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The extreme heat wave in Australia in 2009 resulted in significantly increased number of daily deaths. The circumstances that lead to deaths during extreme heat have not been explored before in Australia. This study aims to identify the individual and community risk factors for deaths during this extreme heat wave in Adelaide. A matched case-control study was conducted. Cases were those who died in the Adelaide metropolitan area during the heat wave period. For each case, two community controls were randomly selected, matched by age and gender. Face-to-face or telephone interviews were conducted to collect data of demographic information, living environment, social support, health status and behavioural changes during the heat wave. Descriptive analysis, as well as simple and multiple conditional logistic regressions were performed. In total, 82 deaths and 164 matched community controls were included in the analysis, with a median age of 77.5 (range 26.6-100.7). The multiple logistic regression model indicated that, compared with controls, the risk of death during the heat wave was significantly increased for people living alone (AOR = 42.31, 95 % CI 2.3, 792.8) or having existing chronic heart disease (AOR = 22.4, 95 % CI 1.7, 303.0). In addition, having air conditioning in bedrooms (AOR = 0.004, 95 % CI 0.00006, 0.28) and participating in social activities more than once a week (AOR = 0.011, 95 % CI 0.0004, 0.29) indicated significant protective effects. We have identified factors that could significantly impact on the likelihood of deaths during heat waves. Our findings could assist in the development of future intervention programs and policies to reduce mortality associated with a warmer climate. [ABSTRACT FROM AUTHOR]

Background After reviewing urethral gonorrhoea cases among men who have sex with men (MSM) at the South Australia Specialist Sexual Health (SASSH) in Adelaide, Australia, we noticed peaks of gonorrhoea among MSM occurred predominantly in the first quarter of the year (January-March). The aim of this study was to formally test this hypothesis against data from a similar period at three sexual health services, one each in Adelaide, Melbourne and Sydney.Methods: This study was a retrospective analysis of computerised records at the three Australian sexual health services. Potential risk factors for urethral gonorrhoea among MSM were also reviewed at the SASSH.Results: More peaks of gonorrhoea cases were observed in the first quarter of the year in Adelaide and Sydney and in the second and fourth quarter in Melbourne. Factors independently associated with urethral gonorrhoea at the SASSH were being a young MSM, especially those aged 25-29 (odds ratio (OR) 2.66, 95% confidence interval (CI): 2.00-3.54), having more than one sexual partner (OR 1.71, 95% CI: 1.43-2.04), having had sex interstate and overseas (OR 1.52, 95% CI: 1.06-2.17), and presenting in the first quarter (OR 1.30, 95% CI: 1.10-1.55).Conclusion: Our data suggest that gonorrhoea among MSM occurs in a seasonal pattern, particularly late summer into early autumn. This has implications for the provision of health services over the year and for the timing of health promotion activities. [ABSTRACT FROM AUTHOR]

This study aims to investigate the impact of heatwaves on worker׳s health and safety; to identify workers at higher risk of prevalent illnesses and injuries due to heatwaves; and to provide evidence for policy-makers and service providers. South Australian workers׳ compensation claims data for 2001–2010 were transformed into time series format, merged with meteorological data and analysed using generalized estimating equation (GEE) models. For total injury claims there was no significant difference detected between heatwave and non-heatwave periods. However, for outdoor industries, daily claims increased significantly by 6.2% during heatwaves. Over-represented in hot weather were male labourers and tradespersons aged ≥55 years, and those employed in ‘agriculture, forestry and fishing’ and ‘electricity, gas and water’. Occupational burns, wounds, lacerations, and amputations as well as heat illnesses were significantly associated with heatwaves. Similarly, moving objects, contact with chemicals, and injuries related to environmental factors increased significantly during heatwaves, especially among middle-aged and older male workers. With the predicted increase of extremely hot weather, there is a need for relevant adaptation and prevention measures at both practice and policy levels for vulnerable work groups. [ABSTRACT FROM AUTHOR]

Record breaking heat waves have been recorded in Adelaide, Australia in recent years and climate change would likely increase the frequency, duration and severity of heat waves. This paper describes the governance and institutional arrangements during the development of an adaptation strategy (herein referred to as heat-health policy) for heat waves in Adelaide, Australia. In-depth, semi-structured interviews were conducted between June and August 2011 among 18 stakeholders who were involved in the participatory process during the development of the heat-health policy. Informed consent was obtained and interviews were recorded, transcribed verbatim and the data analysed using framework analysis. Interview data were supplemented by data gathered through a review of documents associated with the process. The results found that the process of developing the heat-health policy was initiated by the state government and comprised of stakeholders from both the state and non-state sectors. There was a high level of leadership and political commitment demonstrated during the process, given that the different players wanted a policy to be in place before any future heat wave. A Steering Committee was established that provided coordination and oversight in addition to the Emergency Management Act within the state which provided the legislative framework during the heat-health policy development process. Although the decision-making authority was controlled by a controlled by a public institution, to a larger extent, there was collaborative decision-making by virtue of the context in which the heat-health policy was developed. An assurance mechanism established during the process was among the factors that ensured accountability during the participatory process. Overall, the development of the heat-health policy in Adelaide was largely successful, attributed to the extent of political commitment from the state government and the sound institutional and legislative framework that facilitated the process. Good governance and institutional arrangements provide the enabling environment, the structures, systems and resources that would facilitate the development of adaptation strategies such as heat-health policies. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The goal of this study was to identify mental, behavioral, and cognitive disorders that may be triggered or exacerbated during heat waves, predisposing individuals to heat-related morbidity and mortality. DESIGN: Using health outcome data from Adelaide, South Australia, for 1993--2006, we estimated the effect of heat waves on hospital admissions and mortalities attributed to mental, behavioral, and cognitive disorders. We analyzed data using Poisson regression accounting for overdispersion and controlling for season and long-term trend, and we performed threshold analysis using hockey stick regression. RESULTS: Above a threshold of 26.7°C, we observed a positive association between ambient temperature and hospital admissions for mental and behavioral disorders. Compared with non--heat-wave periods, hospital admissions increased by 7.3% during heat waves. Specific illnesses for which admissions increased included organic illnesses, including symptomatic mental disorders; dementia; mood (affective) disorders; neurotic, stress related, and somatoform disorders; disorders of psychological development; and senility. Mortalities attributed to mental and behavioral disorders increased during heat waves in the 65- to 74-year age group and in persons with schizophrenia, schizotypal, and delusional disorders. Dementia deaths increased in those up to 65 years of age. CONCLUSION: Our results suggest that episodes of extreme heat pose a salient risk to the health and well-being of the mentally ill. RELEVANCE TO CLINICAL OR PROFESSIONAL PRACTICE: Improvements in the management and care of the mentally ill need to be addressed to avoid an increase in psychiatric morbidity and mortality as heat waves become more frequent. [ABSTRACT FROM AUTHOR]

Background The adverse effects of heat on workers' health and work productivity are well documented. However, the resultant economic consequences and productivity loss are less understood. This review aims to summarize the retrospective and potential future economic burden of workplace heat exposure in the context of climate change. Methods Literature was searched from database inception to October 2020 using Embase, PubMed, and Scopus. Articles were limited to original human studies investigating costs from occupational heat stress in English. Results Twenty studies met the criteria. Eighteen studies estimated costs from heat-induced labor productivity loss. Predicted global costs from lost worktime, in US$, were 280 billion in 1995, 311 billion in 2010 (≈0.5% of GDP), 2.5 trillion in 2030 (>1% of GDP) and up to 4.0% of GDP by 2100, with additional expenses after considering reduced work efficiency. Three studies estimated heat-related healthcare expenses from occupational injuries with averaged annual costs (US$) exceeding 1 million in Spain, 1 million in Guangzhou, China and 250,000 in Adelaide, Australia. Low- and middle-income countries and countries with warmer climates had greater losses as a proportion of GDP. Greater costs per worker were observed in outdoor industries, amongst males, and workers aged 25 to 44 years. Conclusions The estimated global economic burden of occupational heat stress is substantial. Climate change adaptation and mitigation strategies should be implemented to likely minimize future costs. Further research exploring the relationship between occupational heat stress and related expenses from lost productivity, decreased work efficiency and healthcare, and costs stratified by demographic factors, is warranted. Key messages The estimated retrospective and future economic burden from occupational heat stress is large. Responding to climate change is crucial to minimize this burden. Analyzing heat-attributable occupational costs may guide the development of workplace heat management policies and practices as part of global warming strategies. [ABSTRACT FROM AUTHOR]

Background Heatwaves are associated with increases in mortality and morbidity (mostly hospitalisations). However, evidence regarding heatwave impacts on the use of frontline health-services such as general practitioner (GP) consultations and emergency department (ED) services is limited. This study quantified the impact of heatwaves on the use of GP and ED services in Adelaide. Methods Data on GP services (2011-2016) from the Medicare Benefits Schedule and ED visits (2013-2018) were obtained from the Australian Bureau of Statistics and the Department of Health, respectively. Heatwaves were defined using Excess Heat Factor. Using time-stratified case-crossover models, we modelled heatwave-severity (low, severe/extreme) against the use of GP and ED services in the warm-season (October-March). Effect estimates are reported as relative risks (RRs). Results Total GP visits decreased during low-intensity heatwaves and increased during severe/extreme heatwaves (RR 1.14; 95%CI: 1.13-1.15). The highest increases during severe/extreme heatwaves were observed for respiratory (RR 1.36; 95%CI: 1.27-1.45) and psychiatric services. While ED visits decreased overall during low-intensity and severe/extreme heatwaves, those due to heat-light disorders (RR 4.23; 95%CI: 2.98-6.00), volume depletion, and respiratory diseases increased during severe/extreme heatwaves. Conclusions There were significant increases in the use of GP and specific ED services during heatwaves in Adelaide. Further research is needed to identify the intrinsic and extrinsic vulnerability factors contributing to these increases in Adelaide and other Australian cities. Key messages Impacts of heatwaves extend beyond mortality to include frontline health-services (GP/EDs) that are already challenged. Evidence presented may assist policymakers for resource allocation and healthcare workforce capacity building. [ABSTRACT FROM AUTHOR]

Abstract: Adelaide experienced an extreme and prolonged 13days heatwave in summer 2009. The health impacts of this heatwave included an almost 14-fold increase in direct heat-related hospital admissions. This study aims to investigate the risk factors for this extra health burden. A case crossover study was conducted in metropolitan Adelaide to compare the characteristics of patients from the heatwave (exposure) period and non-heatwave (control) periods before and after. Direct heat-related hospitalizations were identified based on the ICD-10 codes (X30, T67, and E86). Patients'' data, including age, gender, indicators of health status, living conditions and socio-economic status, were collected from the South Australian Department of Health and patients'' case-notes from seven major Adelaide hospitals. Multivariate logistic regression model was used to estimate the odd ratios (OR) and the 95% confidence intervals (CI). Results indicate that living at residential aged care (OR=0.41, 95% CI: 0.15–0.70) and having higher number of co-morbidities (OR=0.89, 95% CI: 0.83–0.95) reduced the risk of hospital admission for direct heat-related illnesses during the heatwave, while having renal problems (OR=1.72, 95% CI: 1.07–2.94), reporting a fall prior to hospitalization (OR=2.04, 95% CI: 1.10–3.77), receiving assistance from community (OR=2.31, 95% CI: 1.24–4.30), living alone (OR=2.41, 95% CI: 1.32–4.40), socio-economic disadvantage (OR=2.10, 95% CI: 1.09–4.04) and no private health insurance (OR=1.82, 95% CI: 1.05–3.16) increased the risk. In conclusion, the people most at risk during the 2009 heatwave in Adelaide were those who lived alone, received help from community services, with co-existing renal problems or a risk of falls, and with a lower socio-economic status. Findings will assist in refining heat-health response systems and developing intervention programmes. [Copyright &y& Elsevier]

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

Abstract: Background: Climate change projections have highlighted the need for public health planning for extreme heat. In Adelaide, South Australia, hot weather is characteristic of summer and heatwaves can have a significant health burden. This study examines the heat thresholds and temperature relationships for mortality and morbidity outcomes in Adelaide. Methods: Daily maximum and minimum temperatures, daily mortality, ambulance call-outs, emergency department (ED) presentations and hospital admissions were obtained for Adelaide, between 1993 and 2009. Heat thresholds for health outcomes were estimated using an observed/expected analysis. Generalized estimating equations were used to estimate the percentage increase in mortality and morbidity outcomes above the threshold temperatures, with adjustment for the effects of ozone (O3) and particulate matter<10μm in mass median aerodynamic diameter (PM10). Effect estimates are reported as incidence rate ratios (IRRs). Results: Heat-related mortality and morbidity become apparent above maximum and minimum temperature thresholds of 30°C and 16°C for mortality; 26°C and 18°C for ambulance call-outs; and 34°C and 22°C for heat-related ED presentations. Most health outcomes showed a positive relationship with daily temperatures over thresholds. When adjusted for air pollutants, a 10°C increase in maximum temperature was associated with a 4.9% increase in daily ambulance call-outs (IRR 1.049; 95% CI 1.027–1.072), and a 3.4% increase in mental health related hospital admissions (IRR 1.034; 95% CI 1.009–1.059) for the all-age population. Heat-related ED presentations increased over 6-fold per 10°C increase in maximum temperature. Daily temperatures were also associated with all-cause and mental health related ED presentations. Associations between temperature over thresholds and daily mortality and renal hospital admissions were not significant when adjusted for ozone and PM10; however at extreme temperatures mortality increased significantly with increasing heat duration. Conclusions: Heat-attributable mortality and morbidity are associated with elevated summer temperatures in Adelaide, particularly ambulance call-outs, mental health and heat-related illness. [Copyright &y& Elsevier]

The adverse effects of heat on workers' health and work productivity are well documented. However, the resultant economic consequences and productivity loss are less understood. This review aims to summarize the retrospective and potential future economic burden of workplace heat exposure in the context of climate change. Literature was searched from database inception to October 2020 using Embase, PubMed, and Scopus. Articles were limited to original human studies investigating costs from occupational heat stress in English. Twenty studies met criteria for inclusion. Eighteen studies estimated costs secondary to heat-induced labor productivity loss. Predicted global costs from lost worktime, in US$, were 280 billion in 1995, 311 billion in 2010 (≈0.5% of GDP), 2.4–2.5 trillion in 2030 (>1% of GDP) and up to 4.0% of GDP by 2100. Three studies estimated heat-related healthcare expenses from occupational injuries with averaged annual costs (US$) exceeding 1 million in Spain, 1 million in Guangzhou, China and 250,000 in Adelaide, Australia. Low- and middle-income countries and countries with warmer climates had greater losses as a proportion of GDP. Greater costs per worker were observed in outdoor industries, medium-sized businesses, amongst males, and workers aged 25–44 years. The estimated global economic burden of occupational heat stress is substantial. Climate change adaptation and mitigation strategies should be implemented to likely minimize future costs. Further research exploring the relationship between occupational heat stress and related expenses from lost productivity, decreased work efficiency and healthcare, and costs stratified by demographic factors, is warranted. Key messages. The estimated retrospective and future economic burden from occupational heat stress is large. Responding to climate change is crucial to minimize this burden. Analyzing heat-attributable occupational costs may guide the development of workplace heat management policies and practices as part of global warming strategies. [ABSTRACT FROM AUTHOR]