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Robust high spatiotemporal resolution daily PM2.5 exposure estimates are limited in Australia. Estimates of daily PM2.5 and the PM2.5 component from extreme pollution events (e.g., bushfires and dust storms) are needed for epidemiological studies and health burden assessments attributable to these events. We sought to: (1) estimate daily PM2.5 at a 5 km × 5 km spatial resolution across the Australian continent between 1 January 2001 and 30 June 2020 using a Random Forest (RF) algorithm, and (2) implement a seasonal-trend decomposition using loess (STL) methodology combined with selected statistical flags to identify extreme events and estimate the extreme pollution PM2.5 component. We developed an RF model that achieved an out-of-bag R-squared of 71.5% and a root-mean-square error (RMSE) of 4.5 µg/m3. We predicted daily PM2.5 across Australia, adequately capturing spatial and temporal variations. We showed how the STL method in combination with statistical flags can identify and quantify PM2.5 attributable to extreme pollution events in different locations across the country. [ABSTRACT FROM AUTHOR]

A warming climate is increasing the duration of fire seasons and the risk of more extensive and intense bushfires. The Black Summer bushfires that occurred in Australia from September 2019 to early February 2020 were unprecedented in their scale and intensity. The fires led to loss of lives and homes, and widespread destruction of flora, fauna and ecosystems. Dense smoke from these catastrophic fires blanketed major cities and towns for weeks. A Commonwealth Royal Commission and two state inquiries provided recommendations for reducing the risk of future bushfires and for better disaster management processes to support the preparedness, relief, response and recovery to such megafires. While strategies to reduce the risk of bushfires and the damage to our biota and ecosystems are necessary and important, there is also an urgent need for mitigation strategies to reduce or prevent emission of greenhouse gases. If we are to minimise the planetary effects of a warming climate, we need to limit global warming to well below 2°C compared to pre-industrial levels and to reach net zero carbon emissions by 2050. This requires transformative thinking and action by our political leaders that builds on the Australian public and industry's willingness to play their part. [ABSTRACT FROM AUTHOR]

Abstract Background Short- and long-term spatiotemporal variation in exposure to air pollution is associated with respiratory morbidity in areas with moderate-to-high level of air pollution, but very few studies have examined whether these associations also exist in areas with low level exposure. Objectives We assessed the association between spatial variation in long-term exposure to PM 2.5 and NO 2 and hospitalisation for all respiratory diseases, asthma, chronic obstructive pulmonary disease (COPD), and pneumonia, in older adults residing in Sydney, Australia, a city with low-level concentrations. Methods We recorded data on hospitalisations for 100,084 participants, who were aged >45 years at entry in 2006–2009 until June 2014. Annual NO 2 and PM 2.5 concentrations were estimated for the participants' residential addresses and Cox proportional hazards regression was used to model the association between exposure to air pollutants and first episode of hospitalisation, controlling for personal and area level covariates. We further investigated the shape of the exposure-response association and potential effect modification by age, sex, education level, smoking status, and BMI. Results NO 2 and PM 2.5 annual mean exposure estimates were 17.5 μg·m−3 and 4.5 μg·m−3 respectively. NO 2 and PM 2.5 was positively, although not significantly, associated with asthma. The adjusted hazard ratio for a 1 μg·m−3 increase in PM 2.5 was 1.08, 95% confidence interval 0.89–1.30. The adjusted hazard ratio for a 5 μg·m−3 increase in NO 2 was 1.03, 95% confidence interval 0.88–1.19. We found no positive statistically significant associations with hospitalisation for all respiratory diseases, and pneumonia while negative associations were observed with COPD. Conclusions We found weak positive associations of exposure to air pollution with hospitalisation for asthma while there was no evidence of an association for all respiratory diseases. Highlights • NO 2 and PM 2.5 were weakly associated with hospitalisation for asthma • No associations were found with hospitalisation for all respiratory diseases, and pneumonia • Effects of air pollution on asthma may persist at low levels of air pollution • Negative associations were observed with hospitalisation for COPD [ABSTRACT FROM AUTHOR]

Management decisions underpinning availability of ecosystem services and the organisms that provide them in agroecosystems, such as pollinators and pollination services, have emerged as a foremost consideration for both conservation and crop production goals. There is growing evidence that innovative management practices can support diverse pollinators and increase crop pollination. However, there is also considerable debate regarding factors that support adoption of these innovative practices. This study investigated pollination management practices and related knowledge systems in a major crop producing region of southwest Michigan in the United States, where 367 growers were surveyed to evaluate adoption of three innovative practices that are at various stages of adoption. The goals of this quantitative, social survey were to investigate grower experience with concerns and benefits associated with each practice, as well as the influence of grower networks, which are comprised of contacts that reflect potential pathways for social and technical learning. The results demonstrated that 17% of growers adopted combinations of bees (e.g. honey bees, Apis mellifera , with other species), representing an innovation in use by early adopters; 49% of growers adopted flowering cover crops, an innovation in use by the early majority 55% of growers retained permanent habitat for pollinators, an innovation in use by the late majority. Not all growers adopted innovative practices. We found that growers' personal experience with potential benefits and concerns related to the management practices had significant positive and negative relationships, respectively, with adoption of all three innovations. The influence of these communication links likely has different levels of importance, depending on the stage of the adoption that a practice is experiencing in the agricultural community. Social learning was positively associated with adopting the use of combinations of bees, highlighting the potentially critical roles of peer-to-peer networks and social learning in supporting early stages of adoption of innovations. Engaging with grower networks and understanding grower experience with benefits and concerns associated with innovative practices is needed to inform outreach, extension, and policy efforts designed to stimulate management innovations in agroecosystems. [ABSTRACT FROM AUTHOR]

Background: Individual-level studies support a positive relation between walkable built environments and participation in moderate-intensity walking. However, the utility of this evidence for population-level planning is less clear as it is derived at much finer spatial scales than those used for regional programming. The aims of this study were to: evaluate if individual-level relations between walkability and walking to improve health manifest at population-level spatial scales; assess the specificity of area-level walkability for walking relative to other moderate and vigorous physical activity (MVPA); describe geographic variation in walking and other MVPA; and quantify the contribution of walkability to this variation. Methods: Data on sufficient walking, sufficient MVPA, and high MVPA to improve health were analyzed for 95,837 Sydney respondents to the baseline survey of the 45 and Up Study between January 2006 and April 2010. We used conditional autoregressive models to create smoothed MVPA "disease maps" and assess relations between sufficient MVPA to improve health and area-level walkability adjusted for individual-level demographic, socioeconomic, and health factors, and area-level relative socioeconomic disadvantage. Results: Within-cohort prevalence of meeting recommendations for sufficient walking, sufficient MVPA, and high MVPA were 31.7 (95% CI 31.4-32.0), 69.4 (95% CI 69.1-69.7), and 56.1 (95% CI 55.8-56.4) percent. Prevalence of sufficient walking was increased by 1.20 (95% CrI 1.12-1.29) and 1.07 (95% CrI 1.01-1.13) for high and medium-high versus low walkability postal areas, and for sufficient MVPA by 1.05 (95% CrI 1.01-1.08) for high versus low walkability postal areas. Walkability was not related to high MVPA. Postal area walkability explained 65.8 and 47.4 percent of residual geographic variation in sufficient walking and sufficient MVPA not attributable to individual-level factors. Conclusions: Walkability is associated with area-level prevalence and geographic variation in sufficient walking and sufficient MVPA to improve health in Sydney, Australia. Our study supports the use of walkability indexes at multiple spatial scales for informing population-level action to increase physical activity and the utility of spatial analysis for walkability research and planning. [ABSTRACT FROM AUTHOR]

Background: This study examined the association between unusually high temperature and daily mortality (1997-2007) and hospital admissions (1997-2010) in the Sydney Greater Metropolitan Region (GMR) to assist in the development of targeted health programs designed to minimise the public health impact of extreme heat.Methods: Sydney GMR was categorized into five climate zones. Heat-events were defined as severe or extreme. Using a time-stratified case-crossover design with a conditional logistic regression model we adjusted for influenza epidemics, public holidays, and climate zone. Odds ratios (OR) and 95% confidence intervals were estimated for associations between daily mortality and hospital admissions with heat-event days compared to non-heat event days for single and three day heat-events.Results: All-cause mortality overall had similar magnitude associations with single day and three day extreme and severe events as did all cardiovascular mortality. Respiratory mortality was associated with single day and three day severe events (95th percentile, lag0: OR = 1.14; 95%CI: 1.04 to 1.24). Diabetes mortality had similar magnitude associations with single day and three day severe events (95th percentile, lag0: OR = 1.22; 95%CI: 1.03 to 1.46) but was not associated with extreme events. Hospital admissions for heat related injuries, dehydration, and other fluid disorders were associated with single day and three day extreme and severe events. Contrary to our findings for mortality, we found inconsistent and sometimes inverse associations for extreme and severe events with cardiovascular disease and respiratory disease hospital admissions. Controlling for air pollutants did not influence the mortality associations but reduced the magnitude of the associations with hospital admissions particularly for ozone and respiratory disease.Conclusions: Single and three day events of unusually high temperatures in Sydney are associated with similar magnitude increases in mortality and hospital admissions. The trend towards an inverse association between cardio-vascular admissions and heat-events and the strong positive association between cardio-vascular mortality and heat-events suggests these events may lead to a rapid deterioration in persons with existing cardio-vascular disease resulting in death. To reduce the adverse effects of high temperatures over multiple days, and less extreme but more frequent temperatures over single days, targeted public health messages are critical. [ABSTRACT FROM AUTHOR]

The theory of constructuralism describes how shared knowledge, representative of cultural forms, develops between individuals through social interaction. Constructuralism argues that through interaction and individual learning, the social network (who interacts with whom) and the knowledge network (who knows what) coevolve. In the present work, we extend the theory of constructuralism and implement this extension in an agentbased model (ABM). Our work focuses on the theory's inability to describe how people form and utilize stereotypes of higher order social structures, in particular observable social groups and society as a whole. In our ABM, we formalize this theoretical extension by creating agents that construct, adapt, and utilize social stereotypes of individuals, social groups, and society. We then use this model to carry out a virtual experiment that explores how ethnocentric stereotypes and the underlying distribution of culture in an artificial society interact to produce varying levels of social relationships across social groups. In general, we find that neither stereotypes nor the form of underlying cultural structures alone are sufficient to explain the extent of social relationships across social groups. Rather, we provide evidence that shared culture, social relations, and group stereotypes all intermingle to produce macrosocial structure. [ABSTRACT FROM AUTHOR]

Decision makers need capabilities to quickly model and effectively assess consequences of actions and reactions in crisis de-escalation environments. The creation and what-if exercising of such models has traditionally had onerous resource requirements. This research demonstrates fast and viable ways to build such models in operational environments. Through social network extraction from texts, network analytics to identify key actors, and then simulation to assess alternative interventions, advisors can support practicing and execution of crisis de-escalation activities. We describe how we used this approach as part of a scenario-driven modeling effort. We demonstrate the strength of moving from data to models and the advantages of data-driven simulation, which allow for iterative refinement. We conclude with a discussion of the limitations of this approach and anticipated future work. [ABSTRACT FROM PUBLISHER]

Background Walkability describes the capacity of the built environment to support walking for various purposes. This paper describes the construction and validation of two objective walkability indexes for Sydney, Australia. Methods Walkability indexes using residential density, intersection density, land use mix, with and without retail floor area ratio were calculated for 5,858 Sydney Census Collection Districts in a geographical information system. Associations between variables were evaluated using Spearman's rho (p). Internal consistency and factor structure of indexes were estimated with Cronbach's alpha and principal components analysis; convergent and predictive validity were measured using weighted kappa (κw) and by comparison with reported walking to work at the 2006 Australian Census using logistic regression. Spatial variation in walkability was assessed using choropleth maps and Moran's I. Results A three-attribute abridged Sydney Walkability Index comprising residential density, intersection density and land use mix was constructed for all Sydney as retail floor area was only available for 5.3% of Census Collection Districts. A four-attribute full index including retail floor area ratio was calculated for 263 Census Collection Districts in the Sydney Central Business District. Abridged and full walkability index scores for these 263 areas were strongly correlated (p=0.93) and there was good agreement between walkability quartiles ((κw=0.73). Internal consistency ranged from 0.60 to 0.71, and all index variables loaded highly on a single factor. The percentage of employed persons who walked to work increased with increasing walkability: 3.0% in low income-low walkability areas versus 7.9% in low income-high walkability areas; and 2.1% in high income-low walkability areas versus 11% in high income-high walkability areas. The adjusted odds of walking to work were 1.05 (0.96- 1.15), 1.58 (1.45-1.71) and 3.02 (2.76-3.30) times higher in medium, high and very high compared to low walkability areas. Associations were similar for full and abridged indexes. Conclusions The abridged Sydney Walkability Index has predictive validity for utilitarian walking, will inform urban planning in Sydney, and will be used as an objective measure of neighbourhood walkability in a large population cohort. Abridged walkability indexes may be useful in settings where retail floor area data are unavailable. [ABSTRACT FROM AUTHOR]

Abstract: Aim: This paper describes the spatio-temporal variation of trihalomethanes in drinking water in New South Wales, Australia from 1997 to 2007 Method: We obtained data on trihalomethanes (THMs) from two metropolitan and 13 rural water utilities and conducted a descriptive analysis of the spatial and temporal trends in THMs and the influence of season and drought. Results: Concetrations of monthly THMs in the two metropolitan water utilities of Sydney/Illawarra (mean 66.8 μg/L) and Hunter (mean 62.7 μg/L) were similar compared to the considerable variation between rural water utilities (range in mean THMs: 14.5–330.7 μg/L). Chloroform was the predominate THM in two-thirds of the rural water utilities. Higher concentrations of THMs were found in chlorinated water distribution systems compared to chloraminated systems, and in distribution systems sourced from surface water compared to ground water or mixed surface and ground water. Ground water sourced supplies had a greater proportion of brominated THMs than surface water sourced supplies. There was substantial variation in concentration of THMs between seasons and between periods of drought or no drought. There was a moderate correlation between heavy rainfall and elevated concentrations of THMs. Conclusion: There is considerable spatial and temporal variation in THMs amongst New South Wales water utilities and these variations are likely related to water source, treatment processes, catchments, drought and seasonal factors. [Copyright &y& Elsevier]

Study Objective. To compare the efficacy of echinocandins and nonechinocandins in the treatment of candidemia or invasive candidiasis due to Candida parapsilosis. Design. Meta-analysis of five randomized, blinded, comparative trials. Patients. A total of 1169 patients (mean age 55.5 yrs, 57.8% male) with invasive candidiasis or candidemia treated with an echinocandin or other antifungal agents. Measurements and Main Results. The PubMed, MEDLINE, Toxnet, and Cochrane Central Register of Controlled Trials databases were searched for relevant English-language articles to identify appropriate randomized trials. The quality of studies was assessed with the Jadad scoring system. Data on number of patients, age, and treatment success rate were extracted by two investigators independently into a standardized data collection form. Overall C. parapsilosis treatment success rates with echinocandins were compared with nonechinocandins. Jadad scores of the five studies that met all of the selection criteria ranged from 2-5 (out of 5), with a median of 4. Among the 1169 patients with invasive candidiasis or candidemia, 202 (17.3%) had C. parapsilosis. Among these C. parapsilosis cases, 102 received an echinocandin and 100 received a comparator drug. The success rates of treating C. parapsilosis were similar for the echinocandin group versus other antifungal treatment groups (76.5% [78/102] vs 73% [73/100]). A fixed-effects model was applied secondary to a low level of heterogeneity among the studies (I²=0%). The combined risk ratio demonstrated that echinocandins are not significantly different from other antifnngal agents for the treatment of candidemia or invasive candidiasis due to C. parapsilosis (risk ratio 1.03, 95% confidence interval 0.88-1.21). Conclusion. Echinocandins are as effective as comparator drugs for the treatment of candidemia or invasive candidiasis due to C. parapsilosis. [ABSTRACT FROM AUTHOR]

There are no reported studies on the effects of ambient air pollution on emergency department (ED) attendances in Sydney, Australia. This study aimed to determine associations between ambient air pollutants and ED attendances for cardiovascular disease (CVD) in those aged 65+ years. We constructed daily time series of hospital ED attendances, air pollutants and meteorological factors for the Sydney metropolitan area from 1 January 1997 to 31 December 2001. We used generalised linear models to determine associations between daily air pollution and daily ED attendances and controlled for the effects of long-term trends, seasonality, weather and other potential confounders. Increased ED attendances for all CVD, cardiac disease and ischaemic heart disease were seen with 24-h particulate pollution, 1-h NO2, 8-h CO and 24-h SO2. Air pollutants were associated with decreased ED attendances for stroke. The effects of air pollutants on CVD, cardiac disease and stroke attendances were generally greater in the cool period compared to the warm period. The single-pollutant effects of CO, O3, NO2 and SO2 were essentially unchanged in two-pollutant models. Although air pollution levels in Sydney are relatively low compared to similar cities, we have demonstrated associations between ambient air pollutants and ED attendances for CVD in people aged 65+ years. Our study adds to the growing evidence for the effects of ambient air pollution on CVD outcomes even at relatively low ambient concentrations.Journal of Exposure Science and Environmental Epidemiology (2006) 16, 225–237. doi:10.1038/sj.jea.7500451; published online 24 August 2005 [ABSTRACT FROM AUTHOR]

Objective. This study examined the effects of outdoor air pollutants on daily hospital admissions in Sydney, Australia. Methods. A time-series analysis of counts of daily hospital admissions and outdoor air pollutants (1990 to 1994) was performed, by means of Poisson regression that allowed for overdispersion and autocorrelation. Results. An increase in daily maximum 1-hour concentration of nitrogen dioxide from the 10th to the 90th percentile was associated with an increase of 5.29% (95% confidence interval = 1.07, 9.68) in childhood asthma admissions and 4.60% (-0.17, 9.61) in chronic obstructive pulmonary disease (COPD) admissions. A similar increase in daily maximum 1-hour particular concentration was associated with an increase of 3.01% (-0.38, 6.52) in COPD admissions. An increase from the 10th to the 90th percentile in daily maximum 1-hour nitrogen dioxide, daily maximum 1-hour ozone, and daily mean particulate was associated with an increase in heart disease admissions among those 65 years and older of 6.71% (4.25, 9.23), 2.45% (-0.37, 5.35), and 2.82% (0.90, 4.77), respectively. Heart disease and childhood asthma were primarily associated with nitrogen dioxide; COPD was associated with both nitrogen dioxide and particular. Conclusion. Current levels of air pollution in Sydney are associated with increased hospitalization for respiratory and heart disease. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study examined the effects of outdoor air pollutants in Sydney, Australia, on daily mortality. METHODS: Time-series analysis was performed on counts of daily mortality and major outdoor air pollutants (particulates, ozone, and nitrogen dioxide) in Sydney (1989 to 1993) with adjustment for seasonal and cyclical factors. Poisson regression was calculated with allowance for overdispersion and autocorrelation. The effects of lagging exposure by 0 to 2 days were assessed with single- and multiple-pollutant models. RESULTS: An increase in daily mean particulate concentration from the 10th to the 90th centile was associated with an increase of 2.63% (95% confidence interval 0.87 to 4.41) in all-cause mortality and 2.68% (0.25 to 5.16) in cardiovascular mortality. An increase in daily maximum 1-hour ozone concentration from the 10th to the 90th centile was associated with an increase of 2.04% (0.37 to 3.73) in all-cause mortality and 2.52% (-0.25 to 5.38) in cardiovascular mortality. An increase in the daily mean nitrogen dioxide concentration from the 10th to the 90th centile was associated with an increase of 7.71% (-0.34 to 16.40) in respiratory mortality. Multiple-pollutant models suggest that the effects of particulates and ozone on all-cause and cardiovascular mortality, and of nitrogen dioxide on respiratory mortality, are independent of the effects of the other pollutants. CONCLUSIONS: Current levels of air pollution in Sydney are associated with daily mortality. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate associations of wildfire fine particulate matter ≤2.5 mm in diameter (PM2.5) with diabetes across multiple countries and territories. RESEARCH DESIGN AND METHODS: We collected data on 3,612,135 diabetes hospitalizations from 1,008 locations in Australia, Brazil, Canada, Chile, New Zealand, Thailand, and Taiwan during 2000–2019. Daily wildfire-specific PM2.5 levels were estimated through chemical transport models and machine-learning calibration. Quasi-Poisson regression with distributed lag nonlinear models and random-effects meta-analysis were applied to estimate associations between wildfire-specific PM2.5 and diabetes hospitalization. Subgroup analyses were by age, sex, location income level, and country or territory. Diabetes hospitalizations attributable to wildfire-specific PM2.5 and nonwildfire PM2.5 were compared. RESULTS: Each 10 µg/m3 increase in wildfire-specific PM2.5 levels over the current day and previous 3 days was associated with relative risks (95% CI) of 1.017 (1.011–1.022), 1.023 (1.011–1.035), 1.023 (1.015–1.032), 0.962 (0.823–1.032), 1.033 (1.001–1.066), and 1.013 (1.004–1.022) for all-cause, type 1, type 2, malnutrition-related, other specified, and unspecified diabetes hospitalization, respectively. Stronger associations were observed for all-cause, type 1, and type 2 diabetes in Thailand, Australia, and Brazil; unspecified diabetes in New Zealand; and type 2 diabetes in high-income locations. An estimate of 0.67% (0.16–1.18%) and 1.02% (0.20–1.81%) for all-cause and type 2 diabetes hospitalizations were attributable to wildfire-specific PM2.5. Compared with nonwildfire PM2.5, wildfire-specific PM2.5 posed greater risks of all-cause, type 1, and type 2 diabetes and were responsible for 38.7% of PM2.5-related diabetes hospitalizations. CONCLUSIONS: We show the relatively underappreciated links between diabetes and wildfire air pollution, which can lead to a nonnegligible proportion of PM2.5-related diabetes hospitalizations. Precision prevention and mitigation should be developed for those in advantaged communities and in Thailand, Australia, and Brazil. [ABSTRACT FROM AUTHOR]

Over the past decades, air pollution has become one of the critical environmental health issues in China. The present study aimed to evaluate links between ambient air pollution and the prevalence of type 2 diabetes mellitus (T2DM) and the levels of glycosylated hemoglobin (HbA1c). A multilevel linear and logistic regression was used to assess these associations among 7,770 participants aged ≥50 years from the WHO Study on global AGEing and adult health (SAGE) in China in 2007-2010. The average exposure to each of pollutants (particulate matter with an aerodynamic diameter of ≤10 μm/≤2.5 μm/≤1 μm [PM10/PM2.5/PM1] and nitrogen dioxide [NO2]) was estimated using a satellite-based spatial statistical model. In logistic models, a 10 µg/m3 increase in PM10 and PM2.5 was associated with increased T2DM prevalence (Prevalence Odds Ratio, POR: 1.27; 95% CI: 1.11, 1.45 and POR: 1.23; 95% CI: 1.03, 1.46). Similar increments in PM10, PM2.5, PM1 and NO2 were associated with increase in HbA1c levels of 1.8% (95% CI: 1.3, 2.3), 1.3% (95% CI: 1.1, 1.5), 0.7% (95% CI: 0.1, 1.3), and 0.8% (95% CI: 0.4, 1.2), respectively. In a large cohort of older Chinese adults, air pollution was liked to both higher T2DM prevalence and elevated HbA1c levels. [ABSTRACT FROM AUTHOR]

Background Emergency ambulance dispatches (EAD) are a novel outcome for evaluating the public health impacts of air pollution. We assessed the relationships between ambient particulate matter (PM) from all sources, PM from landscape fire smoke (LFS), and EADs likely to be associated with cardiorespiratory problems in the Sydney greater metropolitan region for an 11-year period from 2004 to 2015. Methods EAD codes are assigned at the time of the call to emergency services using standard computer assisted algorithms. We assessed EADs coded as: breathing problems, chest pain, stroke or cerebrovascular accident (stroke), cardiac or respiratory arrest and death (arrest), and heart or defibrillator problems (other heart problems). Using a daily times series study design with a generalized linear Poisson regression model we quantified the association between EAD and daily PM 2.5 from all sources (PM 2.5,all ) and PM 2.5 primarily due to LFS (PM 2.5,LFS ). Results Increases of 10 μg·m − 3 in PM 2.5,all were positively associated with same day EAD for breathing problems (RR = 1.03, 95% CI 1.02 to 1.04), arrest (RR = 1.03, 95% CI 1.00 to 1.06), and chest pain (RR = 1.01 CI 1.00 to 1.02) but not with other outcomes. Increases of 10 μg·m − 3 PM 2.5,LFS were also positively associated with breathing problems on the same day (RR = 1.04, 95% CI 1.02 to 1.05) and other heart problems at lag of two days (RR = 1.05, 95% CI 1.01 to 1.09). Conclusions Emergency dispatches for breathing problems are associated with PM 2.5,all and PM 2.5,LFS and provide a sensitive end point for continued research and surveillance activities investigating the impacts of daily fluctuations in ambient PM 2.5 . [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

In 2018, around 640,000 non-road diesel engines (NRDEs) were in use in Australia, with a projected stock of one million units by the mid-2040s. There are no Australian regulations to limit emissions from NRDEs, and Australia has not fully benefitted from legislation elsewhere. All engines (and equipment) are imported, but the uptake of the most recent technologies has been low. The locations of NRDEs in Australia and their patterns of activity are also poorly understood. This analysis involved the development of a whole-of-Australia impact pathway modelling approach for NRDEs, focussing on PM2.5 and NO2. It defined the NRDE stock and spatial distributions of emissions, air quality and health outcomes in a business-as-usual (BAU) scenario for the period 2018 to 2063, as well as three emission management scenarios. The NONROAD model formed the basis of a bottom-up calculation of emissions for the scenarios. This covered 27 equipment types, with a breakdown by power, emission standard and age. The bottom-up results were calibrated using ABS diesel statistics, and various methods were employed to allocate emissions spatially. The CSIRO Chemical Transport Model (C-CTM) was then used to simulate air pollution across Australia without NRDEs. The C-CTM predictions were refined using satellite land-use regression, followed by perturbation for NRDE emissions. The impacts of the NRDE perturbation on health - as years of life lost (YLL) - were estimated using a life table approach, including a cessation lag structure. In 2018 NRDEs were responsible for up to 15% of anthropogenic NOX emissions, and up to 5% of anthropogenic PM2.5 emissions in Australia. The annual YLL for NRDE-related NO2 and PM2.5 concentrations equated to around 9% of the total YLL for all anthropogenic NO2 and PM2.5. Over the full time period of the analysis, the management scenarios reduced YLL by between 6% and 27%. [ABSTRACT FROM AUTHOR]

Background: The 2019/2020 Australian landscape fires (bushfires) resulted in prolonged extreme air pollution; little is known about the effects on breastfeeding women and their infants. This study aimed to examine the impact of prolonged landscape fires on infant feeding methods and assess the concentration of polycyclic aromatic hydrocarbons (PAHs) and elements in breast milk samples. Methods: From May – December 2020, women with asthma, who were feeding their infants during the fires, were recruited from an existing cohort. Data on infant feeding and maternal concern during the fires were retrospectively collected. Breast milk samples were collected from a sample of women during the fire period and compared with samples collected outside of the fire period for levels of 16 PAHs (gas chromatography coupled with mass spectrometry), and 20 elements (inductively coupled plasma-mass spectrometry). Results: One-hundred-and-two women who were feeding infants completed the survey, and 77 provided 92 breast milk samples. Two women reported concern about the impact of fire events on their infant feeding method, while four reported the events influenced their decision. PAHs were detected in 34% of samples collected during, versus no samples collected outside, the fire period (cross-sectional analysis); specifically, fluoranthene (median concentration 0.015 mg/kg) and pyrene (median concentration 0.008 mg/kg) were detected. Women whose samples contained fluoranthene and pyrene were exposed to higher levels of fire-related fine particulate matter and more fire days, versus women whose samples had no detectable fluoranthene and pyrene. Calcium, potassium, magnesium, sodium, sulphur, and copper were detected in all samples. No samples contained chromium, lead, nickel, barium, or aluminium. No statistically significant difference was observed in the concentration of elements between samples collected during the fire period versus outside the fire period. Conclusions: Few women had concerns about the impact of fire events on infant feeding. Detection of fluoranthene and pyrene in breast milk samples was more likely during the 2019/2020 Australian fire period; however, levels detected were much lower than levels expected to be related to adverse health outcomes. [ABSTRACT FROM AUTHOR]

A response by Geoffrey Morgan, Stephen Corbett, John Wlodarczyk and Peter Lewis to a letter to the editor about their article on the toxic effects of air pollution and mortality is presented.

Background: Little is known about the physical and mental health impact of exposure to landscape fire smoke in women with asthma. This study examined the health impacts and information-seeking behaviours of women with asthma exposed to the 2019/2020 Australian fires, including women who were pregnant. Methods: Women with asthma were recruited from the Breathing for Life Trial in Australia. Following the landscape fire exposure period, self-reported data were collected regarding symptoms (respiratory and non-respiratory), asthma exacerbations, wellbeing, quality of life, information seeking, and landscape fire smoke exposure mitigation strategies. Participants' primary residential location and fixed site monitoring was used to geolocate and estimate exposure to landscape fire-related fine Particulate Matter (PM2.5). Results: The survey was completed by 81 pregnant, 70 breastfeeding and 232 non-pregnant and non-breastfeeding women with asthma. Participants had a median daily average of 17 μg/m3 PM2.5 and 105 μg/m3 peak PM2.5 exposure over the fire period (October 2019 to February 2020). Over 80% of participants reported non-respiratory and respiratory symptoms during the fire period and 41% reported persistent symptoms. Over 82% reported asthma symptoms and exacerbations of asthma during the fire period. Half the participants sought advice from a health professional for their symptoms. Most (97%) kept windows/doors shut when inside and 94% stayed indoors to minimise exposure to landscape fire smoke. Over two in five (43%) participants reported that their capacity to participate in usual activities was reduced due to prolonged smoke exposure during the fire period. Participants reported greater anxiety during the fire period than after the fire period (mean (SD) = 53(13) versus 39 (13); p < 0.001). Two in five (38%) pregnant participants reported having concerns about the effect of fire events on their pregnancy. Conclusion: Prolonged landscape fire smoke exposure during the 2019/2020 Australian fire period had a significant impact on the health and wellbeing of women with asthma, including pregnant women with asthma. This was despite most women taking actions to minimise exposure to landscape fire smoke. Effective and consistent public health messaging is needed during landscape fire events to guard the health of women with asthma. [ABSTRACT FROM AUTHOR]

Limitations of this study include a small and selected sample which might reflect more severe asthma phenotypes, and thus, our results may not be representative for a non-selected pediatric asthma population. Global Lung Initiative (GLI) reference equations were used to calculate spirometry measurements (FEV1, FVC, and FEV1/FVC ratio percent of predicted value [% predicted]). The investigation of potential long-term effects on FVC growth as a result of repeated exposure to bushfire requires further studies. While bushfires have long been a part of Australia's ecosystem, the 2019-20 bushfires were an unprecedented event leading to 5.5 million hectares of land being affected in New South Wales (NSW) alone.1 This is approximately the same as the area burnt in the combined bushfire seasons of 1993-94 and 2018-19.2 Air pollution has been recognized as a risk factor for asthma development.3 An increase in emergency department visits and hospital admissions has been described in asthmatic children exposed to bushfire smoke.4 Bushfire smoke contains a complex range of gases and particles, including a particulate matter measuring less than 2.5 microns (PM SB 2.5 sb ) composition, carbon monoxide, ozone, methane, and nitrogen oxides which is different from the one emitted by fossil fuel combustion.5 The NSW Air Quality Monitoring Network reported that 74% of the spring and summer days in 2019-20 met poor air quality standards according to the Air Quality Index.6 This study therefore aimed to determine the effects of bushfire smoke exposure during the 2019-20 bushfire season on lung function in asthmatic children. [Extracted from the article]

Hylobius abietis develop in conifer root-stumps and emerging adults attack replanted trees. Development is largely semi-voltine and this is an important determinant of economic impact, influencing the length of a fallow period or the frequency of chemical control., A simulation model followed a generation of weevils through the life cycle to predict voltinism based on temperature in the root-stump microhabitat modelled from air temperature. Daily air temperatures for representative U.K. locations simulated from the U.K. Climate Projections 20 09 Weather Generator for the 2030-2070s were used to predict the potential effect of climate change on voltinism., The life cycle currently takes 2-3 years in the north and west ( N&W) of the U.K. but, in the south and east ( S&E), a 2-year cycle predominates. From the 2030s onwards, a predominant 2-year life cycle in the N&W was predicted to reduce economic impact in this region. In the S&E, however, the predicted 1-2-year cycle would be unlikely to reduced the period over which pest management was required., Changes in voltinism to the 2070s revealed different temporal patterns, emphasizing the importance for management of modelling local, as well as regional scale variation in the effects of climate change in Europe. [ABSTRACT FROM AUTHOR]

Heatwaves are associated with increased mortality and are exacerbated by the urban heat island (UHI) effect. Thus, to inform climate change mitigation and adaptation, we quantified the mortality burden of historical heatwave days in Sydney, Australia, assessed the contribution of the UHI effect and used climate change projection data to estimate future health impacts. We also assessed the potential for tree cover to mitigate against the UHI effect. Mortality (2006–2018) records were linked with census population data, weather observations (1997–2016) and climate change projections to 2100. Heatwave-attributable excess deaths were calculated based on risk estimates from a published heatwave study of Sydney. High resolution satellite observations of UHI air temperature excesses and green cover were used to determine associated effects on heat-related mortality. These data show that >90% of heatwave days would not breach heatwave thresholds in Sydney if there were no UHI effect and that numbers of heatwave days could increase fourfold under the most extreme climate change scenario. We found that tree canopy reduces urban heat, and that widespread tree planting could offset the increases in heat-attributable deaths as climate warming progresses. [ABSTRACT FROM AUTHOR]

Background: Air pollution in Darwin, Northern Australia, is dominated by smoke from seasonal fires in the surrounding savanna that burn during the dry season from April to November. Our aim was to study the association between particulate matter less than or equal to 10 microns diameter (PM10) and daily emergency hospital admissions for cardio-respiratory diseases for each fire season from 1996 to 2005. We also investigated whether the relationship differed in indigenous Australians; a disadvantaged population sub-group. Methods: Daily PM10 exposure levels were estimated for the population of the city from visibility data using a previously validated model. We used over-dispersed Poisson generalized linear models with parametric smoothing functions for time and meteorology to examine the association between admissions and PM10 up to three days prior. An interaction between indigenous status and PM10 was included to examine differences in the impact on indigenous people. Results: We found both positive and negative associations and our estimates had wide confidence intervals. There were generally positive associations between respiratory disease and PM10 but not with cardiovascular disease. An increase of 10 µg/m3 in same-day estimated ambient PM10 was associated with a 4.81% (95%CI: -1.04%, 11.01%) increase in total respiratory admissions. When the interaction between indigenous status and PM10 was assessed a statistically different association was found between PM10 and admissions three days later for respiratory infections of indigenous people (15.02%; 95%CI: 3.73%, 27.54%) than for non-indigenous people (0.67%; 95%CI: -7.55%, 9.61%). There were generally negative estimates for cardiovascular conditions. For nonindigenous admissions the estimated association with total cardiovascular admissions for same day ambient PM10 and admissions was -3.43% (95%CI: -9.00%, 2.49%) and the estimate for indigenous admissions was -3.78% (95%CI: -13.4%, 6.91%), although ambient PM10 did have positive (non-significant) associations with cardiovascular admissions of indigenous people two and three days later. Conclusion: We observed positive associations between vegetation fire smoke and daily hospital admissions for respiratory diseases that were stronger in indigenous people. While this study was limited by the use of estimated rather than measured exposure data, the results are consistent with the currently small evidence base concerning this source of air pollution. [ABSTRACT FROM AUTHOR]

Background: The effect of individual pollutants and the period(s) during pregnancy when pollutant levels are likely to have most impact on preterm birth is not clear. We evaluated the effect of prenatal exposure to six common urban air pollutants in the Sydney metropolitan area on preterm birth. Methods: We obtained information on all births in metropolitan Sydney between January 1, 1998 and December 31, 2000. For each birth, exposure to each air pollutant was estimated for the first trimester, the three months preceding birth, the first month after the estimated date of conception and the month prior to delivery. Gestational age was analysed as a categorical variable in logistic regression models. Results: There were 123 840 singleton births in Sydney in 1998-2000 and 4.9% were preterm. Preterm birth was significantly associated with maternal age, maternal smoking, male infant, indigenous status and first pregnancy. Air pollutant levels in the month and three months preceding birth had no significant effect on preterm birth after adjusting for maternal and infant covariates. Ozone levels in the first trimester of pregnancy and spring months of conception and sulphur dioxide were associated with increased risks for preterm births. Nitrogen dioxide was associated with a decreased risk of preterm births. Conclusion: We found more protective than harmful associations between ambient air pollutants and preterm births with most associations non-significant. In view of these inconsistent associations, it is important to interpret the harmful effects with caution. If our results are confirmed by future studies then it will be imperative to reduce Sydney's already low air pollution levels even further. [ABSTRACT FROM AUTHOR]

Background: Exposure to high ambient temperatures has been shown to increase the risk of spontaneous preterm birth. Determining which maternal factors increase or decrease this risk will inform climate adaptation strategies.Objectives: This study aims to assess the risk of spontaneous preterm birth associated with exposure to ambient temperature and differences in this relationship between mothers with different health and demographic characteristics.Methods: We used quasi-Poisson distributed lag non-linear models to estimate the effect of high temperature-measured as the 95th percentile of daily minimum, mean and maximum compared with the median-on risk of spontaneous preterm birth (23-36 weeks of gestation) in pregnant women in New South Wales, Australia. We estimated the cumulative lagged effects of daily temperature and analyses on population subgroups to assess increased or decreased vulnerability to this effect.Results: Pregnant women (n = 916,678) exposed at the 95th percentile of daily mean temperatures (25ºC) had an increased risk of preterm birth (relative risk 1.14, 95% confidence interval 1.07, 1.21) compared with the median daily mean temperature (17℃). Similar effect sizes were seen for the 95th percentile of minimum and maximum daily temperatures compared with the median. This risk was slightly higher among women with diabetes, hypertension, chronic illness and women who smoked during pregnancy.Conclusions: Higher temperatures increase the risk of preterm birth and women with pre-existing health conditions and who smoke during pregnancy are potentially more vulnerable to these effects. [ABSTRACT FROM AUTHOR]

Compares of the mortality of outdoor working staff as part of an insecticide application program during 1935-1996 with that of outdoor workers not occupationally exposed to insecticides and with the Australian population. Mortality in both exposed and control subjects; Increase of mortality in exposed subjects for a number of conditions that do not appear to be the result of smoking patterns.

Air pollution poses a threat to children's respiratory health. This study aims to quantify the association between short-term air pollution exposure and respiratory hospital admissions among children in Hanoi, Vietnam, and estimate the population-attributable burden using local data. A case-crossover analysis was conducted based on the individual records where each case is their own control. The health data was obtained from 13 hospitals in Hanoi and air pollution data was collected from four monitoring stations from 2007 to 2019. We used conditional logistic regression to estimate Percentage Change (PC) and 95% Confidence Interval (CI) in odd of hospital admissions per 10 μg/m3 increase in daily average particulate matter (e.g. PM 1 , PM 2.5 , PM 10), Sulfur Dioxide (SO 2), Nitrogen Dioxide (NO 2), 8-h maximum Ozone and per 1000 μg/m3 increase in daily mean of Carbon Monoxide (CO). We also calculated the number and fraction of admissions attributed to air pollution in Hanoi by using the coefficient at lag 0. A 10 μg/m3 increase in the concentration of PM 10 , PM 2.5 , PM 1 , SO 2 , NO 2 , O 3 8-h maximum and 1000 μg/m3 increase in CO concentration was associated with 0.6%, 1.2%, 1.4%, 0.8%, 1.6%, 0.3%, and 1.7% increase in odd of admission for all respiratory diseases among children under 16 years at lag 0–2. All PM metrics and NO 2 are associated with childhood admission for pneumonia and bronchitis. Admissions due to asthma and upper respiratory diseases are related to increments in NO 2 and CO. For attributable cases, PM 2.5 concentrations in Hanoi exceeding the World Health Organization Air Quality Guidelines accounted for 1619 respiratory hospital admissions in Hanoi children in 2019. Our findings show that air pollution has a detrimental impact on the respiratory health of Hanoi children and there will be important health benefits from improved air quality management planning to reduce air pollution in Vietnam. [Display omitted] • 302,345 child admissions data in 13 years was obtained from Hanoi public hospitals. • All pollutants are associated with childhood respiratory admissions. • NO 2 and PM 1 are strongly associated with bronchitis and pneumonia admissions. • High concentration of SO 2 , CO and NO 2 are associated with asthma hospitalization. • In 2019, 1619 hospital admissions were attributed to PM 2.5 in Hanoi, Vietnam. [ABSTRACT FROM AUTHOR]

Abstract Background Epidemiological studies show that long-term exposure to ambient air pollution reduces life expectancy. Most studies have been in environments with relatively high concentrations such as North America, Europe and Asia. Associations at the lower end of the concentration-response function are not well defined. Objectives We assessed associations between all-cause mortality and exposure to annual average particulate matter <2.5 μm (PM 2.5) and nitrogen dioxide (NO 2) in Sydney, Australia, where concentrations are relatively low. Methods The '45 and Up Study' comprises a prospective longitudinal cohort from the state of New South Wales, Australia with 266,969 participants linked to death registry data. We analyzed data for the participants who resided in Sydney at baseline questionnaire (n = 75,268). Exposures to long-term pollution were estimated using annual averages from a chemical transport model (PM 2.5), and a satellite-based land-use regression model (NO 2). Socio-demographic information was extracted from the baseline questionnaire. Cox proportional hazard models were applied to estimate associations, while adjusting for covariates. Results In our cohort mean annual PM 2.5 was 4.5 μg/m3 and mean NO 2 was 17.8 μg/m3. The mortality rate was 4.4% over the 7 years of follow up. Models that adjusted for individual-level and area-level risk factors resulted in a detrimental non statistically significant hazard ratio (HR) of 1.05 (95% CI: 0.98–1.12) per 1 μg/m3 increase in PM 2.5 , and 1.03 (95% CI: 0.98–1.07) per 5 μg/m3 increase in NO 2. Conclusions We found evidence that low-level air pollution exposure was associated with increased risk of mortality in this cohort of adults aged 45 years and over, even at the relatively low concentrations seen in Sydney. However, a clear determination of the association with mortality is difficult because the results were sensitive to some covariates. Our findings are supportive of emerging evidence that exposure to low levels of air pollution reduces life expectancy. Highlights • We report new information on the effects of long-term exposure to low levels of ambient air pollution on mortality • PM 2.5 and NO 2 had detrimental but non statistically significant associations with all-cause mortality at low concentrations • Our results were larger than comparable studies in higher pollution environments but were variable under the model sensitivity test • Exposure measurement error and other statistical issues complicate studies of air pollution concentrations at this low end of the spectrum • It is unknown if there is any safe low threshold of air pollution for health, and this is important as many countries strive to continuously reduce air pollution emission levels to protect public health [ABSTRACT FROM AUTHOR]

Background and aims Traffic Related Air Pollution (TRAP) exposure is known to exacerbate existing respiratory diseases. We investigated longer term effects of TRAP exposure for individuals with or without existing asthma, and with or without lower lung function. Methods Associations between TRAP exposure and asthma (n = 689) and lung function (n = 599) were investigated in the prospective Tasmanian Longitudinal Health Study (TAHS). TRAP exposure at age 45 years was measured using two methods based on residential address: mean annual NO 2 exposure; and distance to nearest major road. Adjusted multinomial logistic regression was used to model the association between exposure to TRAP at 45 years and changes in asthma and lung function, using three follow ups of TAHS (45, 50 and 53 years). Results For those who never had asthma by 45, living <200 m from a major road was associated with increased odds of new asthma that persisted from 50 to 53 years (adjusted Odds Ratio [aOR] 5.20; 95% CI 1.07, 25.4). Asthmatic participants at 45 had an increased risk of persistent asthma up to 53 years if they were living <200 m from a major road, compared with asthmatic participants living >200 m from a major road (aOR = 5.21; 95% CI 1.54, 17.6). Conclusion For middle aged adults, living <200 m for a major road (a marker of TRAP exposure) influences both the development and persistence of asthma. These findings have public health implications for asthma prevention strategies in primary and secondary settings. [ABSTRACT FROM AUTHOR]

Introduction Wildland fires degrade air quality and adversely affect human health. A growing body of epidemiology literature reports increased rates of emergency departments, hospital admissions and premature deaths from wildfire smoke exposure. Objective Our research aimed to characterize excess mortality and morbidity events, and the economic value of these impacts, from wildland fire smoke exposure in the U.S. over a multi-year period; to date no other burden assessment has done this. Methods We first completed a systematic review of the epidemiologic literature and then performed photochemical air quality modeling for the years 2008 to 2012 in the continental U.S. Finally, we estimated the morbidity, mortality, and economic burden of wildland fires. Results Our models suggest that areas including northern California, Oregon and Idaho in the West, and Florida, Louisiana and Georgia in the East were most affected by wildland fire events in the form of additional premature deaths and respiratory hospital admissions. We estimated the economic value of these cases due to short term exposures as being between $11 and $20B (2010$) per year, with a net present value of $63B (95% confidence intervals $6–$170); we estimate the value of long-term exposures as being between $76 and $130B (2010$) per year, with a net present value of $450B (95% confidence intervals $42–$1200). Conclusion The public health burden of wildland fires—in terms of the number and economic value of deaths and illnesses—is considerable. [ABSTRACT FROM AUTHOR]

Exposure to traffic related nitrogen dioxide (NO2) air pollution is associated with adverse health outcomes. Average pollutant concentrations for fixed monitoring sites are often used to estimate exposures for health studies, however these can be imprecise due to difficulty and cost of spatial modeling at the resolution of neighborhoods (e.g., a scale of tens of meters) rather than at a coarse scale (around several kilometers). The objective of this study was to derive improved estimates of neighborhood NO2 concentrations by blending measurements with modeled predictions in Sydney, Australia (a low pollution environment). We implemented the Bayesian maximum entropy approach to blend data with uncertainty defined using informative priors. We compiled NO2 data from fixed-site monitors, chemical transport models, and satellite-based land use regression models to estimate neighborhood annual average NO2. The spatial model produced a posterior probability density function of estimated annual average concentrations that spanned an order of magnitude from 3 to 35 ppb. Validation using independent data showed improvement, with root mean squared error improvement of 6% compared with the land use regression model and 16% over the chemical transport modeL These estimates will be used in studies of health effects and should minimize misclassification bias. [ABSTRACT FROM AUTHOR]

Background: Three variant formulations of a spatiotemporal shared component model are proposed that allow examination of changes in shared underlying factors over time. Methods: Models are evaluated within the context of a case study examining hospitalisation rates for five chronic diseases for residents of a regional area in New South Wales: type II diabetes mellitus (DMII), chronic obstructive pulmonary disease (COPD), coronary arterial disease (CAD), hypertension (HT) and congestive heart failure (CHF) between 2001–2006. These represent ambulatory care sensitive (ACS) conditions, often used as a proxy for avoidable hospitalisations. Using a selected model, the effects of socio-economic status (SES) as a shared component are estimated and temporal patterns in the influence of the residual shared spatial component are examined. Results: Choice of model depends upon the application. In the featured application, a model allowing for changing influence of the shared spatial component over time was found to have the best fit and was selected for further analyses. Hospitalisation rates were found to be increasing for COPD and DMII, decreasing for CHF and stable for CAD and HT. SES was substantively associated with hospitalisation rates, with differing degrees of influence for each disease. In general, most of the spatial variation in hospitalisation rates was explained by disease-specific spatial components, followed by the residual shared spatial component. Conclusion: Appropriate selection of a joint disease model allows for the examination of temporal patterns of disease outcomes and shared underlying spatial factors, and distinction between different shared spatial factors. [ABSTRACT FROM AUTHOR]

Background China's rapid economic development has resulted in severe particulate matter (PM) air pollution and the control and prevention of infectious disease is an ongoing priority. This study examined the relationships between short-term exposure to ambient particles with aerodynamic diameter ≤2.5 µm (PM 2.5 ) and measles incidence in China. Methods Data on daily numbers of new measles cases and concentrations of ambient PM 2.5 were collected from 21 cities in China during Oct 2013 and Dec 2014. Poisson regression was used to examine city-specific associations of PM 2.5 and measles, with a constrained distributed lag model, after adjusting for seasonality, day of the week, and weather conditions. Then, the effects at the national scale were pooled with a random-effect meta-analysis. Results A 10 µg/m 3 increase in PM 2.5 at lag 1 day, lag 2 day and lag 3 day was significantly associated with increased measles incidence [relative risk (RR) and 95% confidence interval (CI) were 1.010 (1.003, 1.018), 1.010 (1.003, 1.016) and 1.006 (1.000, 1.012), respectively]. The cumulative relative risk of measles associated with PM 2.5 at lag 1–3 days was 1.029 (95% CI: 1.010, 1.048). Stratified analyses by meteorological factors showed that the PM 2.5 and measles associations were stronger on days with high temperature, low humidity, and high wind speed. Conclusions We provide new evidence that measles incidence is associated with exposure to ambient PM 2.5 in China. Effective policies to reduce air pollution may also reduce measles incidence. [ABSTRACT FROM AUTHOR]

In 2012, the ACEs Public-Private Initiative (APPI), a Washington State consortium of public agencies, private foundations, and local networks, was formed to study interventions to prevent and mitigate adverse childhood experiences (ACEs) and facilitate statewide learning and dialogue on these topics. The evaluation team assessed the extent to which five community sites developed sufficient capacity to achieve their goals, and examined the relationship of the sites' capacity to selected site efforts and their impact on ACEs-related outcomes. To help accomplish that a survey was created to measure the APPI sites' collective community capacity to address ACEs and increase resilience in their communities. This article describes the development, design, implementation, and results of the APPI evaluation's ACEs and Resilience Collective Community Capacity (ARC 3 ) survey. [ABSTRACT FROM AUTHOR]

Background: Australia has a universal health care system and a comprehensive safety net. Despite this, outcomes for Australians living in rural and remote areas are worse than those living in cities. This study will examine the current state of equity of access to birthing services for women living in small communities in rural and remote Australia from a population perspective and investigates whether services are distributed according to need.Methods: Health facilities in Australia were identified and a service catchment was determined around each using a one-hour road travel time from that facility. Catchment exclusions: metropolitan areas, populations above 25,000 or below 1,000, and a non-birthing facility within the catchment of one with birthing. Catchments were attributed with population-based characteristics representing need: population size, births, demographic factors, socio-economic status, and a proxy for isolation - the time to the nearest facility providing a caesarean section (C-section). Facilities were dichotomised by service level - those providing birthing services (birthing) or not (no birthing). Birthing services were then divided by C-section provision (C-section vs no C-section birthing). Analysis used two-stage univariable and multivariable logistic regression.Results: There were 259 health facilities identified after exclusions. Comparing services with birthing to no birthing, a population is more likely to have a birthing service if they have more births, (adjusted Odds Ratio (aOR): 1.50 for every 10 births, 95% Confidence Interval (CI) [1.33-1.69]), and a service offering C-sections 1 to 2 h drive away (aOR: 28.7, 95% CI [5.59-148]). Comparing the birthing services categorised by C-section vs no C-section, the likelihood of a facility having a C-section was again positively associated with increasing catchment births and with travel time to another service offering C-sections. Both models demonstrated significant associations with jurisdiction but not socio-economic status.Conclusions: Our investigation of current birthing services in rural and remote Australia identified disparities in their distribution. Population factors relating to vulnerability and isolation did not increase the likelihood of a local birthing facility, and very remote communities were less likely to have any service. In addition, services are influenced by jurisdictions. [ABSTRACT FROM AUTHOR]

Bushfire smoke is a major ongoing environmental hazard in Australia. In the summer of 2019–2020 smoke from an extreme bushfire event exposed large populations to high concentrations of particulate matter (PM) pollution. In this study we aimed to estimate the effect of bushfire-related PM of less than 2.5 μm in diameter (PM 2.5) on the risk of mortality in Sydney, Australia from 2010 to 2020. We estimated concentrations of PM 2.5 for three subregions of Sydney from measurements at monitoring stations using inverse-distance weighting and cross-referenced extreme days (95th percentile or above) with satellite imagery to determine if bushfire smoke was present. We then used a seasonal and trend decomposition method to estimate the Non-bushfire PM 2.5 concentrations on those days. Daily PM 2.5 concentrations above the Non-bushfire concentrations on bushfire smoke days were deemed to be Bushfire PM 2.5. We used distributed-lag non-linear models to estimate the effect of Bushfire and Non-bushfire PM 2.5 on daily counts of mortality with sub-analyses by age. These models controlled for seasonal trends in mortality as well as daily temperature, day of week and public holidays. Within the three subregions, between 110 and 134 days were identified as extreme bushfire smoke days within the subregions of Sydney. Bushfire-related PM 2.5 ranged from 6.3 to 115.4 µg/m3. A 0 to 10 µg/m3 increase in Bushfire PM 2.5 was associated with a 3.2% (95% CI 0.3, 6.2%) increase in risk of all-cause death, cumulatively, in the 3 days following exposure. These effects were present in those aged 65 years and over, while no effect was observed in people under 65 years. Bushfire PM 2.5 exposure is associated with an increased risk of mortality, particularly in those over 65 years of age. This increase in risk was clearest at Bushfire PM 2.5 concentrations up to 30 µg/m3 above background (Non-bushfire), with possible plateauing at higher concentrations of Bushfire PM 2.5. [ABSTRACT FROM AUTHOR]

Background: Planning and transport agencies play a vital role in influencing the design of townscapes, travel modes and travel behaviors, which in turn impact on the walkability of neighbourhoods and residents' physical activity opportunities. Optimising neighbourhood walkability is desirable in built environments, however, the population health benefits of walkability may be offset by increased exposure to traffic related air pollution. This paper describes the spatial distribution of neighbourhood walkability and weighted road density, a marker for traffic related air pollution, in Sydney, Australia. As exposure to air pollution is related to socio-economic status in some cities, this paper also examines the spatial distribution of weighted road density and walkability by socio-economic status (SES).Methods: We calculated walkability, weighted road density (as a measure of traffic related air pollution) and SES, using predefined and validated measures, for 5858 Sydney neighbourhoods, representing 3.6 million population. We overlaid tertiles of walkability and weighted road density to define "sweet-spots" (high walkability-low weighted road density), and "sour- spots" (low walkability-high weighted road density) neighbourhoods. We also examined the distribution of walkability and weighted road density by SES quintiles.Results: Walkability and weighted road density showed a clear east-west gradient across the region. Our study found that only 4 % of Sydney's population lived in sweet-spot" neighbourhoods with high walkability and low weighted road density (desirable), and these tended to be located closer to the city centre. A greater proportion of neighbourhoods had health limiting attributes of high weighted road density or low walkability (about 20 % each), and over 5 % of the population lived in "sour-spot" neighbourhoods with low walkability and high weighted road density (least desirable). These neighbourhoods were more distant from the city centre and scattered more widely. There were no linear trends between walkability/weighted road density and neighbourhood SES.Conclusions: Our walkability and weighted road density maps and associated analyses by SES can help identify neighbourhoods with inequalities in health-promoting or health-limiting environments. Planning agencies should seek out opportunities for increased neighbourhood walkability through improved urban development and transport planning, which simultaneously minimizes exposure to traffic related air pollution. [ABSTRACT FROM AUTHOR]

This study investigates the mortality effect of primary and secondary PM 2.5 related to ship exhaust in the Sydney greater metropolitan region of Australia. A detailed inventory of ship exhaust emissions was used to model a) the 2010/11 concentration of ship-related PM 2.5 across the region, and b) the reduction in PM 2.5 concentration that would occur if ships used distillate fuel with a 0.1% sulfur content at berth or within 300 km of Sydney. The annual loss of life attributable to 2010/11 levels of ship-related PM 2.5 and the improvement in survival associated with use of low-sulfur fuel were estimated from the modelled concentrations. In 2010/11, approximately 1.9% of the region-wide annual average population weighted-mean concentration of all natural and human-made PM 2.5 was attributable to ship exhaust, and up to 9.4% at suburbs close to ports. An estimated 220 years of life were lost by people who died in 2010/11 as a result of ship exhaust-related exposure (95% CI β : 140–290, where CI β is the uncertainty in the concentration-response coefficient only). Use of 0.1% sulfur fuel at berth would reduce the population weighted-mean concentration of PM 2.5 related to ship exhaust by 25% and result in a gain of 390 life-years over a twenty year period (95% CI β : 260–520). Use of 0.1% sulfur fuel within 300 km of Sydney would reduce the concentration by 56% and result in a gain of 920 life-years over twenty years (95% CI β : 600–1200). Ship exhaust is an important source of human exposure to PM 2.5 in the Sydney greater metropolitan region. This assessment supports intervention to reduce ship emissions in the GMR. Local strategies to limit the sulfur content of fuel would reduce exposure and will become increasingly beneficial as the shipping industry expands. A requirement for use of 0.1% sulfur fuel by ships within 300 km of Sydney would provide more than twice the mortality benefit of a requirement for ships to use 0.1% sulfur fuel at berth. [ABSTRACT FROM AUTHOR]

Among industrialised countries, fine particle (PM 2.5 ) and ozone levels in the Sydney metropolitan area of Australia are relatively low. Annual mean PM 2.5 levels have historically remained below 8 μg/m 3 while warm season (November–March) ozone levels occasionally exceed the Australian guideline value of 0.10 ppm (daily 1 h max). Yet, these levels are still below those seen in the United States and Europe. This analysis focuses on two related questions: (1) what is the public health burden associated with air pollution in Sydney; and (2) to what extent would reducing air pollution reduce the number of hospital admissions, premature deaths and number of years of life lost (YLL)? We addressed these questions by applying a damage function approach to Sydney population, health, PM 2.5 and ozone data for 2007 within the BenMAP-CE software tool to estimate health impacts and economic benefits. We found that 430 premature deaths (90% CI: 310–540) and 5800 YLL (95% CI: 3900–7600) are attributable to 2007 levels of PM 2.5 (about 2% of total deaths and 1.8% of YLL in 2007). We also estimate about 630 (95% CI: 410–840) respiratory and cardiovascular hospital admissions attributable to 2007 PM 2.5 and ozone exposures. Reducing air pollution levels by even a small amount will yield a range of health benefits. Reducing 2007 PM 2.5 exposure in Sydney by 10% would, over 10 years, result in about 650 (95% CI: 430–850) fewer premature deaths, a gain of 3500 (95% CI: 2300–4600) life-years and about 700 (95% CI: 450–930) fewer respiratory and cardiovascular hospital visits. These results suggest that substantial health benefits are attainable in Sydney with even modest reductions in air pollution. [ABSTRACT FROM AUTHOR]

Background: Potentially preventable hospital admission (an admission deemed to be potentially preventable given appropriate care in the community-based healthcare setting) has been a topic of international research attention for almost three decades. Recently this has been largely driven by the imperative to reduce ever-increasing unplanned hospital admissions. However, identifying potentially preventable admissions is difficult. As a result, the population level indicator of admissions for ambulatory care sensitive conditions (ACSCs) has been used as a proxy measure for potentially preventable admission. The adoption of this measure has become common, and in Australia, the rate of admissions for chronic ACSCs is now an important component of measuring health system performance and accountability, and is directly linked to funding. Admission for a chronic ACSC is also used to identify individuals for targeting of interventions to reduce preventable admissions.Discussion: Hospital admission for chronic ACSCs is a population measure based on admission diagnoses, it therefore should not be used to identify individual preventable admissions. At present we are unable to determine individual admissions that are deemed to be preventable or, therefore, articulate the factors associated with admissions which are preventable. As we are currently unable to identify individual admissions that are preventable, little is understood about the underlying causes and factors contributing to preventable admissions. A means of assessing preventability of individual admissions is required. Only then can we explore the antecedents, and patient and clinician perspectives on preventable admissions. Until we have a clearer understanding of this, our capacity to inform policy and program development remains compromised. [ABSTRACT FROM AUTHOR]

• We reviewed the association between temperature and Ross river virus infection. • A 1 °C rise in temperature increases the risk of Ross river virus infection by 9%.x0025 • Ross river virus infection was higher in the humid subtropical climate zone. • The evidence could contribute to Ross river virus intervention and control. • Future studies need to account for socio-demographic and environmental factors. Ross River virus (RRV) infection is one of the emerging and prevalent arboviral diseases in Australia and the Pacific Islands. Although many studies have been conducted to establish the relationship between temperature and RRV infection, there has been no comprehensive review of the association so far. In this study, we performed a systematic review and meta-analysis to assess the effect of temperature on RRV transmission. We searched PubMed, Scopus, Embase, and Web of Science with additional lateral searches from references. The quality and strength of evidence from the included studies were evaluated following the Navigation Guide framework. We have qualitatively synthesized the evidence and conducted a meta-analysis to pool the relative risks (RRs) of RRV infection per 1 °C increase in temperature. Subgroup analyses were performed by climate zones, temperature metrics, and lag periods. A total of 17 studies met the inclusion criteria, of which six were included in the meta-analysis The meta-analysis revealed that the overall RR for the association between temperature and the risk of RRV infection was 1.09 (95% confidence interval (CI): 1.02, 1.17). Subgroup analyses by climate zones showed an increase in RRV infection per 1 °C increase in temperature in humid subtropical and cold semi-arid climate zones. The overall quality of evidence was "moderate" and we rated the strength of evidence to be "limited", warranting additional evidence to reduce uncertainty. The results showed that the risk of RRV infection is positively associated with temperature. However, the risk varies across different climate zones, temperature metrics and lag periods. These findings indicate that future studies on the association between temperature and RRV infection should consider local and regional climate, socio-demographic, and environmental factors to explore vulnerability at local and regional levels. [Display omitted] [ABSTRACT FROM AUTHOR]

Background Severe air pollution generated by forest fires across the globe is becoming an increasingly frequent public health management problem. We measured the association between forest fire smoke events and hospital emergency department (ED) attendances in Sydney from 1996-2007. Methods A smoke event occurred when forest fires caused the daily citywide average concentration of particulate matter (PM10 or PM2.5) to exceed the 99th percentile of the entire study period. We used a time-stratified case-crossover design and conditional logistic regression models adjusted for meteorology, influenza epidemics, and holidays to estimate odds ratios (OR) and 95% confidence intervals (CI) for ED attendances on event days compared with non-event days for all non-trauma ED attendances and selected cardiorespiratory conditions. Results The 46 validated fire smoke event days during the study period were associated with same day increases in ED attendances for all non-trauma conditions (1.03, 95%CI 1.02,1.04), respiratory conditions (OR1.07, 95%CI 1.04,1.10), asthma (OR1.23, 95%CI 1.15,1.30), and chronic obstructive pulmonary disease (OR1.12, 95%CI 1.02,1.24). Positive associations persisted for one to three days after the event. Ischaemic heart disease ED attendances were increased at a lag of two days (OR1.07, 95%CI 1.01,1.15) while arrhythmias had an inverse association at a lag of two days (OR0.91, 95%CI 0.83,0.99). In age-specific analyses, no associations present in children less than 15 years of age for any outcome, although a non-significant trend towards a positive association was seen with childhood asthma. A further association between smoke event and heart failure attendances was present for the 15-65 year age group, but not older adults at a lag of two days (OR1.37 95%CI 1.05,1.78). Conclusion Smoke events were associated with an immediate increase in presentations for respiratory conditions and a lagged increase in attendances for ischaemic heart disease and heart failure. Respiratory impacts were either absent or considerably attenuated in those <15 years. Similar to previous studies we found inconsistent associations between fire smoke and cardiovascular diseases. Better characterisation of the spectrum of population health risks is needed to guide public heath responses to severe smoke events as this exposure becomes increasingly common with global climate change [ABSTRACT FROM AUTHOR]

Objective. This paper articulates the importance of accurately identifying maternity services. It describes the process and challenges of identifying the number, level and networks of rural and remote maternity services in public hospitals serving communities of between 1000 and 25 000 people across Australia, and presents the findings of this process. Methods. Health departments and the national government's websites, along with lists of public hospitals, were used to identify all rural and remote Australian public hospitals offering maternity services in small towns. State perinatal reports were reviewed to establish numbers of births by hospital. The level of maternity services and networks of hospitals within which services functioned were determined via discussion with senior jurisdictional representatives. Results. In all, 198 rural and remote public hospitals offering maternity services were identified. There were challenges in sourcing information on maternity services to generate an accurate national picture. The nature of information about maternity services held centrally by jurisdictions varied, and different frameworks were used to describe minimum requirements for service levels. Service networks appeared to be based on a combination of individual links, geography and transport infrastructure. Conclusions. The lack of readily available centralised and comparable information on rural and remote maternity services has implications for policy review and development, equity, safety and quality, network development and planning. Accountability for services and capacity to identify problems is also compromised. [ABSTRACT FROM AUTHOR]