[Show abstract][Hide abstract]ABSTRACT: 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.
Full-text · Article · Dec 2016 · Environmental Health
[Show abstract][Hide abstract]ABSTRACT: Background:
Between 2010 and 2012, the World Health Organization Division of Pacific Technical Support led a regional climate change and health vulnerability assessment and adaptation planning project, in collaboration with health sector partners, in thirteen Pacific island countries - Cook Islands, Federated States of Micronesia, Fiji, Kiribati, Marshall Islands, Nauru, Niue, Palau, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu.
To assess the vulnerabilities of Pacific island countries to the health impacts of climate change and plan adaptation strategies to minimize such threats to health.
This assessment involved a combination of quantitative and qualitative techniques. The former included descriptive epidemiology, time series analyses, Poisson regression and spatial modeling of climate and climate-sensitive disease data, in the few instances where this was possible; the latter included wide stakeholder consultations, iterative consensus-building and expert opinion. Vulnerabilities were ranked using a "likelihood versus impact" matrix, and adaptation strategies prioritized and planned accordingly.
The highest priority climate-sensitive health risks in Pacific island countries include trauma from extreme weather events; heat-related illnesses; compromised safety and security of water and food; vector-borne diseases; zoonoses; respiratory illnesses; psychosocial ill-health; non-communicable diseases; population pressures and health system deficiencies. Adaptation strategies relating to these climate change and health risks can be clustered according to categories common to many countries in the Pacific region.
Pacific island countries are among the most vulnerable in the world to the health impacts of climate change. This vulnerability is a function of their unique geographic, demographic and socioeconomic characteristics, combined with their exposure to changing weather patterns associated with climate change, the health risks entailed, and the limited capacity of the countries to manage and adapt in the face of such risks.
Full-text · Article · Dec 2015 · Environmental Health Perspectives
[Show abstract][Hide abstract]ABSTRACT: Background:
Anecdotal reports indicate a decreasing number of patients presenting for assessment, and in particular a reduction in the number of patients requiring cataract surgery in Pacific Island Countries (PICs). Furthermore, research and routine surveillance is uncommon.
To analyse and describe the records of eye health outreach clinics from a single provider in seven Pacific Islands.
Routine data collected at the Fred Hollows Foundation eye health outreach clinics in Fiji, Kiribati, Papua New Guinea (PNG), Samoa, the Solomon Islands, Tonga and Vanuatu between 2009 and 2013 were analysed.
Over the study period the number of patients treated per clinic fell in Fiji, Samoa and the Solomon Islands. Data from PNG show a higher mean number of patients per clinic and the numbers of patients presenting at PNG outreach clinics appears to be increasing. Cataract was the main eye health condition for between 40%-70% of visits overall, but this range varied between 14% (PNG) and 94% (Fiji). In all countries, males were more likely to receive cataract surgery than females. Refractive error was the most common presenting complaint at PNG outreach clinics; diabetic retinopathy was most common in Tonga. Cases of trachoma or trichiasis were identified in all countries, excepting Kiribati, Samoa and Tonga.
Data from outreach eye health clinics show marked differences between PICs in the most common presenting conditions. In three countries, it appears there has recently been a reduction in the overall number of patients presenting for treatment. Cautious interpretation of the data is required due to concern about data completeness and quality.
Full-text · Article · Sep 2015 · The New Zealand medical journal
[Show abstract][Hide abstract]ABSTRACT: The social and financial burden of road traffic injury in New Zealand is high compared with many other developed countries. In addition, the population is affected by chronic diseases such as obesity, diabetes and cardiovascular disease, all of which share physical inactivity as a risk factor. Road safety is currently a major objective of transport policy, while other public health outcomes are often ignored. There is a need to better understand the integrated outcomes that may arise from neighbourhood streets and routes that facilitate active travel through evidence-based design.
[Show abstract][Hide abstract]ABSTRACT: There is increased interest in the effectiveness and cobenefits of measures to promote walking and cycling, including health gains from increased physical activity and reductions in fossil fuel use and vehicle emissions. This paper analyses the changes in walking and cycling in two New Zealand cities that accompanied public investment in infrastructure married with programmes to encourage active travel.
Using a quasi-experimental two-group pre-post study design, we estimated changes in travel behaviour from baseline in 2011 to mid-programme in 2012, and postprogramme in 2013. The intervention and control cities were matched in terms of sociodemographic variables and baseline levels of walking and cycling. A face-to-face survey obtained information on walking and cycling. We also drew from the New Zealand Travel Survey, a national ongoing survey of travel behaviour, which was conducted in the study areas. Estimates from the two surveys were combined using meta-analysis techniques.
The trips and physical activity were evaluated. Relative to the control cities, the odds of trips being by active modes (walking or cycling) increased by 37% (95% CI 8% to 73%) in the intervention cities between baseline and postintervention. The net proportion of trips made by active modes increased by about 30%. In terms of physical activity levels, there was little evidence of an overall change.
Comparing the intervention cities with the matched controls, we found substantial changes in walking and cycling, and conclude that the improvements in infrastructure and associated programmes appear to have successfully arrested the general decline in active mode use evident in recent years.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
No preview · Article · Jun 2015 · Journal of epidemiology and community health
[Show abstract][Hide abstract]ABSTRACT: Designing walking and cycling back into urban communities may be most effective at achieving a sustained shift from car trips to walking and cycling. Such a shift could deliver substantial benefits for mitigating climate change, public health, social and health inequities, and economic resilience. There is a lack of robust evidence about what designs successfully result in these integrated benefits and are generalizable.
[Show abstract][Hide abstract]ABSTRACT: Climate change may significantly affect human health. The possible effects of high ambient temperature must be better understood, particularly in terms of certain diseases' sensitivity to heat (as reflected in relative risks [RR]) and the consequent disease burden (number or fraction of cases attributable to high temperatures), in order to manage the threat.
This study investigated the number of deaths attributable to abnormally high ambient temperatures in Seoul, South Korea, for a wide range of diseases.
The relationship between mortality and daily maximum temperature using a generalized linear model was analyzed. The threshold temperature was defined as the 90th percentile of maximum daily temperatures. Deaths were classified according to ICD-10 codes, and for each disease, the RR and attributable fractions were determined. Using these fractions, the total number of deaths attributable to daily maximum temperatures above the threshold value, from 1992 to 2009, was calculated. Data analyses were conducted in 2012-2013.
Heat-attributable deaths accounted for 3,177 of the 271,633 deaths from all causes. Neurological (RR 1.07; 95% CI, 1.04-1.11) and mental and behavioral disorders (RR 1.04; 95% CI, 1.01-1.07) had relatively high increases in the RR of mortality. The most heat-sensitive diseases (those with the highest RRs) were not the diseases that caused the largest number of deaths attributable to high temperatures.
This study estimated RRs and deaths attributable to high ambient temperature for a wide variety of diseases. Prevention-related policies must account for both particular vulnerabilities (heat-sensitive diseases with high RRs) and the major causes of the heat mortality burden (common conditions less sensitive to high temperatures).
[Show abstract][Hide abstract]ABSTRACT: 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.ResultsThe 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.
Full-text · Article · Jan 2015 · BMC Public Health
[Show abstract][Hide abstract]ABSTRACT: Human-caused climate change poses an increasingly serious and urgent threat to health and health equity. Under all the climate projections reported in the recent Intergovernmental Panel on Climate Change assessment, New Zealand will experience direct impacts, biologically mediated impacts, and socially mediated impacts on health. These will disproportionately affect populations that already experience disadvantage and poorer health. Without rapid global action to reduce greenhouse gas emissions (particularly from fossil fuels), the world will breach its carbon budget and may experience high levels of warming (land temperatures on average 4-7 degrees Celsius higher by 2100). This level of climate change would threaten the habitability of some parts of the world because of extreme weather, limits on working outdoors, and severely reduced food production. However, well-planned action to reduce greenhouse gas emissions could bring about substantial benefits to health, and help New Zealand tackle its costly burden of health inequity and chronic disease.
No preview · Article · Dec 2014 · The New Zealand medical journal
[Show abstract][Hide abstract]ABSTRACT: The rapid increase in mobile phone use in young people has generated concern about possible health effects of exposure to radiofrequency (RF) and extremely low frequency (ELF) electromagnetic fields (EMF). MOBI-Kids, a multinational case-control study, investigates the potential effects of childhood and adolescent exposure to EMF from mobile communications technologies on brain tumor risk in 14 countries. The study, which aims to include approximately 1,000 brain tumor cases aged 10-24 years and two individually matched controls for each case, follows a common protocol and builds upon the methodological experience of the INTERPHONE study. The design and conduct of a study on EMF exposure and brain tumor risk in young people in a large number of countries is complex and poses methodological challenges. This manuscript discusses the design of MOBI-Kids and describes the challenges and approaches chosen to address them, including: (1) the choice of controls operated for suspected appendicitis, to reduce potential selection bias related to low response rates among population controls; (2) investigating a young study population spanning a relatively wide age range; (3) conducting a large, multinational epidemiological study, while adhering to increasingly stricter ethics requirements; (4) investigating a rare and potentially fatal disease; and (5) assessing exposure to EMF from communication technologies. Our experience in thus far developing and implementing the study protocol indicates that MOBI-Kids is feasible and will generate results that will contribute to the understanding of potential brain tumor risks associated with use of mobile phones and other wireless communications technologies among young people.
Full-text · Article · Sep 2014 · Frontiers in Public Health
[Show abstract][Hide abstract]ABSTRACT: Background
Policy advisers are seeking robust evidence on the effectiveness of measures, such as promoting walking and cycling, that potentially offer multiple benefits, including enhanced health through physical activity, alongside reductions in energy use, traffic congestion and carbon emissions. This paper outlines the ‘ACTIVE’ study, designed to test whether the Model Communities Programme in two New Zealand cities is increasing walking and cycling. The intervention consists of the introduction of cycle and walkway infrastructure, along with measures to encourage active travel. This paper focuses on the rationale for our chosen study design and methods.
The study design is multi-level and quasi-experimental, with two intervention and two control cities. Baseline measures were taken in 2011 and follow-up measures in 2012 and 2013. Our face-to-face surveys measured walking and cycling, but also awareness, attitudes and habits. We measured explanatory and confounding factors for mode choice, including socio-demographic and well-being variables. Data collected from the same households on either two or three occasions will be analysed using multi-level models that take account of clustering at the household and individual levels. A cost-benefit analysis will also be undertaken, using our estimates of carbon savings from mode shifts. The matching of the intervention and control cities was quite close in terms of socio-demographic variables, including ethnicity, and baseline levels of walking and cycling.
This multidisciplinary study provides a strong design for evaluating an intervention to increase walking and cycling in a developed country with relatively low baseline levels of active travel. Its strengths include the use of data from control cities as well as intervention cities, an extended evaluation period with a reasonable response rate from a random community survey and the availability of instrumental variables for sensitivity analyses.
Full-text · Article · Sep 2014 · BMC Public Health