Jianjun Xiang

Health impacts of workplace heat exposure: an epidemiological review.

With predicted increasing frequency and intensity of extremely hot weather due to changing climate, workplace heat exposure is presenting an increasing challenge to occupational health and safety. This article aims to review the characteristics of workplace heat exposure in selected relatively high risk occupations, to summarize findings from published studies, and ultimately to provide suggestions for workplace heat exposure reduction, adaptations, and further research directions. All published epidemiological studies in the field of health impacts of workplace heat exposure for the period of January 1997 to April 2012 were reviewed. Finally, 55 original articles were identified. Manual workers who are exposed to extreme heat or work in hot environments may be at risk of heat stress, especially those in low-middle income countries in tropical regions. At risk workers include farmers, construction workers, fire-fighters, miners, soldiers, and manufacturing workers working around process-generated heat. The potential impacts of workplace heat exposure are to some extent underestimated due to the underreporting of heat illnesses. More studies are needed to quantify the extent to which high-risk manual workers are physiologically and psychologically affected by or behaviourally adapt to workplace heat exposure exacerbated by climate change.

Association between high temperature and work-related injuries in Adelaide, South Australia, 2001–2010

Objectives (1) To investigate the association between temperature and work-related injuries and (2) to identify groups of workers at high risk of work-related injuries in hot environments in Adelaide, South Australia. Methods Workers’ compensation claims in Adelaide, South Australia for 2001–2010 were used. The relationship between temperature and daily injury claims was estimated using a generalised estimating equation model. A piecewise linear spline function was used to quantify the effect of temperature on injury claims below and above thresholds. Results Overall, a 1°C increase in maximum temperature between 14.2°C and 37.7°C was associated with a 0.2% increase in daily injury claims. Specifically, the incidence rate ratios (IRRs) for male workers and young workers aged ≤24 were (1.004, 95% CI 1.002 to 1.006) and (1.005, 95% CI 1.002 to 1.008), respectively. Significant associations were also found for labourers (IRR 1.005, 95% CI 1.001 to 1.010), intermediate production and transport workers (IRR 1.003, 95% CI 1.001 to 1.005) and tradespersons (IRR 1.002, 95% CI 1.001 to 1.005). Industries at risk were agriculture, forestry and fishing (IRR 1.007, 95% CI 1.001 to 1.013), construction (IRR 1.006, 95% CI 1.002 to 1.011), and electricity, gas and water (IRR 1.029, 95% CI 1.002 to 1.058). Conclusions There is a significant association between injury claims and temperature in Adelaide, South Australia, for certain industries and groups. Relevant adaptation and prevention measures are required at both policy and practice levels to address occupational exposure to high temperatures.

Association between dengue fever incidence and meteorological factors in Guangzhou, China, 2005–2014

ABSTRACT This study aims to (1) investigate the associations between climatic factors and dengue; and (2) identify the susceptible subgroups. De‐identified daily dengue cases in Guangzhou for 2005–2014 were obtained from the Chinese Center for Disease Control and Prevention. Weather data were downloaded from the China Meteorological Data Sharing Service System. Distributed lag non‐linear models (DLNM) were used to graphically demonstrate the three‐dimensional temperature‐dengue association. Generalised estimating equation models (GEE) with piecewise linear spline functions were used to quantify the temperature‐dengue associations. Threshold values were estimated using a broken‐stick model. Middle‐aged and older people, people undertaking household duties, retirees, and those unemployed were at high risk of dengue. Reversed U‐shaped non‐linear associations were found between ambient temperature, relative humidity, extreme wind velocity, and dengue. The optimal maximum temperature (Tmax) range for dengue transmission in Guangzhou was 21.6–32.9 °C, and 11.2–23.7 °C for minimum temperature (Tmin). A 1 °C increase of Tmax and Tmin within these ranges was associated with 11.9% and 9.9% increase in dengue at lag0, respectively. Although lag effects of temperature were observed for up to 141 days for Tmax and 150 days for Tmin, the maximum lag effects were observed at 32 days and 39 days respectively. Average relative humidity was negatively associated with dengue when it exceeded 78.9%. Maximum wind velocity (>10.7 m/s) inhibited dengue transmission. Climatic factors had significant impacts on dengue in Guangzhou. Lag effects of temperature on dengue lasted the local whole epidemic season. To reduce the likely increasing dengue burden, more efforts are needed to strengthen the capacity building of public health systems. HighlightsClimatic factors had significant impacts on dengue transmission in Guangzhou.Lag effects of temperature on dengue lasted the local whole epidemic season.The optimal maximum temperature range for dengue transmission was 21.6–32.9 °C.Relative humidity (RH) was negatively associated with dengue when RH exceeded 79%.Middle‐aged and older people, retirees and unemployed were at high risk of dengue.

Extreme heat and occupational heat illnesses in South Australia, 2001–2010

Objectives This study aims to examine the epidemiological characteristics of occupational heat illnesses in South Australia, to quantify the association between ambient temperature and occupational heat illnesses, and to investigate the impact of heatwaves on occupational heat illnesses. Methods Workers’ compensation claims data and weather data were obtained from SafeWork South Australia and the Bureau of Meteorology, respectively, for 2001–2010. Time series analysis with generalised estimation equation models and linear spline functions was used to quantify the temperature–heat illness claims association. A case-crossover design was applied to investigate the impact of heatwaves on occupational heat illnesses. Results There were 306 heat illness claims during the study period, with an incidence rate of 4.5 per 100 000 employees. The overall risk of occupational heat illness was positively associated with maximum temperature (Tmax), especially when Tmax was over the threshold of 35.5°C. One degree increase of Tmax was associated with a 12.7% (incidence rate ratio 1.127, 95% CI 1.067 to 1.190) increase of occupational heat illness claims. During heatwave periods, the risk of occupational heat illness was about 4–7 times higher than that of non-heatwave periods. Conclusions There is a need to develop or refine current heat-related regulations and guidelines to minimise the risk of occupational heat illnesses in vulnerable workers in a warming climate.

Infectious Diseases, Urbanization and Climate Change: Challenges in Future China

China is one of the largest countries in the world with nearly 20% of the world’s population. There have been significant improvements in economy, education and technology over the last three decades. Due to substantial investments from all levels of government, the public health system in China has been improved since the 2003 severe acute respiratory syndrome (SARS) outbreak. However, infectious diseases still remain a major population health issue and this may be exacerbated by rapid urbanization and unprecedented impacts of climate change. This commentary aims to explore China’s current capacity to manage infectious diseases which impair population health. It discusses the existing disease surveillance system and underscores the critical importance of strengthening the system. It also explores how the growing migrant population, dramatic changes in the natural landscape following rapid urbanization, and changing climatic conditions can contribute to the emergence and re-emergence of infectious disease. Continuing research on infectious diseases, urbanization and climate change may inform the country’s capacity to deal with emerging and re-emerging infectious diseases in the future.

Perceptions of Workplace Heat Exposure and Controls among Occupational Hygienists and Relevant Specialists in Australia.

With warmer weather projections, workplace heat exposure is presenting a growing challenge to workers’ health and safety. Occupational hygienists are the specialist group conducting measurements and providing advice on heat stress management to industry. In order to provide insights into hygienists perceptions on workplace heat exposure, current and future preparedness for extreme heat, and barriers to possible heat adaptation strategies, a self-administered questionnaire survey was conducted during a national conference of the Australian Institute of Occupational Hygienists. Nearly 90% of the 180 respondents were at least moderately concerned about extreme heat and 19% were dissatisfied with current heat stress prevention measures. Barriers recognized by the participants were lack of awareness (68%), insufficient training (56%), unsatisfactory management commitment (52%), and low compliance with prevention policies (40%). The findings suggest a need to refine occupational heat management and prevention strategies.

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

BackgroundThough 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.MethodsA 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.ResultsA 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.ConclusionsThis 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.

Experts' Perceptions on China's Capacity to Manage Emerging and Re-emerging Zoonotic Diseases in an Era of Climate Change.

Zoonotic diseases transmitted by arthropods and rodents are a major public health concern in China. However, interventions in recent decades have helped lower the incidence of several diseases despite the countrys large, frequently mobile population and socio‐economic challenges. Increasing globalization, rapid urbanization and a warming climate now add to the complexity of disease control and prevention and could challenge Chinas capacity to respond to threats of emerging and re‐emerging zoonoses. To investigate this notion, face‐to‐face interviews were conducted with 30 infectious disease experts in four cities in China. The case study diseases under discussion were malaria, dengue fever and haemorrhagic fever with renal syndrome, all of which may be influenced by changing meteorological conditions. Data were analysed using standard qualitative techniques. The study participants viewed the current disease prevention and control system favourably and were optimistic about Chinas capacity to manage climate‐sensitive diseases in the future. Several recommendations emerged from the data including the need to improve health literacy in the population regarding the transmission of infectious diseases and raising awareness of the health impacts of climate change amongst policymakers and health professionals. Participants thought that research capacity could be strengthened and human resources issues for front‐line staff should be addressed. It was considered important that authorities are well prepared in advance for outbreaks such as dengue fever in populous subtropical areas, and a prompt and coordinated response is required when outbreaks occur. Furthermore, health professionals need to remain skilled in the identification of diseases for which incidence is declining, so that re‐emerging or emerging trends can be rapidly identified. Recommendations such as these may be useful in formulating adaptation plans and capacity building for the future control and prevention of climate‐sensitive zoonotic diseases in China and neighbouring countries.

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

Abstract 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.

366 The association between heat exposure and work-related injuries in South Australia, 2001–2010

Objective To investigate the association between work-related injuries and temperature, to identify the groups of workers at high risk of heat-related injuries, and to explore the possible lagged effects of extreme heat on work-related injuries. Method Workers’ compensation claims data obtained from SafeWork South Australia for the period of 2001–2010 were transformed into time series format and merged with daily meteorological data. The impacts of temperature on daily work-related injury rates were estimated by using generalised estimating equation model with negative binomial distribution, a log link function and a first order autocorrelation structure. A piecewise linear spline function was utilised to quantify the effect of temperature on work-related injury rates below and above thresholds. The day of the week and long-term trends were adjusted. Result Overall, there was an association between work-related injuries and temperature in South Australia. One degree Celsius increase in temperature below 38 was associated with 0.2% increase of injury rate. However, the injury risk declined significantly above this temperature. Specifically, the following groups of workers were at high risk of heat-related injury: male workers (IRR 1.004, 95% CI 1.002–1.005); and young workers aged < = 24 (IRR 1.003, 95% CI 1.000–1.006). Occupations at risk were labourers and related workers (IRR 1.004, 95% CI 1.001–1.006), intermediate production and transport workers (IRR 1.002, 95% CI1.000–1.004), and tradespersons and related workers (IRR 1.003, 95% CI 1.001–1.006). Industries showing an association between injuries and temperature were agriculture (IRR 1.007, 95% CI 1.002–1.013), construction (IRR 1.005, 95% CI 1.002–1.008), finance, property and business services (IRR 1.006, 95% CI 1.001–1.012), and overall outdoor industries (IRR 1.004, 95% CI 1.002–1.006). A lagged effect of extreme heat on work-related injury rates has not been found. Conclusion The risk of work-related injuries is significantly associated with heat exposure, especially for vulnerable groups in the workplace.