Cordia Ming-Yeuk Chu

The health–promoting workplace: an integrative perspective

Abstract: The workplace is an important setting, affecting the physical, mental, economic and social wellbeing of workers, and, in turn, their families. Health of workers has many determinants, and a multidisciplinary, integrated approach is important. An overview of trends in workplace health promotion shows that current thinking has changed from a narrowly based risk–factors approach aimed at individual behaviour changes, to an integrative approach aimed at creating health–promoting workplaces. The health–promoting workplace has ‘an all—encompassing approach that empowers workers and employers to improve all facets of their health’. There are gaps in knowledge, at the state and national levels, relevant to the planning and assessment of workplace health. A national information network is needed to facilitate better links between public health practitioners and researchers in advancing the health of working Australians.

The short-term effect of heat waves on mortality and its modifiers in China: An analysis from 66 communities

BACKGROUND Many studies have reported increased mortality risk associated with heat waves. However, few have assessed the health impacts at a nation scale in a developing country. This study examines the mortality effects of heat waves in China and explores whether the effects are modified by individual-level and community-level characteristics. METHODS Daily mortality and meteorological variables from 66 Chinese communities were collected for the period 2006-2011. Heat waves were defined as ≥2 consecutive days with mean temperature ≥95th percentile of the year-round community-specific distribution. The community-specific mortality effects of heat waves were first estimated using a Distributed Lag Non-linear Model (DLNM), adjusting for potential confounders. To investigate effect modification by individual characteristics (age, gender, cause of death, education level or place of death), separate DLNM models were further fitted. Potential effect modification by community characteristics was examined using a meta-regression analysis. RESULTS A total of 5.0% (95% confidence intervals (CI): 2.9%-7.2%) excess deaths were associated with heat waves in 66 Chinese communities, with the highest excess deaths in north China (6.0%, 95% CI: 1%-11.3%), followed by east China (5.2%, 95% CI: 0.4%-10.2%) and south China (4.5%, 95% CI: 1.4%-7.6%). Our results indicate that individual characteristics significantly modified heat waves effects in China, with greater effects on cardiovascular mortality, cerebrovascular mortality, respiratory mortality, the elderly, females, the population dying outside of a hospital and those with a higher education attainment. Heat wave mortality effects were also more pronounced for those living in urban cities or densely populated communities. CONCLUSION Heat waves significantly increased mortality risk in China with apparent spatial heterogeneity, which was modified by some individual-level and community-level factors. Our findings suggest adaptation plans that target vulnerable populations in susceptible communities during heat wave events should be developed to reduce health risks.

Short-term effects of the 2008 cold spell on mortality in three subtropical cities in Guangdong Province, China.

Background: Few studies have been conducted to investigate the impact of extreme cold events on mortality in subtropical regions. Objective: In the present study we aimed to investigate the effects of the 2008 cold spell on mortality and the possibility of mortality displacement in three subtropical cities in China. Methods: Daily mortality, air pollution, and weather data were collected from 2006 to 2009 in Guangzhou, Nanxiong (no air pollutants), and Taishan. We used a polynomial distributed lag model (DLM) to analyze the relationship between the 2008 cold spell and mortality. To observe the mortality displacement of the cold spell, we estimated the cumulative effects at lag0, lag0–6, lag0–13, lag0–20, and lag0–27 separately. Results: During the 2008 cold spell, the cumulative risk of nonaccidental mortality increased significantly in Guangzhou [relative risk (RR) = 1.60; 95% CI: 1.19, 2.14] and Taishan (RR = 1.60; 95% CI: 1.06, 2.40) when lagged up to 4 weeks after the cold spell ended. Estimated effects at lag0–27 were more pronounced for males than for females, for respiratory mortality than for cardiovascular mortality, and for the elderly (≥ 75 years of age) than for those 0–64 years of age. Most of the cumulative RRs increased with longer lag times in Guangzhou and Taishan. However, in Nanxiong, the trend with cumulative RRs was less consistent, and we observed no statistically significant associations at lag0–27. Conclusion: We found associations between the 2008 cold spell and increased mortality in the three subtropical cities of China. The lag effect structure of the cold spell varied with location and the type of mortality, and evidence of short-term mortality displacement was inconsistent. These findings suggest that extreme cold is an important public health problem in subtropical regions.

Managing the health effects of temperature in response to climate change: challenges ahead.

BACKGROUND Although many studies have shown that high temperatures are associated with an increased risk of mortality and morbidity, there has been little research on managing the process of planned adaptation to alleviate the health effects of heat events and climate change. In particular, economic evaluation of public health adaptation strategies has been largely absent from both the scientific literature and public policy discussion. OBJECTIVES We examined how public health organizations should implement adaptation strategies and, second, how to improve the evidence base required to make an economic case for policies that will protect the publics health from heat events and climate change. DISCUSSION Public health adaptation strategies to cope with heat events and climate change fall into two categories: reducing the heat exposure and managing the health risks. Strategies require a range of actions, including timely public health and medical advice, improvements to housing and urban planning, early warning systems, and assurance that health care and social systems are ready to act. Some of these actions are costly, and given scarce financial resources the implementation should be based on the cost-effectiveness analysis. Therefore, research is required not only on the temperature-related health costs, but also on the costs and benefits of adaptation options. The scientific community must ensure that the health co-benefits of climate change policies are recognized, understood, and quantified. CONCLUSIONS The integration of climate change adaptation into current public health practice is needed to ensure the adaptation strategies increase future resilience. The economic evaluation of temperature-related health costs and public health adaptation strategies are particularly important for policy decisions.

Quality of life in caregivers of children and adolescents with intellectual disabilities: use of WHOQOL-BREF survey.

The present study based on World Health Organization quality of life (WHOQOL-BREF) scale to examine quality of life of the caregivers caring for their children/adolescents with intellectual disabilities in Taiwan, and the factors contributing to their quality of life. Structured interviews were conducted with 597 caregivers of children/adolescents with intellectual disabilities. The results found that the mean scores in each domain of WHOQOL-BREF of the caregivers as the followings: physical capacity (PC) was 13.71+/-2.35, psychological well-being (PW) was 12.21+/-2.55, social relationship (SR) was 12.99+/-2.43 and environment (EN) was 12.32+/-2.38. These mean scores were lower than the general population and slight higher than the caregivers of adults with intellectual disabilities in Taiwan. Finally, multiple stepwise regressions were conducted to examine the characteristics of caregiver and children/adolescents with intellectual disabilities will more likely explained the WHOQOL-BREF mean scores. The study found the following three factors: self-perceived health status, household income and stress from insufficient family support were significantly correlated to all four domains in multiple stepwise regression analyses. The results highlights that caregivers of children and adolescents with intellectual disabilities seem to display a lower WHOQOL-BREF mean score than the general population, probably for a combination of stress, health and household income factors. These finding must be taken into account in policy making to provide better and more specific supports and interventions for the caregivers of people with intellectual disabilities.

Predicting unprecedented dengue outbreak using imported cases and climatic factors in Guangzhou, 2014.

Introduction Dengue is endemic in more than 100 countries, mainly in tropical and subtropical regions, and the incidence has increased 30-fold in the past 50 years. The situation of dengue in China has become more and more severe, with an unprecedented dengue outbreak hitting south China in 2014. Building a dengue early warning system is therefore urgent and necessary for timely and effective response. Methodology and Principal Findings In the study we developed a time series Poisson multivariate regression model using imported dengue cases, local minimum temperature and accumulative precipitation to predict the dengue occurrence in four districts of Guangzhou, China. The time series data were decomposed into seasonal, trend and remainder components using a seasonal-trend decomposition procedure based on loess (STL). The time lag of climatic factors included in the model was chosen based on Spearman correlation analysis. Autocorrelation, seasonality and long-term trend were controlled in the model. A best model was selected and validated using Generalized Cross Validation (GCV) score and residual test. The data from March 2006 to December 2012 were used to develop the model while the data from January 2013 to September 2014 were employed to validate the model. Time series Poisson model showed that imported cases in the previous month, minimum temperature in the previous month and accumulative precipitation with three month lags could project the dengue outbreaks occurred in 2013 and 2014 after controlling the autocorrelation, seasonality and long-term trend. Conclusions Together with the sole transmission vector Aedes albopictus, imported cases, monthly minimum temperature and monthly accumulative precipitation may be used to develop a low-cost effective early warning system.

The effect of heat waves on mortality and effect modifiers in four communities of Guangdong Province, China

BACKGROUND Heat waves have been reported to be associated with increased mortality; however, fewer studies have examined the effect modification by heat wave characteristics, individual characteristics and community characteristics. METHODS This study investigated the effect of extreme heat on mortality in 2 urban and 2 rural communities in Guangdong Province, China during 2006-2010. The effect of extreme heat was divided into two parts: main effect due to high temperature and added effect due to prolonged heat for several consecutive days. A distributed lag non-linear model was used to calculate the relative risk with consideration of lag days and potential confounding factors. Separate models were further fit by individual characteristics (cause of death, age and gender) and heat wave characteristics (intensity, duration and timing), and potential effect modification of community characteristics was examined using a meta-regression, such as educational levels, percentage of the elderly, Gross Regional Domestic Product (GDP). RESULTS The overall main effects (ER=8.2%, 95% CI: 3.4%, 13.2%) were greater than the added effects (ER=0.0%, 95% CI: -3.8%, 4.0%) on the current day. The main effect peaked at lag0-2, and was higher for the two rural areas compared to the two cities, for respiratory compared to cardiovascular mortality, for those ≥75 years old and for females. The modifying effects of heat wave characteristics and community characteristics on mortality were not statistically significant. CONCLUSION This study suggests the effects of extreme heat were mainly driven by high temperature, which can be modified by some individual characteristics.

Postnatal experience and health needs of Chinese migrant women in Brisbane, Australia

In Chinese society, traditional postnatal practices and family support protect the health and well-being of women after childbirth. The absence of support for these practices for Chinese migrants in Western societies can have negative implications for their health. Recent studies reveal that postnatal stress is a growing concern among Chinese migrant women in Brisbane, Australia. There is a need to investigate the experiences of these women in order to understand factors affecting their postnatal health and to identify gaps in, and ways to improve, existing services and support identified needs. This paper examines postnatal experience and health needs of Chinese migrant women in Brisbane from three different places of origin: Taiwan, Hong Kong and the Peoples Republic of China (PRC). Previous studies on reproductive health beliefs and practices of Chinese women have found that a relationship exists between postnatal maternal health and postnatal cultural practices, appropriate family and community support and social circumstances, particularly pressures relating to employment. This study further tests and confirms these findings by comparing the experience of the three Chinese groups who have different migration circumstances, socio-economic and employment status, and support networks. The study reveals that among the three groups, PRC migrants are more likely to have encountered downward social mobility, economic hardship, social isolation, employment and language problems. While all three groups believe in the necessity of traditional postnatal practices, the PRC group has less support and is also more likely to have experienced postnatal health problems than the other two groups. This paper concludes with two sets of recommendations: one for community organisations with a focus on empowerment and cooperation; and one for service providers concerning improvement of multi-sectoral partnership, cross-cultural communication and the development of a postnatal care service model.

The temperature–mortality relationship in China: An analysis from 66 Chinese communities

BACKGROUND Previous studies examining temperature-mortality associations in China focused on a single city or a small number of cities. A multi-city study covering different climatic zones is necessary to better understand regional differences in temperature risk on mortality in China. METHODS Sixty-six communities from 7 regions across China were included in this study. We first used a Distributed Lag Non-linear Model (DLNM) to estimate community-specific effects of temperature on non-accidental mortality during 2006-2011. A multivariate meta-analysis was then applied to pool the estimates of community-specific effects. RESULTS A U-shaped curve was observed between temperature and mortality at the national level in China, indicating both low and high temperatures were associated with increased mortality risk. The overall threshold was at about the 75th percentile of the pooled temperature distribution. The relative risk was 1.61 (95% CI: 1.48-1.74) for extremely cold temperature (1st percentile of temperature), and 1.21 (95% CI: 1.10-1.34) for extreme hot temperature (99th percentile of temperature) at lag0-21 days. The temperature-mortality relationship is different for different regions. Compared with north China, south China had a higher minimum mortality temperature (MMT), and there was a larger cold effect in the more southern parts of China and a more pronounced hot effect in more northern parts. CONCLUSIONS Both cold and hot temperatures increase mortality risk in China, and the relationship varies geographically. Our findings suggest that public health policies for climate change adaptation should be tailored to the local climate conditions.

Body mass index and risk of pneumonia: a systematic review and meta-analysis

The aims of our meta‐analysis were to examine the pattern and genders influence on body mass index (BMI) – pneumonia relationship. Published studies were searched from PubMed, Web of Science, Cochrane Library databases using keywords of pneumonia, BMI and epidemiologic studies. Random‐effects analysis was applied to estimate pooled effect sizes from individual studies. The Cochrane Q‐test and index of heterogeneity (I2) were used to evaluate heterogeneity, and Eggers test was used to evaluate publication bias. Random‐effects meta‐regression was applied to examine the pattern and genders influence on BMI–pneumonia relationship.