epilepsy was associated with an increased OR for glioma (2.94; CI 1.87-4.63) and for meningioma (2.12; CI 1.27-3.56), but not for acoustic neuroma. This large-scale case-control study adds to the growing evidence that people with allergies have a lower risk of developing glioma, but not meningioma or acoustic neuroma. It also supports clinical observations of epilepsy prior to the diagnosis of glioma and meningioma.
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Neoplasias Encefálicas , Epilepsia , Glioma , Hipersensibilidad , Neoplasias Meníngeas , Meningioma , Neuroma Acústico , Neoplasias Encefálicas/epidemiología , Estudios de Casos y Controles , Epilepsia/complicaciones , Glioma/epidemiología , Humanos , Hipersensibilidad/complicaciones , Hipersensibilidad/epidemiología , Neoplasias Meníngeas/complicaciones , Neoplasias Meníngeas/epidemiología , Meningioma/complicaciones , Meningioma/epidemiología , Neuroma Acústico/complicaciones , Neuroma Acústico/epidemiología , Factores de RiesgoRESUMEN
The MJA-Lancet Countdown on health and climate change in Australia was established in 2017 and produced its first national assessment in 2018 and annual updates in 2019, 2020 and 2021. It examines 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. In this, the fifth year of the MJA-Lancet Countdown, we track progress on an extensive suite of indicators across these five domains, accessing and presenting the latest data and further refining and developing our analyses. Within just two years, Australia has experienced two unprecedented national catastrophes - the 2019-2020 summer heatwaves and bushfires and the 2021-2022 torrential rains and flooding. Such events are costing lives and displacing tens of thousands of people. Further, our analysis shows that there are clear signs that Australia's health emergency management capacity substantially decreased in 2021. We find some signs of progress with respect to health and climate change. The states continue to lead the way in health and climate change adaptation planning, with the Victorian plan being published in early 2022. At the national level, we note progress in health and climate change research funding by the National Health and Medical Research Council. We now also see an acceleration in the uptake of electric vehicles and continued uptake of and employment in renewable energy. However, we also find Australia's transition to renewables and zero carbon remains unacceptably slow, and the Australian Government's continuing failure to produce a national climate change and health adaptation plan places the health and lives of Australians at unnecessary risk today, which does not bode well for the future.
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Cambio Climático , Energía Renovable , Humanos , Australia , Planificación en SaludRESUMEN
BACKGROUND: Epidemiological evidence in multiple jurisdictions has shown an association between nitrate exposure in drinking water and an increased risk of colorectal cancer (CRC). OBJECTIVE: We aimed to review the extent of nitrate contamination in New Zealand drinking water and estimate the health and financial burden of nitrate-attributable CRC. METHODS: We collated data on nitrate concentrations in drinking water for an estimated 85% of the New Zealand population (â¼4 million people) who were on registered supplies. We estimated nitrate levels for the remaining population (â¼600,000 people) based on samples from 371 unregistered (private) supplies. We used the effective rate ratio from previous epidemiological studies to estimate CRC cases and deaths attributable to nitrate in drinking water. RESULTS: Three-quarters of New Zealanders are on water supplies with less than 1 mg/L NO3-N. The population weighted average for nitrate exposure for people on registered supplies was 0.49 mg/L NO3-N with 1.91% (95%CI 0.49, 3.30) of CRC cases attributable to nitrates. This correlates to 49.7 cases per year (95%CI 14.9, 101.5) at a cost of 21.3 million USD (95% 6.4, 43.5 million USD). When combining registered and unregistered supplies, we estimated 3.26% (95%CI 0.84, 5.57) of CRC cases were attributable to nitrates, resulting in 100 cases (95%CI 25.7, 171.3) and 41 deaths (95%CI 10.5, 69.7) at a cost of 43.2 million USD (95%CI 10.9, 73.4). CONCLUSION: A substantial minority of New Zealanders are exposed to high or unknown levels of nitrates in their drinking water. Given the international epidemiological studies showing an association between cancer and nitrate ingestion from drinking water, this exposure may cause an important burden of preventable CRC cases, deaths, and economic costs. We consider there is sufficient evidence to justify a review of drinking water standards. Protecting public health adds to the strong environmental arguments to improve water management in New Zealand.
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Neoplasias Colorrectales , Agua Potable , Contaminantes Químicos del Agua , Neoplasias Colorrectales/inducido químicamente , Neoplasias Colorrectales/epidemiología , Humanos , Nueva Zelanda/epidemiología , Nitratos/análisis , Nitratos/toxicidad , Óxidos de Nitrógeno , Contaminantes Químicos del Agua/análisis , Contaminantes Químicos del Agua/toxicidad , Abastecimiento de AguaRESUMEN
Children are experiencing an increase in so-called 'eco-anxiety'. Along with others, we argue that children need more concrete, meaningful opportunities to feel they can make a difference in climate. In this article, we contend that bringing back the bicycle, and the opportunities for independent and active mobility that it affords children, is an important form of climate action for young people. We assert that as well as providing sustainability and wellbeing co-benefits for children, cycling can help bolster the neighbourhood resilience and social cohesion that will be key resources for communities adapting to new climate risks.
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Ciclismo , Cohesión Social , Adolescente , Ansiedad , Trastornos de Ansiedad , Niño , Humanos , Características de la ResidenciaRESUMEN
Due to the COVID-19 outbreak, the Chinese government implemented nationwide traffic restrictions and self-quarantine measures from January 23 to April 8 (in Wuhan), 2020. We estimated how these measures impacted ambient air pollution and the subsequent consequences on health and the health-related economy in 367 Chinese cities. A random forests modeling was used to predict the business-as-usual air pollution concentrations in 2020, after adjusting for the impact of long-term trend and weather conditions. We calculated changes in mortality attributable to reductions in air pollution in early 2020 and health-related economic benefits based on the value of statistical life (VSL). Compared with the business-as-usual scenario, we estimated 1239 (95% CI: 844-1578) PM2.5-related deaths were avoided, as were 2777 (95% CI: 1565-3995) PM10-related deaths, 1587 (95% CI: 98-3104) CO-related deaths, 4711 (95% CI: 3649-5781) NO2-related deaths, 215 (95% CI: 116-314) O3-related deaths, and 1088 (95% CI: 774-1421) SO2-related deaths. Based on the reduction in deaths, economic benefits for in PM2.5, PM10, CO, NO2, O3, and SO2 were 1.22, 2.60, 1.36, 4.05, 0.20, and 0.95 billion USD, respectively. Our findings demonstrate the substantial benefits in human health and health-related costs due to improved urban air quality during the COVID lockdown period in China in early 2020.
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Contaminantes Atmosféricos , Contaminación del Aire , COVID-19 , Contaminantes Atmosféricos/análisis , Contaminación del Aire/efectos adversos , Contaminación del Aire/análisis , China/epidemiología , Ciudades , Control de Enfermedades Transmisibles , Brotes de Enfermedades , Humanos , Material Particulado/análisis , SARS-CoV-2RESUMEN
This commentary addresses being an epidemiologist at a time when the field of epidemiology again faces a paradigm shift as the tools for research on human health draw increasingly on emerging technologies-various omics and new methods for collecting individual data at high intensity-and on new methods for carrying out research through administrative and health care data bases linked to biobanks. At the same time, epidemiologists in public health practice continue to face the usual array of challenges, but with the threat of global issues as well. The profession of epidemiologist is not monolithic; it embraces a broad range of activities and professional venues, reflecting the many contexts where epidemiologists do their work, the nature of the problems addressed, and the span and application of their findings. Obtaining data from people and populations comes with serious ethical obligations related to privacy and confidentiality of individuals and respect for the populations studied. Beyond generating and analyzing data, epidemiologists engage in guiding action through the evidence they have created with the ultimate goal of advancing health. This commentary addresses "mega-trends" that will affect the profession in the decades to come.
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Epidemiólogos/organización & administración , Epidemiólogos/tendencias , Epidemiología/organización & administración , Epidemiología/tendencias , Práctica de Salud Pública , Confidencialidad , Recolección de Datos/métodos , Epidemiólogos/normas , Epidemiología/normas , Humanos , Competencia Profesional/normas , Rol ProfesionalRESUMEN
Rapid and wide-ranging reductions in greenhouse gas emissions are required to meet the climate targets agreed upon at the 2015 Paris climate conference. There will be significant transition risks for health, livelihoods, and ecosystems associated with large-scale mitigation, but also opportunities. The aim of this study was to investigate the impacts, positive and negative, of climate policies on population health in China. We review the Intended Nationally Determined Contribution (INDC) that China took to the Paris meeting, link commitments in the INDC to national planning documents relevant to environment and health, and search the literature for Chinese publications on health trade-offs and synergies. Synergies are evident in the measures taken to reduce local air pollution in China: controls on coal burning have materially improved local air quality and benefited health. But there may be risks to health also, depending on how policies are implemented and what safeguards are provided. To date most assessments of the health impacts of climate policies in China have been modelling studies. We recommend work of this kind is complemented by observational research to identify unexpected impacts and vulnerabilities. It will become even more important to undertake this work as emission reductions accelerate to meet the Paris climate targets.
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Cambio Climático , Política Ambiental , Salud Poblacional , Contaminación del Aire/legislación & jurisprudencia , China , Ecosistema , Humanos , Salud Poblacional/estadística & datos numéricosRESUMEN
BACKGROUND: Evidence is mounting to suggest a causal relationship between the built environment and people's physical activity behaviours, particularly active transport. The evidence base has been hindered to date by restricted consideration of cost and economic factors associated with built environment interventions, investigation of socioeconomic or ethnic differences in intervention effects, and an inability to isolate the effect of the built environment from other intervention types. The aims of this systematic review were to identify which environmental interventions increase physical activity in residents at the local level, and to build on the evidence base by considering intervention cost, and the differential effects of interventions by ethnicity and socioeconomic status. METHODS: A systematic database search was conducted in June 2015. Articles were eligible if they reported a quantitative empirical study (natural experiment or a prospective, retrospective, experimental, or longitudinal research) investigating the relationship between objectively measured built environment feature(s) and physical activity and/or travel behaviours in children or adults. Quality assessment was conducted and data on intervention cost and whether the effect of the built environment differed by ethnicity or socioeconomic status were extracted. RESULTS: Twenty-eight studies were included in the review. Findings showed a positive effect of walkability components, provision of quality parks and playgrounds, and installation of or improvements in active transport infrastructure on active transport, physical activity, and visits or use of settings. There was some indication that infrastructure improvements may predominantly benefit socioeconomically advantaged groups. Studies were commonly limited by selection bias and insufficient controlling for confounders. Heterogeneity in study design and reporting limited comparability across studies or any clear conclusions to be made regarding intervention cost. CONCLUSIONS: Improving neighbourhood walkability, quality of parks and playgrounds, and providing adequate active transport infrastructure is likely to generate positive impacts on activity in children and adults. The possibility that the benefits of infrastructure improvements may be inequitably distributed requires further investigation. Opportunities to improve the quality of evidence exist, including strategies to improve response rates and representativeness, use of valid and reliable measurement tools, cost-benefit analyses, and adequate controlling for confounders.
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Planificación Ambiental , Ejercicio Físico , Equidad en Salud , Transportes , Ciclismo , Análisis Costo-Beneficio , Humanos , Características de la Residencia , Factores Socioeconómicos , CaminataRESUMEN
BACKGROUND: The health status of Indigenous populations of Australia and New Zealand (NZ) Maori manifests as life expectancies substantially lower than the total population. Accurate assessment of time trends in mortality and life expectancy allows evaluation of progress in reduction of health inequalities compared to the national or non-Indigenous population. METHODS: Age-specific mortality and life expectancy (at birth) (LE) for Indigenous populations (Australia from 1990 and NZ from 1950); and all Australia and non-Maori NZ (from 1890), males (M) and females (F), were obtained from published sources and national statistical agency reports. Period trends were assessed for credible estimates of Indigenous LE, and the LE gap compared to the total population for Australia, and non-Maori for NZ. Period trends in premature adult mortality, as cumulative probability of dying over 15-59 years, were assessed similarly. The relative contribution of differences in age-specific mortality to the LE gap between Indigenous and the all-Australia population, and the non-Maori NZ, was estimated for each country by sex for the most recent period: 2010-2012 for Australia, 2012-2014 for NZ. RESULTS: LE increased for all populations, although LE gaps between Indigenous and all Australia showed little change over time. LE gaps between NZ Maori and non-Maori increased significantly from the early 1980s to the mid-1990s, and since then have fallen again. Recent LE gaps in Australia (M 12.5; F 12.0 years in 2010-2012) were larger than in NZ (M 7.3; F 6.8 years in 2012-2014). Premature adult mortality (15-59 years) improved for all populations, but mortality ratios show little change since 2000, with Indigenous at 3½-4 times that of all Australians, and Maori 2-3 times that of non-Maori. Using decomposition analysis, the age interval contributing most strongly to differences in LE between Indigenous and all Australia was 35-59 years, but between Maori and non-Maori it was 60-74 years. CONCLUSION: In Australia and NZ, Indigenous LE and adult mortality are improving in absolute terms, but not relative to the entire or non-Indigenous populations, causing gaps in life expectancy to persist.
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Etnicidad , Disparidades en el Estado de Salud , Esperanza de Vida/tendencias , Longevidad , Nativos de Hawái y Otras Islas del Pacífico , Adolescente , Adulto , Anciano , Australia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad Prematura , Nueva Zelanda , Factores Socioeconómicos , Adulto JovenRESUMEN
When investigating the association between brain tumors and use of mobile telephones, accurate data on tumor position are essential, due to the highly localized absorption of energy in the human brain from the radio-frequency fields emitted. We used a point process model to investigate this association using information that included tumor localization data from the INTERPHONE Study (Australia, Canada, Denmark, Finland, France, Germany, Israel, Italy, Japan, New Zealand, Norway, Sweden, and the United Kingdom). Our main analysis included 792 regular mobile phone users diagnosed with a glioma between 2000 and 2004. Similar to earlier results, we found a statistically significant association between the intracranial distribution of gliomas and the self-reported location of the phone. When we accounted for the preferred side of the head not being exclusively used for all mobile phone calls, the results were similar. The association was independent of the cumulative call time and cumulative number of calls. However, our model used reported side of mobile phone use, which is potentially inï¬uenced by recall bias. The point process method provides an alternative to previously used epidemiologic research designs when one is including localization in the investigation of brain tumors and mobile phone use.
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Neoplasias Encefálicas/patología , Teléfono Celular/estadística & datos numéricos , Glioma/patología , Neoplasias Inducidas por Radiación/patología , Adulto , Diseño de Investigaciones Epidemiológicas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Factores de Riesgo , Factores de Tiempo , Carga TumoralRESUMEN
BACKGROUND: Tibet is especially vulnerable to climate change due to the relatively rapid rise of temperature over past decades. The effects on mortality and morbidity of extreme heat in Tibet have been examined in previous studies; no heat adaptation initiatives have yet been implemented. We estimated heat vulnerability of urban and rural populations in 73 Tibetan counties and identified potential areas for public health intervention and further research. METHODS: According to data availability and vulnerability factors identified previously in Tibet and elsewhere, we selected 10 variables related to advanced age, low income, illiteracy, physical and mental disability, small living spaces and living alone. We separately created and mapped county-level cumulative heat vulnerability indices for urban and rural residents by summing up factor scores produced by a principal components analysis (PCA). RESULTS: For both study populations, PCA yielded four factors with similar structure. The components for rural and urban residents explained 76.5 % and 77.7 % respectively of the variability in the original vulnerability variables. We found spatial variability of heat vulnerability across counties, with generally higher vulnerability in high-altitude counties. Although we observed similar median values and ranges of the cumulative heat vulnerability index values among urban and rural residents overall, the pattern varied strongly from one county to another. CONCLUSIONS: We have developed a measure of population vulnerability to high temperatures in Tibet. These are preliminary findings, but they may assist targeted adaptation plans in response to future rapid warming in Tibet.
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Calentamiento Global/estadística & datos numéricos , Estado de Salud , Calor , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Calor Extremo/efectos adversos , Humanos , Estaciones del Año , Tibet/epidemiologíaRESUMEN
BACKGROUND: The incidence of early childhood acute respiratory infections (ARIs) has been associated with aspects of the indoor environment. In recent years, public awareness about some of these environmental issues has increased, including new laws and subsequent changes in occupant behaviours. This New Zealand study investigated current exposures to specific risk factors in the home during the first five years of life and provided updated evidence on the links between the home environment and childhood ARI hospitalisation. METHODS: Pregnant women (n = 6822) were recruited in 2009 and 2010, and their 6853 children created a child cohort that was representative of New Zealand births from 2007-10. Longitudinal data were collected through face-to-face interviews and linkage to routinely collected national datasets. Incidence rates with Poisson distribution confidence intervals were computed and Cox regression modelling for repeated events was performed. RESULTS: Living in a rented dwelling (48%), household crowding (22%) or dampness (20%); and, in the child's room, heavy condensation (20%) or mould or mildew on walls or ceilings (13%) were prevalent. In 14% of the households, the mother smoked cigarettes and in 30%, other household members smoked. Electric heaters were commonly used, followed by wood, flued gas and unflued portable gas heaters. The incidence of ARI hospitalisation before age five years was 33/1000 person-years. The risk of ARI hospitalisation was higher for children living in households where there was a gas heater in the child's bedroom: hazard ratio for flued gas heater 1.69 (95% CI: 1.21-2.36); and for unflued gas heater 1.68 (95% CI: 1.12-2.53); and where a gas heater was the sole type of household heating (hazard ratio: 1.64 (95% CI: 1.29-2.09)). The risk was reduced in households that used electric heaters (Hazard ratio: 0.74 (95% CI: 0.61-0.89)) or wood burners (hazard ratio: 0.79 (95% CI: 0.66-0.93)) as a form of household heating. The associations with other risk factors were not significant. CONCLUSIONS: The risk of early childhood ARI hospitalisation is increased by gas heater usage, specifically in the child's bedroom. Use of non-gas forms of heating may reduce the risk of early childhood ARI hospitalisation.
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Vivienda , Infecciones del Sistema Respiratorio/epidemiología , Preescolar , Composición Familiar , Femenino , Calefacción , Humanos , Lactante , Estudios Longitudinales , Masculino , Nueva Zelanda/epidemiología , Embarazo , Fumar/epidemiologíaRESUMEN
BACKGROUND: Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia, and the incidence of AF is increased markedly among elite athletes. It is not clear how lesser levels of physical activity in the general population influence AF. We asked whether participation in the Taupo Cycle Challenge was associated with increased hospital admissions due to AF, and within the cohort, whether admissions for AF were related to frequency and intensity of cycling. METHODS: Participants in the 2006 Lake Taupo Cycle Challenge, New Zealand's largest mass cycling event, were invited to complete an on-line questionnaire. Those who agreed (n = 2590, response rate = 43.1%) were followed up by record linkage via the National Minimum Health Database from December 1 2006 until June 30 2013, to identify admissions to hospital due to AF. RESULTS: The age and gender standardized admission rate for AF was similar in the Taupo cohort (19.60 per 10,000 per year) and the national population over the same period (2006-2011) (19.45 per 10,000 per year). Within the study cohort (men only), for every additional hour spent cycling per week the risk changed by 0.90 (95% confidence interval 0.79 - 1.01). This result did not change appreciably after adjustment for age and height. CONCLUSIONS: Hospital admission due to AF was not increased above the national rate in this group of non-elite cyclists, and within the group the rate of AF did not increase with amount of cycling. The level of activity undertaken by this cohort of cyclists was, on average, not sufficient to increase the risk of hospitalization for AF.
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Fibrilación Atrial/epidemiología , Ciclismo/fisiología , Adolescente , Adulto , Arritmias Cardíacas/epidemiología , Atletas , Síndrome de Brugada , Trastorno del Sistema de Conducción Cardíaco , Bases de Datos Factuales , Femenino , Estudios de Seguimiento , Sistema de Conducción Cardíaco/anomalías , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Factores de Riesgo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Bicycle use, despite its proven health and other benefits, is rarely part of everyday travel for many people due to the perceived risk of injury from collision crashes. This article investigated the role of physical vs. attention conspicuity in preventing bicycle crashes involving a motor vehicle in New Zealand. METHODS: The Taupo Bicycle Study involved 2590 adult cyclists recruited in 2006 (43.1% response rate) and followed for bicycle crash outcomes through linkage to four national databases. A composite measure of physical conspicuity was created using latent class analysis based on the use of fluorescent colours, lights and reflective materials, and the main colour of top, helmet and bike frame. Attention conspicuity was assessed based on regional differences in travel patterns and the amount of riding in a bunch. Cox regression modelling for repeated events was performed with multivariate adjustments. RESULTS: During a median follow-up period of 6.4 years, 162 participants experienced 187 bicycle-motor vehicle crashes. The crash risk was not predicted by the four latent classes identified and the amount of bunch riding but was higher in Auckland, the region with the lowest level of bicycle use relative to car use. In subgroup analyses, compared to other latent classes, the most physically conspicuous group had a higher risk in Auckland but a lower risk in other regions. CONCLUSION: Conspicuity aids may not be effective in preventing bicycle-motor vehicle crashes in New Zealand, particularly in Auckland, where attention conspicuity is low.
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Accidentes de Tránsito/prevención & control , Accidentes de Tránsito/estadística & datos numéricos , Ciclismo/estadística & datos numéricos , Vehículos a Motor , Seguridad/estadística & datos numéricos , Adolescente , Adulto , Estudios de Cohortes , Color , Femenino , Dispositivos de Protección de la Cabeza/estadística & datos numéricos , Humanos , Masculino , Nueva Zelanda , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Adulto JovenAsunto(s)
Contaminación del Aire Interior/efectos adversos , Prescripciones de Medicamentos/estadística & datos numéricos , Calefacción/efectos adversos , Enfermedades Respiratorias/epidemiología , Enfermedades de la Piel/epidemiología , Humo/efectos adversos , Composición Familiar , Humanos , Nueva Zelanda/epidemiología , Oportunidad Relativa , Vigilancia en Salud Pública , Enfermedades Respiratorias/tratamiento farmacológico , Enfermedades Respiratorias/etiología , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/etiologíaRESUMEN
BACKGROUND: Human leptospirosis is an emerging infectious disease of global significance, and is endemic to several countries in the Pacific. Zoonotic transmission dynamics combined with diagnostic challenges lead to difficulties in prevention and identification of cases. The Federated States of Micronesia (FSM) lacks surveillance data for human leptospirosis. This hospital-based serologic survey sought to estimate the burden of leptospirosis, collect information relating to associated factors, and assess the leptospirosis point-of-care rapid diagnostic test (RDT) commonly used in FSM. METHODS: A four-month hospital-based survey was conducted in Pohnpei State, FSM in 2011. Patients with undifferentiated fevers presenting to hospital were referred for enrolment by physicians. Consenting participants provided paired blood specimens 10-30 days apart, and responded to interview questions regarding demographics, clinical symptoms, exposure to animals, and environmental exposure. Blood samples were subjected to immunochromatographic RDT and confirmed by microscopic agglutination test (MAT). RESULTS: Of 54 participants tested by MAT, 20.4% (95% confidence interval [CI] 10.1-30.6%) showed serologic evidence of acute infection. Occupation student (odds ratio [OR], 17.5; 95% CI: 1.9-161.1) and recreational gardening (OR, 8.6; 95% CI: 1.0-73.8), identified by univariate logistic regression, were associated with infection. The local rapid diagnostic test (RDT) performed with a sensitivity of 69.2 (42.3-89.3 CI) and specificity of 90.0 (81.6-95.6 CI) compared to MAT. CONCLUSIONS: This study demonstrated a high burden of leptospirosis in Pohnpei. Further work is warranted to identify additional risk factors and opportunities to control leptospirosis in Pohnpei and other Pacific settings.
Asunto(s)
Enfermedades Transmisibles Emergentes/epidemiología , Leptospirosis/epidemiología , Adolescente , Adulto , Niño , Enfermedades Transmisibles Emergentes/microbiología , Femenino , Fiebre/epidemiología , Fiebre/microbiología , Hospitales/estadística & datos numéricos , Humanos , Leptospirosis/diagnóstico , Masculino , Micronesia/epidemiología , Estudios Seroepidemiológicos , Adulto JovenRESUMEN
BACKGROUND: Improving social circumstances (e.g., an increase in income, finding a job or moving into a good neighbourhood) may reduce tobacco use, but robust evidence on the effects of such improvements is scarce. Accordingly we investigated the link between changing social circumstances and changing tobacco smoking using repeated measures data. METHODS: 15â 000 adults with at least two observations over three waves (each 2â years apart) of a panel study had data on smoking status, family, labour force, income and deprivation (both neighbourhood and individual). Fixed effects regression modelling was used. FINDINGS: The odds of smoking increased 1.42-fold (95% CI 1.16 to 1.74) for a one log-unit increase in personal income among 15-24-year-olds, but there was no association of increased smoking with an increase in income among 25+ year olds. Moving out of a family nucleus, increasing neighbourhood deprivation (e.g., 1.83-fold (95% CI 1.18 to 2.83) increased odds of smoking for moving from least to most deprived quintile of neighbourhoods), increasing personal deprivation and moving into employment were all associated with increased odds of smoking. The number of cigarettes smoked a day changed little with changing social circumstances. INTERPRETATION: Worsening social circumstances over the short run are generally associated with higher smoking risk. However, there were counter examples: for instance, decreasing personal income among young people was associated with decreased odds of smoking, a finding consistent with income elasticity of demand (the less one's income, the less one can consume). This paper suggests that improving social circumstances is not always pro-health over the short run; a more nuanced approach to the social determinants of health is required.
Asunto(s)
Empleo , Composición Familiar , Disparidades en el Estado de Salud , Renta , Características de la Residencia , Fumar , Clase Social , Adolescente , Adulto , Femenino , Humanos , Estudios Longitudinales , Masculino , Factores de Riesgo , Fumar/economía , Productos de Tabaco , Tabaquismo/economía , Adulto JovenRESUMEN
BACKGROUND: Loss to follow-up, if related to exposures, confounders and outcomes of interest, may bias association estimates. We estimated the magnitude and direction of such bias in a prospective cohort study of crash injury among cyclists. METHODS: The Taupo Bicycle Study involved 2590 adult cyclists recruited from New Zealand's largest cycling event in 2006 and followed over a median period of 4.6â years through linkage to four administrative databases. We resurveyed the participants in 2009 and excluded three participants who died prior to the resurvey. We compared baseline characteristics and crash outcomes of the baseline (2006) and follow-up (those who responded in 2009) cohorts by ratios of relative frequencies and estimated potential bias from loss to follow-up on seven exposure-outcome associations of interest by ratios of HRs. RESULTS: Of the 2587 cyclists in the baseline cohort, 1526 (60%) responded to the follow-up survey. The responders were older, more educated and more socioeconomically advantaged. They were more experienced cyclists who often rode in a bunch, off-road or in the dark, but were less likely to engage in other risky cycling behaviours. Additionally, they experienced bicycle crashes more frequently during follow-up. The selection bias ranged between -10% and +9% for selected associations. CONCLUSIONS: Loss to follow-up was differential by demographic, cycling and behavioural risk characteristics as well as crash outcomes, but did not substantially bias association estimates of primary research interest.