Climate change and infectious disease surveillance in Nepal: qualitative study exploring social, cultural, political and institutional factors influencing disease surveillance.

BACKGROUND: To explore the impacts of contextual issues encompassing social, cultural, political and institutional elements, on the operation of public health surveillance systems in Nepal concerning the monitoring of infectious diseases in the face of a changing climate. METHODS: Semi-structured interviews (n = 16) were conducted amongst key informants from the Department of Health Services, Health Information Management System, Department of Hydrology and Meteorology, World Health Organization, and experts working on infectious disease and climate change in Nepal, and data were analysed using thematic analysis technique. RESULTS: Analysis explicates how climate change is constructed as a contingent risk for infectious diseases transmission and public health systems, and treated less seriously than other 'salient' public health risks, having implications for how resources are allocated. Further, analysis suggests a weak alliance among different stakeholders, particularly policy makers and evidence generators, resulting in the continuation of traditional practices of infectious diseases surveillance without consideration of the impacts of climate change. CONCLUSIONS: We argue that along with strengthening systemic issues (epidemiological capacity, data quality and inter-sectoral collaboration), it is necessary to build a stronger political commitment to urgently address the influence of climate change as a present and exponential risk factor in the spread of infectious disease in Nepal.

Older Adults' Perspectives of Smart Technologies to Support Aging at Home: Insights from Five World Café Forums.

Globally, there is an urgent need for solutions that can support our aging populations to live well and reduce the associated economic, social and health burdens. Implementing smart technologies within homes and communities may assist people to live well and 'age in place'. To date, there has been little consultation with older Australians addressing either the perceived benefits, or the potential social and ethical challenges associated with smart technology use. To address this, we conducted five World Cafés in two Australian states, aiming to capture citizen knowledge about the possibilities and challenges of smart technologies. The participants (n = 84) were aged 55 years and over, English-speaking, and living independently. Grounding our analysis in values-based social science and biomedical ethical principles, we identified the themes reflecting the participants' understanding, resistance, and acceptance of smart technologies, and the ethical principles, including beneficence, non-maleficence, autonomy, privacy, confidentiality, and justice. Similar to other studies, many of the participants demonstrated cautious and conditional acceptance of smart technologies, while identifying concerns about social isolation, breaches of privacy and confidentiality, surveillance, and stigmatization. Attention to understanding and incorporating the values of older citizens will be important for the acceptance and effectiveness of smart technologies for supporting independent and full lives for older citizens.

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

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

Non-linear effect of temperature variation on childhood rotavirus infection: A time series study from Kathmandu, Nepal.

INTRODUCTION: This study aimed to investigate the effects of temperature variability on rotavirus infections among children under 5 years of age in Kathmandu, Nepal. Findings may inform infection control planning, especially in relation to the role of environmental factors in the transmission of rotavirus infection. METHODS: Generalized linear Poisson regression equations with distributed lag non-linear model were fitted to estimate the effect of temperature (maximum, mean and minimum) variation on weekly counts of rotavirus infections among children under 5 years of age living in Kathmandu, Nepal, over the study period (2013 to 2016). Seasonality and long-term effects were adjusted in the model using Fourier terms up to the seventh harmonic and a time function, respectively. We further adjusted the model for the confounding effects of rainfall and relative humidity. RESULTS: During the study period, a total of 733 cases of rotavirus infection were recorded, with a mean of 3 cases per week. We detected an inverse non-linear association between rotavirus infection and average weekly mean temperature, with increased risk (RR: 1.52; 95% CI: 1.08-2.15) at the lower quantile (10th percentile) and decreased risk (RR: 0.64; 95% CI: 0.43-0.95) at the higher quantile (75th percentile). Similarly, we detected an increased risk [(RR: 1.93; 95% CI: 1.40-2.65) and (RR: 1.42; 95% CI: 1.04-1.95)] of rotavirus infection for both maximum and minimum temperature at their lower quantile (10th percentile). We estimated that 344 (47.01%) cases of rotavirus diarrhoea among the children under 5 years of age were attributable to minimum temperature. The significant effect of temperature on rotavirus infection was not observed beyond lag zero week. CONCLUSION: An inverse non-linear association was estimated between rotavirus incidence and all three indices of temperature, indicating a higher risk of infection during the cooler times of the year, and suggesting that transmission of rotavirus in Kathmandu, Nepal may be influenced by temperature.

Determinants of heat-related injuries in Australian workplaces: Perceptions of health and safety professionals.

INTRODUCTION: Hot workplace environments can lead to adverse health effects and contribute to a range of injuries. However, there is limited contextual understanding of heat-related injury occurrence. Gaining the perspectives of occupational health and safety professionals (HSPs) may elucidate the issue and inform targeted interventions. METHODS: A cross-sectional national online survey was conducted in Australia to characterise HSP perceptions of heat-related injuries; current preventive measures; training, policies and guidelines; and perspectives on barriers for prevention. Results were analysed descriptively and a log-Poisson regression model was used to identify risk factors associated with HSP reported injury occurrence, assessed through prevalence ratio (PR). RESULTS: Of the 307 HSP survey participants, 74% acknowledged the potential for increased risk of occupational injuries in hot weather. A variety of injury types and mechanisms were reported, including manual handling injuries, hand injuries, wounds or lacerations, and loss of control of power tools. Correlates of reported heat-related injuries included working in the sun without shade [PR: 1.26; 95% CI: 1.07-1.48] and too few rest breaks [PR: 1.28; 95% CI: 1.04-1.44]. Other factors of significance were inadequate hydration; issues with personal protective equipment (PPE) and poor supervision of workers. Only 42% reported that adequate heat training was available and 54% reported the provision for outdoor work to cease in extreme temperatures. It was acknowledged that the frequency of injuries could be reduced with wider adoption of self-pacing, and work/rest regimes. Perceived barriers for prevention included: lack of awareness of physical injury risks, and management concerns about productivity loss and/or deadlines. CONCLUSION: The findings indicate a range of potentially modifiable work and organisational risk factors such as more suitable PPE and better supervision. More attention to these factors, in conjunction with traditional interventions to reduce heat effects, could enhance injury prevention and labour productivity in people working in hot environments.

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

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

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

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

Assessing the effect of climate factors on childhood diarrhoea burden in Kathmandu, Nepal.

INTRODUCTION: This study was undertaken to assess the effect of climate variability on diarrhoeal disease burden among children under 5 years of age living in Kathmandu, Nepal. The researchers sought to predict future risk of childhood diarrhoea under different climate change scenarios to advance the evidence base available to public health decision-makers, and the Nepalese infection control division, in planning for climate impacts. METHODS: A time series study was conducted using the monthly case count of diarrhoeal disease (2003-2013) among children under 5 years of age living in Kathmandu, Nepal. A quasi Poisson generalised linear equation with distributed lag linear model was fitted to estimate the lagged effect of monthly maximum temperature and rainfall on childhood diarrhoea. The environmental framework of comparative risk assessment was used to assess the environmental burden of diarrhoea within this population. RESULTS: A total of 219,774 cases of diarrhoeal disease were recorded during the study period with a median value of 1286 cases per month. The results of a regression model revealed that the monthly count of diarrhoea cases increased by 8.1% (RR: 1.081; 95% CI: 1.02-1.14) per 1 °C increase in maximum temperature above the monthly average recorded within that month. Similarly, rainfall was found to have significant effect on the monthly diarrhoea count, with a 0.9% (RR; 1.009; 95% CI: 1.004-1.015) increase in cases for every 10 mm increase in rainfall above the monthly cumulative value recorded within that month. It was estimated that 7.5% (95% CI: 2.2%-12.5%) of the current burden of diarrhoea among children under 5 years of age could be attributed to climatic factors (maximum temperature), and projected that 1357 (UI: 410-2274) additional cases of childhood diarrhoea could be climate attributable by the year 2050 under low-risk scenario (0.9 °C increase in maximum temperature). CONCLUSION: It is estimated that there exists a significant association (p < 0.05) between childhood diarrhoea and an increase in maximum temperature and rainfall in Kathmandu, Nepal. The findings of this study may inform the conceptualization and design of early warning systems for the prediction and control of childhood diarrhoea, based upon the observed pattern of climate change in Kathmandu.

Geographical variation in risk of work-related injuries and illnesses associated with ambient temperatures: A multi-city case-crossover study in Australia, 2005-2016.

BACKGROUND: The thermal working environment can have direct and in-direct effects on health and safety. Ambient temperatures have been associated with an increased risk of occupational injuries but it is unknown how the relationship can vary by weather, location and climate. OBJECTIVES: To examine the relationship between ambient temperatures and work-related injury and illness compensation claims in three Australian cities: Melbourne and Perth (temperate climate) and Brisbane (subtropical climate) in order to determine how hot and cold weather influences the risk of occupational injury in Australia. METHODS: Workers' compensation claims from each city for the period 2005 to 2016 were merged with local daily weather data. A time-stratified case-crossover design combined with a distributed lag non-linear model was used to quantify the impacts of daily maximum temperature (Tmax) on the risk of work-related injuries and illnesses. RESULTS: Compared to the median maximum temperature (Tmax), extremely hot temperatures (99th percentile) were associated with a 14% (95%CI: 3-25%) increase in total workers' compensation claims in Melbourne, but there were no observed effects in Brisbane or Perth, with the exception of traumatic injuries that increased by 17% (95%CI: 3-35%) during extreme heat in Perth. For extremely low temperatures (1st percentile), there was a protective effect in Brisbane (RR 0.89; 95%CI: 0.81-0.98), while no effects were observed in Melbourne or Perth. CONCLUSION: The relationship between injury and ambient temperature appears to be variable depending on location and climate. In general, work-related injuries and illnesses appear to be more common at higher temperatures than lower temperatures. Adopting adaptation and prevention measures could reduce the social and economic burden of injury, and formulating effective measures for dealing with high temperatures should be prioritised given the predicted increase in the frequency and intensity of hot weather.

Characterising the impact of heatwaves on work-related injuries and illnesses in three Australian cities using a standard heatwave definition- Excess Heat Factor (EHF).

BACKGROUND AND AIMS: Heatwaves have potential health and safety implications for many workers, and heatwaves are predicted to increase in frequency and intensity with climate change. There is currently a lack of comparative evidence for the effects of heatwaves on workers' health and safety in different climates (sub-tropical and temperate). This study examined the relationship between heatwave severity (as defined by the Excess Heat Factor) and workers' compensation claims, to define impacts and identify workers at higher risk. METHODS: Workers' compensation claims data from Australian cities with temperate (Melbourne and Perth) and subtropical (Brisbane) climates for the years 2006-2016 were analysed in relation to heatwave severity categories (low and moderate/high severity) using time-stratified case-crossover models. RESULTS: Consistent impacts of heatwaves were observed in each city with either a protective or null effect during heatwaves of low-intensity while claims increased during moderate/high-severity heatwaves compared with non-heatwave days. The highest effect during moderate/high-severity heatwaves was in Brisbane (RR 1.45, 95% CI: 1.42-1.48). Vulnerable worker subgroups identified across the three cities included: males, workers aged under 34 years, apprentice/trainee workers, labour hire workers, those employed in medium and heavy strength occupations, and workers from outdoor and indoor industrial sectors. CONCLUSION: These findings show that work-related injuries and illnesses increase during moderate/high-severity heatwaves in both sub-tropical and temperate climates. Heatwave forecasts should signal the need for heightened heat awareness and preventive measures to minimise the risks to workers.

Dengue control in the context of climate change: Views from health professionals in different geographic regions of China.

BACKGROUND: Dengue is a significant climate-sensitive disease. Public health professionals play an important role in prevention and control of the disease. This study aimed to explore dengue control and prevention in the context of climate change in China. METHODS: A cross-sectional survey was conducted among 630 public health professionals in 2015. Descriptive analysis and logistic regression were performed. RESULTS: More than 80% of participants from southwest and central China believed climate change would affect dengue. However, participants from northeast China were less likely to believe so (65%). Sixty-nine percent of participants in Yunnan perceived that dengue had emerged/re-emerged in recent years, compared with 40.6% in Henan and 23.8% in Liaoning. Less than 60% of participants thought current prevention and control programs had been effective. Participants believed mosquitoes in high abundance, imported cases and climate change were main risk factors for dengue in China. CONCLUSION: There were varying views of dengue in China. Professionals in areas susceptible to dengue were more likely to be concerned about climate change and dengue. Current prevention and control strategies need to be improved. Providing more information for staff in lower levels of Centers for Disease Control and Prevention may help in containing a possible increase of dengue.

Heatwave and work-related injuries and illnesses in Adelaide, Australia: a case-crossover analysis using the Excess Heat Factor (EHF) as a universal heatwave index.

PURPOSE: Heatwaves, or extended periods of extreme heat, are predicted to increase in frequency, intensity and duration with climate change, but their impact on occupational injury has not been extensively studied. We examined the relationship between heatwaves of varying severity and work-related injuries and illnesses. We used a newly proposed metric of heatwave severity, the Excess Heat Factor (EHF), which accounts for local climate characteristics and acclimatization and compared it with heatwaves defined by daily maximum temperature. METHODS: Work-related injuries and illnesses were identified from two administrative data sources: workers' compensation claims and work-related ambulance call-outs for the years 2003-2013 in Adelaide, Australia. The EHF metrics were obtained from the Australian Bureau of Meteorology. A time-stratified case-crossover regression model was used to examine associations between heatwaves of three levels of severity, workers' compensation claims, and work-related ambulance call-outs. RESULTS: There was an increase in work-related ambulance call-outs and compensation claims during low and moderately severe heatwaves as defined using the EHF, and a non-significant decline during high-severity heatwaves. Positive associations were observed during moderate heatwaves in compensation claims made by new workers (RR 1.31, 95% CI 1.10-1.55), workers in medium-sized enterprises (RR 1.15, 95% CI 1.01-1.30), indoor industries (RR 1.09, 95% CI 1.01-1.17), males (RR 1.13, 95% CI 1.03-1.23) and laborers (RR 1.21, 95% CI 1.04-1.39). CONCLUSIONS: Workers should adopt appropriate precautions during moderately severe heatwaves, when the risks of work-related injuries and illnesses are increased. Workplace policies and guidelines need to consider the health and safety of workers during heatwaves with relevant prevention and adaptation measures.

"We Were Totally Supportive, of Course": How People Talk About Supporting a Significant Other to Stop or Reduce Their Drinking.

Despite the strong influence our significant others have on health behaviors such as alcohol consumption, little is known about when they are willing to provide support for changing such behaviors. We conducted interviews with 13 Australian adults who had a partner, friend, or family member who stopped or significantly reduced their alcohol consumption within the past 2 years, to understand how these significant others accounted for providing support for this behavior change as reasonable. Through thematic discourse analysis, we identified three types of accounts: (a) deontological, referring to duty or obligation to support others; (b) consequentialist, where costs for providing support were minimized or balanced; and (c) relational, attending to the importance of maintaining relationships. By identifying the principles people draw on to justify supporting a significant other who changes their alcohol consumption, this study enhances our understanding about when significant others are likely to support health behavior changes.

The effects of ambient temperatures on the risk of work-related injuries and illnesses: Evidence from Adelaide, Australia 2003-2013.

BACKGROUND: The thermal environment can directly affect workers' occupational health and safety, and act as a contributing factor to injury or illness. However, the literature addressing risks posed by varying temperatures on work-related injuries and illnesses is limited. OBJECTIVES: To examine the occupational injury and illness risk profiles for hot and cold conditions. METHODS: Daily numbers of workers' compensation claims in Adelaide, South Australia from 2003 to 2013 (n = 224,631) were sourced together with daily weather data. The impacts of maximum daily temperature on the risk of work-related injuries and illnesses was assessed using a time-stratified case-crossover study design combined with a distributed lag non-linear model. RESULTS: The minimum number of workers' compensation claims occurred when the maximum daily temperature was 25 °C. Compared with this optimal temperature, extremely hot temperatures (99th percentile) were associated with an increase in overall claims (RR: 1.30, 95%CI: 1.18-1.44) whereas a non-significant increase was observed with extremely cold temperatures (1st percentile, RR: 1.10 (95%CI: 0.99-1.21). Heat exposure had an acute effect on workers' injuries whereas cold conditions resulted in delayed effects. Moderate temperatures were associated with a greater injury burden than extreme temperatures. CONCLUSION: Days of very high temperatures were associated with the greatest risks of occupational injuries; whereas moderate temperatures, which occur more commonly, have the greatest burden. These findings suggest that the broader range of thermal conditions should be considered in workplace injury and illness prevention strategies.

Impact of meteorological factors on hemorrhagic fever with renal syndrome in 19 cities in China, 2005-2014.

This study aims to investigate the associations between meteorological factors and hemorrhagic fever with renal syndrome (HFRS) in 19 cities selected from HFRS high risk areas across different climate zones in three Provinces of China. De-identified daily reports of HFRS in Anhui, Heilongjiang, and Liaoning Provinces for 2005-2014 were obtained from the Chinese Center for Disease Control and Prevention. Daily weather data from each study location were obtained from the China meteorological Data Sharing Service System. Generalised estimating equation models (GEE) were used to quantify the city-specific HFRS-weather associations. Multivariate random-effects meta-regression models were used to pool the city-specific HFRS-weather effect estimates. HFRS showed an overall downward trend during the study period with a slight rebound after 2010. Meteorological factors were significantly associated with HFRS incidence. HFRS was relatively more sensitive to weather variability in subtropical regions (Anhui Province) than in temperate regions (Heilongjiang and Liaoning Provinces). The size of effect estimates and the duration of lagged effects varied by locations. Pooled results of the 19 cities showed that a 1 °C increase in maximum temperature (Tmax) resulted in a 1.6% (95% CI: 1.0%-2.2%) increase in HFRS; a 1 mm increase in weekly precipitation was associated with 0.2% (95%CI: 0.1%-0.3%) increase in HFRS; a 1% increase in average relative humidity was associated with a 0.9% (95%CI: 0.5%-1.2%) increase in HFRS. The lags with the largest effects for Tmax, precipitation, and relative humidity occurred in weeks 29, 22, and 16, respectively. Lagged effects of meteorological factors did not end after an epidemic season but waned gradually in the following 3-4 epidemic seasons. Weather variability plays a significant role in HFRS transmission in China. The long duration of lagged effects indicates the necessity of continuous interventions following the epidemics.

China's capacity of hospitals to deal with infectious diseases in the context of climate change.

OBJECTIVES: Infectious diseases are a major cause of morbidity and mortality in China. The capacity of hospitals to deal with the challenge from emerging and re-emerging infectious diseases due to climate change is of great importance to population health. This study aimed to explore the capacity of hospitals in China to deal with such challenges. METHODS: A cross-sectional questionnaire survey was utilized to gauge information regarding capacity of hospitals to deal with infectious diseases in the context of climate change among 611 clinical professionals whose roles pertained to infectious disease diagnosis, treatment and management in Anhui Province of China. Descriptive analysis and logistic regression analysis were performed on the data. RESULTS: More than 90% of participants believed climate change would have an adverse influence on population health and infectious disease control in China. Most indicated that their hospitals were well prepared for emerging infectious diseases at present, and they considered that logistical support in hospitals (e.g. administrative and maintenance services) should be strengthened for future capacity building. The majority of participants suggested that effective prevention and control measures, more interdisciplinary collaborations, more funding in rural areas for health care, and improved access to facilities enabling online reporting of infectious diseases, were extremely important strategies in building capacity to curb the population health impact of emerging and re-emerging infectious diseases due to climate change in China. CONCLUSIONS: Clinical professionals recognized that climate change will likely increase the transmission of infectious diseases. Although rural health care and hospitals' logistical support need to be improved, most professionals believed their hospitals to be capable of dealing with emerging diseases. They thought that interdisciplinary and cross-regional collaborations, together with necessary resource support (e.g. improved facilities for rural health care) would be important control strategies.

What Can We Learn about Workplace Heat Stress Management from a Safety Regulator Complaints Database?

Heat exposure can be a health hazard for many Australian workers in both outdoor and indoor situations. With many heat-related incidents left unreported, it is often difficult to determine the underlying causal factors. This study aims to provide insights into perceptions of potentially unsafe or uncomfortably hot working conditions that can affect occupational health and safety using information provided by the public and workers to the safety regulator in South Australia (SafeWork SA). Details of complaints regarding heat exposure to the regulator's "Help Centre" were assembled in a dataset and the textual data analysed thematically. The findings showed that the majority of calls relate to indoor work environments such as kitchens, factories, and warehouses. The main themes identified were work environment, health effects, and organisational issues. Impacts of hot working conditions ranged from discomfort to serious heat-related illnesses. Poor management practices and inflexibility of supervisors featured strongly amongst callers' concerns. With temperatures predicted to increase and energy prices escalating, this timely study, using naturalistic data, highlights accounts of hot working conditions that can compromise workers' health and safety and the need for suitable measures to prevent heat stress. These could include risk assessments to assess the likelihood of heat stress in workplaces where excessively hot conditions prevail.

Heroic journeys through sobriety: How temporary alcohol abstinence campaigns portray participant experiences.

BACKGROUND: In Australia, recent years have seen a rise in the popularity of temporary abstinence campaigns, in which people pledge to abstain from alcohol for a month while raising funds for charity. In addition to their fundraising aims, such initiatives have been viewed as tools for broader behavioural and cultural change around alcohol, encouraging participants to reflect on their drinking and make longer-term changes to their behaviour. The extent to which these initiatives promote enduring change may depend on how they portray the experience of temporarily abstaining from alcohol, and how they position participants. METHOD: We conducted a thematic discourse analysis of e-mails and website content from the 2016 editions of Dry July™ and Ocsober™, two Australian temporary abstinence campaigns. RESULTS: Both campaigns featured an overarching portrayal of participation as a hero's journey through sobriety, with participants embarking on a quest to fundraise for their cause, and returning from their experience transformed. However, the campaigns differed in the way they positioned participants. Dry July™ consistently positioned participants as heroes, promoting both fundraising and reflection on longer-term behaviour changes. In contrast, Ocsober™ offered varied and inconsistent positions which were less likely to engage participants or prompt enduring changes in behaviour, for example positioning participants as alcohol abusers or on a detox. CONCLUSION: Our findings emphasise the need to attend to how campaigns materials position participants in order to strengthen the effectiveness of such campaigns as health promotion tools.

Developing Health-Related Indicators of Climate Change: Australian Stakeholder Perspectives.

Climate-related health indicators are potentially useful for tracking and predicting the adverse public health effects of climate change, identifying vulnerable populations, and monitoring interventions. However, there is a need to understand stakeholders' perspectives on the identification, development, and utility of such indicators. A qualitative approach was used, comprising semi-structured interviews with key informants and service providers from government and non-government stakeholder organizations in South Australia. Stakeholders saw a need for indicators that could enable the monitoring of health impacts and time trends, vulnerability to climate change, and those which could also be used as communication tools. Four key criteria for utility were identified, namely robust and credible indicators, specificity, data availability, and being able to be spatially represented. The variability of risk factors in different regions, lack of resources, and data and methodological issues were identified as the main barriers to indicator development. This study demonstrates a high level of stakeholder awareness of the health impacts of climate change, and the need for indicators that can inform policy makers regarding interventions.

Perceptions of malaria control and prevention in an era of climate change: a cross-sectional survey among CDC staff in China.

BACKGROUND: Though there was the significant decrease in the incidence of malaria in central and southwest China during the 1980s and 1990s, there has been a re-emergence of malaria since 2000. METHODS: A cross-sectional survey was conducted amongst the staff of eleven Centers for Disease Control and Prevention (CDC) in China to gauge their perceptions regarding the impacts of climate change on malaria transmission and its control and prevention. Descriptive analysis was performed to study CDC staff's knowledge, attitudes, perceptions and suggestions for malaria control in the face of climate change. RESULTS: A majority (79.8%) of CDC staff were concerned about climate change and 79.7% believed the weather was becoming warmer. Most participants (90.3%) indicated climate change had a negative effect on population health, 92.6 and 86.8% considered that increasing temperatures and precipitation would influence the transmission of vector-borne diseases including malaria. About half (50.9%) of the surveyed staff indicated malaria had re-emerged in recent years, and some outbreaks were occurring in new geographic areas. The main reasons for such re-emergence were perceived to be: mosquitoes in high-density, numerous imported cases, climate change, poor environmental conditions, internal migrant populations, and lack of health awareness. CONCLUSIONS: This study found most CDC staff endorsed the statement that climate change had a negative impact on infectious disease transmission. Malaria had re-emerged in some areas of China, and most of the staff believed that this can be managed. However, high densities of mosquitoes and the continuous increase in imported cases of malaria in local areas, together with environmental changes are bringing about critical challenges to malaria control in China. This study contributes to an understanding of climate change related perceptions of malaria control and prevention amongst CDC staff. It may help to formulate in-house training guidelines, community health promotion programmes and policies to improve the capacity of malaria control and prevention in the face of climate change in China.