The burden of occupational injury attributable to high temperatures in Australia, 2014-19: a retrospective observational study.

OBJECTIVES: To assess the population health impact of high temperatures on workplace health and safety by estimating the burden of heat-attributable occupational injury in Australia. STUDY DESIGN, SETTING: Retrospective observational study; estimation of burden of occupational injury in Australia attributable to high temperatures during 2014-19, based on Safe Work Australia (work-related traumatic injury fatalities and workers' compensation databases) and Australian Institute of Health and Welfare data (Australian Burden of Disease Study and National Hospital Morbidity databases), and a meta-analysis of climate zone-specific risk data. MAIN OUTCOME MEASURE: Burden of heat-attributable occupational injuries as disability-adjusted life years (DALYs), comprising the numbers of years of life lived with disability (YLDs) and years of life lost (YLLs), nationally, by Köppen-Geiger climate zone, and by state and territory. RESULTS: During 2014-19, an estimated 42 884 years of healthy life were lost to occupational injury, comprising 39 485 YLLs (92.1%) and 3399 YLDs (7.9%), at a rate of 0.80 DALYs per 1000 workers per year. A total of 967 occupational injury-related DALYs were attributable to heat (2.3% of occupational injury-related DALYs), comprising 890 YLLs (92%) and 77 YLDs (8%). By climate zone, the heat-attributable proportion was largest in the tropical Am (12 DALYs; 3.5%) and Aw zones (34 DALYs; 3.5%); by state and territory, the proportion was largest in New South Wales and Queensland (each 2.9%), which also included the largest numbers of heat-attributable occupational injury-related DALYs (NSW: 379 DALYs, 39% of national total; Queensland: 308 DALYs; 32%). CONCLUSION: An estimated 2.3% of the occupational injury burden in Australia is attributable to high ambient temperatures. To prevent this burden increasing with global warming, adaptive measures and industry-based policies are needed to safeguard workplace health and safety, particularly in heat-exposed industries, such as agriculture, transport, and construction.

Estimating the burden of disease attributable to high ambient temperature across climate zones: methodological framework with a case study.

BACKGROUND: With high temperature becoming an increasing health risk due to a changing climate, it is important to quantify the scale of the problem. However, estimating the burden of disease (BoD) attributable to high temperature can be challenging due to differences in risk patterns across geographical regions and data accessibility issues. METHODS: We present a methodological framework that uses Köppen-Geiger climate zones to refine exposure levels and quantifies the difference between the burden observed due to high temperatures and what would have been observed if the population had been exposed to the theoretical minimum risk exposure distribution (TMRED). Our proposed method aligned with the Australian Burden of Disease Study and included two parts: (i) estimation of the population attributable fractions (PAF); and then (ii) estimation of the BoD attributable to high temperature. We use suicide and self-inflicted injuries in Australia as an example, with most frequent temperatures (MFTs) as the minimum risk exposure threshold (TMRED). RESULTS: Our proposed framework to estimate the attributable BoD accounts for the importance of geographical variations of risk estimates between climate zones, and can be modified and adapted to other diseases and contexts that may be affected by high temperatures. CONCLUSIONS: As the heat-related BoD may continue to increase in the future, this method is useful in estimating burdens across climate zones. This work may have important implications for preventive health measures, by enhancing the reproducibility and transparency of BoD research.

Cardiorespiratory effects of heatwaves: A systematic review and meta-analysis of global epidemiological evidence.

BACKGROUND: Heatwaves affect human health and global heatwave-related disease burden will continue to rise as climate change proceeds, but the effects of heatwaves on cardiovascular and respiratory diseases have not yet been investigated globally and nationally. OBJECTIVES: This systematic review and meta-analysis aim to quantify heatwave effects on four major health outcomes: cardiovascular and respiratory morbidity and mortality. METHODS: We searched PubMed, Scopus, Embase, and Web of Science for relevant studies from database inception to November 2018. Categories of morbidity included hospital admissions, emergency department visits, and ambulance attendances/call-outs. A random-effects meta-analysis model was used to pool previous estimates of heatwave effects on mortality and morbidity due to cardiovascular and respiratory diseases. Subgroup analyses by gender, age, and disease cause were conducted. Sensitivity analyses were performed by the categories of morbidity, heatwave definitions, study design, and using a leave-one-out cross validation approach. This study is registered with PROSPERO (number: CRD42018101964). RESULTS: We identified 54 studies conducted in 20 countries. In total, there were significant associations between heatwaves and cardiovascular mortality (risk estimates (RE): 1.149, 95% confidence interval (CI): 1.090, 1.210) and respiratory mortality (RE: 1.183, 95%CI: 1.092, 1.282), but the magnitude of these associations varied across countries and studies. Heatwaves appeared to be marginally associated with cardiovascular and respiratory morbidities (RE: 0.999, 95%CI: 0.996, 1.002, p-value = 0.61 for cardiovascular morbidity; RE: 1.043, 95%CI: 0.995, 1.093; p-value = 0.08 for respiratory morbidity). For mortality, significant associations were observed for the elderly, ischemic heart disease, stroke, heart failure, and chronic obstructive pulmonary disease. Sensitivity analyses suggested that these findings were robust. CONCLUSION: Mortality of cardiovascular and respiratory diseases appeared to be more vulnerable to heatwaves in comparison to morbidity. Considering high heterogeneity detected between studies and limited investigations into subpopulations, more research are required to provide a clearer picture of how heatwaves affect cardiovascular and respiratory diseases in different settings.

Improving the cardiometabolic health of people with psychosis: A protocol for a randomised controlled trial of the Physical Health Nurse Consultant service.

BACKGROUND: Over 690,000 Australians experience psychosis annually, significantly impacting cardiometabolic illness and healthcare costs. Current models of care are fragmented and a critical implementation gap exists regarding the delivery of coordinated physical healthcare for Australians with psychosis. OBJECTIVES: To describe a trial implementing a Physical Health Nurse Consultant (PHNC) role to coordinate physical health care in a community mental health setting. DESIGN/METHODS: In this 24-month, 2-group randomised controlled trial, 160 adults with psychosis will be randomised to usual care, or to the PHNC in addition to usual care. Using the Positive Cardiometabolic Health treatment framework and working in collaborative partnerships with consumers (consumer-led co-design), the PHNC will provide care coordination including referral to appropriate programmes or services based on the treatment framework, with the consumer. Burden of Disease risk factors will be collected according to Australian Bureau of Statistics' National Health Survey guidelines. Consumer experience will be assessed using the 'Access', 'Acceptability' and 'Shared Decision Making' dimensions of the Patient Experiences in Primary Healthcare Survey. Cost-effectiveness will be modelled from Burden of Disease data using the Assessing Cost Effectiveness Prevention methodology. RESULTS: Data collection of two years duration will commence in late 2018. Preliminary findings are expected in December 2019. Primary outcomes will be the effect of the PHNC role on physical healthcare in community-based adults with psychosis. CONCLUSIONS: The PHNC is an innovative approach to physical health care for adults with psychosis which aims to meet the physical health needs of consumers by addressing barriers to physical health care.

Mechanistic analysis of experimental food allergen-induced cutaneous reactions.

Individuals with food allergy often present with uritcaria and atopic dermatitis. Indeed, susceptibility to food allergy may predispose to the development of these cutaneous allergic disorders. Recently, we developed a model of food allergy, whereby oral consumption of food [pea Pisum sativum L.; expressing alpha-amylase inhibitor-1 (alphaAI) from the common bean Phaseolus vulgaris L. cv Tendergreen (pea-alphaAI)] promotes a T helper cell type 2 (Th2) inflammatory response and predisposes to cutaneous allergic reactions following subsequent food allergen (alphaAI) exposure. To delineate the kinetics of food allergen-induced cutaneous reactions and examine the inflammatory mechanisms involved in this allergic reaction, we used interleukin (IL)-13-, IL-4 receptor alpha-, and eotaxin-1-deficient mice and performed serum transfer and CD4+ T cell depletion studies. We demonstrate that consumption of pea-alphaAI promotes an alphaAI-specific immunoglobulin G1 (IgG1) and IgE antibody response. Furthermore, we show that subsequent food allergen (alphaAI) challenge in the skin induced an early (3 h)- and late-phase (24 h) cutaneous allergic reaction. The early-phase response was associated with mast cell degranulation and the presence of Ig, whereas the late-phase response was characterized by a lymphoid and eosinophilic infiltrate, which was critically regulated by CD4+ T cells, IL-13, and eotaxin-1. Collectively, these studies demonstrate that food allergy can predispose to cutaneous inflammatory reactions, and these processes are critically regulated by Th2 immune factors.

Genetically modified plants and food hypersensitivity diseases: usage and implications of experimental models for risk assessment.

The recent advances in biotechnology in the plant industry have led to increasing crop production and yield that in turn has increased the usage of genetically modified (GM) food in the human food chain. The usage of GM foods for human consumption has raised a number of fundamental questions including the ability of GM foods to elicit potentially harmful immunological responses, including allergic hypersensitivity. To assess the safety of foods derived from GM plants including allergenic potential, the US FDA, Food and Agriculture Organization of the United Nations (FAO)/World Health Organization (WHO), and the EU have developed approaches for evaluation assessment. One assessment approach that has been a very active area of research and debate is the development and usage of animal models to assess the potential allergenicity of GM foods. A number of specific animal models employing rodents, pigs, and dogs have been developed for allergenicity assessment. However, validation of these models is needed and consideration of the criteria for an appropriate animal model for the assessment of allergenicity in GM plants is required. We have recently employed a BALB/c mouse model to assess the potential allergenicity of GM plants. We have been able to demonstrate that this model is able to detect differences in antigenicity and identify aspects of protein post-translational modifications that can alter antigenicity. Furthermore, this model has also enabled us to examine the usage of GM plants as a therapeutic approach for the treatment of allergic diseases. This review discusses the current approaches to assess the allergenic potential of GM food and particularly focusing on the usage of animal models to determine the potential allergenicity of GM foods and gives an overview of our recent findings and implications of these studies.

Transgenic expression of bean alpha-amylase inhibitor in peas results in altered structure and immunogenicity.

The development of modern gene technologies allows for the expression of recombinant proteins in non-native hosts. Diversity in translational and post-translational modification pathways between species could potentially lead to discrete changes in the molecular architecture of the expressed protein and subsequent cellular function and antigenicity. Here, we show that transgenic expression of a plant protein (alpha-amylase inhibitor-1 from the common bean (Phaseolus vulgaris L. cv. Tendergreen)) in a non-native host (transgenic pea (Pisum sativum L.)) led to the synthesis of a structurally modified form of this inhibitor. Employing models of inflammation, we demonstrated in mice that consumption of the modified alphaAI and not the native form predisposed to antigen-specific CD4+ Th2-type inflammation. Furthermore, consumption of the modified alphaAI concurrently with other heterogeneous proteins promoted immunological cross priming, which then elicited specific immunoreactivity of these proteins. Thus, transgenic expression of non-native proteins in plants may lead to the synthesis of structural variants possessing altered immunogenicity.