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1. Evaluating cost benefits from a heat health warning system in Adelaide, South Australia.

Author

Williams S, Nitschke M, Wondmagegn BY, Tong M, Xiang J, Hansen A, Nairn J, Karnon J, and Bi P

Subjects
Australia, Cost-Benefit Analysis, Humans, South Australia, Hot Temperature, Public Health
Abstract

Objective: To examine the cost benefits of a heat health warning system (HHWS) in South Australia., Methods: Information from key agencies was used to estimate the costs associated with the South Australian HHWS, including for three targeted public health interventions. Health cost savings were estimated based on previously reported HHWS-attributable reductions in hospital and emergency department (ED) admissions and ambulance callouts., Results: The estimated cost for a one-week activation of the HHWS was AU$593,000. Activation costs compare favourably with the potential costs averted through HHWS-attributable reductions in hospital admissions and ambulance callouts with an estimated benefit-cost ratio of 2.0-3.3., Conclusions: On the basis of estimated cost benefit, the South Australian HHWS is a no-regret public health response to heatwaves., Implications for Public Health: As global temperatures rise there are likely to be significant health impacts from more frequent and intense heatwaves. This study indicates that HHWSs incorporating targeted supports for vulnerable groups are likely to be cost-effective public health interventions., (© 2021 The Authors.)

Published
2022
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2. Understanding current and projected emergency department presentations and associated healthcare costs in a changing thermal climate in Adelaide, South Australia.

Author

Wondmagegn, Berhanu Yazew, Jianjun Xiang, Dear, Keith, Williams, Susan, Hansen, Alana, Pisaniello, Dino, Nitschke, Monika, Nairn, John, Scalley, Ben, Xiao, Alex, Le Jian, Tong, Michael, Bambrick, Hilary, Karnon, Jonathan, Peng Bi, Xiang, Jianjun, Jian, Le, and Bi, Peng

Abstract

Background: Exposure to extreme temperatures is associated with increased emergency department (ED) presentations. The resulting burden on health service costs and the potential impact of climate change is largely unknown. This study examines the temperature-EDs/cost relationships in Adelaide, South Australia and how this may be impacted by increasing temperatures.Methods: A time series analysis using a distributed lag nonlinear model was used to explore the exposure-response relationships. The net-attributable, cold-attributable and heat-attributable ED presentations for temperature-related diseases and costs were calculated for the baseline (2014-2017) and future periods (2034-2037 and 2054-2057) under three climate representative concentration pathways (RCPs).Results: The baseline heat-attributable ED presentations were estimated to be 3600 (95% empirical CI (eCI) 700 to 6500) with associated cost of $A4.7 million (95% eCI 1.8 to 7.5). Heat-attributable ED presentations and costs were projected to increase during 2030s and 2050s with no change in the cold-attributable burden. Under RCP8.5 and population growth, the increase in heat-attributable burden would be 1.9% (95% eCI 0.8% to 3.0%) for ED presentations and 2.5% (95% eCI 1.3% to 3.7%) for ED costs during 2030s. Under the same conditions, the heat effect is expected to increase by 3.7% (95% eCI 1.7% to 5.6%) for ED presentations and 5.0% (95% eCI 2.6% to 7.1%) for ED costs during 2050s.Conclusions: Projected climate change is likely to increase heat-attributable emergency presentations and the associated costs in Adelaide. Planning health service resources to meet these changes will be necessary as part of broader risk mitigation strategies and public health adaptation actions. [ABSTRACT FROM AUTHOR]

Published
2022
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3. Public health professionals' perceptions of the capacity of China's CDCs to address emerging and re-emerging infectious diseases.

Author

Tong, Michael Xiaoliang, Hansen, Alana, Hanson-Easey, Scott, Xiang, Jianjun, Cameron, Scott, Liu, Qiyong, Liu, Xiaobo, Sun, Yehuan, Weinstein, Philip, Han, Gil-Soo, Mahmood, Afzal, and Bi, Peng

Subjects
PREVENTION of communicable diseases, PREVENTION of epidemics, PUBLIC health surveillance, STATISTICS, HEALTH education, CONFIDENCE, CONFIDENCE intervals, ATTITUDE (Psychology), CROSS-sectional method, MULTIPLE regression analysis, MULTIVARIATE analysis, PUBLIC health, MEDICAL personnel, FISHER exact test, SURVEYS, ORGANIZATIONAL effectiveness, RESEARCH funding, INTERPROFESSIONAL relations, QUESTIONNAIRES, CHI-squared test, GOVERNMENT aid, JUDGMENT sampling, DATA analysis software, ODDS ratio
Abstract

Background China's capacity to control and prevent emerging and re-emerging infectious diseases is critical to the nation's population health. This study aimed to explore the capacity of Centers for Disease Control and Prevention (CDCs) in China to deal with infectious diseases now and in the future. Methods A survey was conducted in 2015 among 973 public health professionals at CDCs in Beijing and four provinces, to assess their capacity to deal with emerging and re-emerging infectious diseases. Results Although most professionals were confident with the current capacity of CDCs to cope with outbreaks, nearly all indicated more funding was required to meet future challenges. Responses indicated that Yunnan Province faced more challenges than Anhui, Henan and Liaoning Provinces in being completely prepared and able to deal with outbreaks. Participants aged 20–39 years were more likely than those aged 40 and over to believe strategies such as interdisciplinary and international collaborations for disease surveillance and control, would assist capacity building. Conclusion The capacity of China's CDCs to deal with infectious diseases was excellent. However, findings suggest it is imperative to increase the number of skilled CDC staff, financial support, and strengthen county level staff training and health education programs. [ABSTRACT FROM AUTHOR]

Published
2021
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4. Dengue control in the context of climate change: Views from health professionals in different geographic regions of China

Author

Alana Hansen, Scott J. Cameron, Scott Hanson-Easey, Qiyong Liu, Jianjun Xiang, Xiaobo Liu, Philip Weinstein, Michael Xiaoliang Tong, Yehuan Sun, Peng Bi, Afzal Mahmood, Gil-Soo Han, Craig R. Williams, Tong, Michael X, Hansen, Alana, Hanson-Easey, Scott, Xiang, Jianjun, Cameron, Scott, Liu, Qiyong, Liu, Xiaobo, Sun, Yehaun, Weinsten, Philip, Han, Gil-Soo, Williams, Craig, Mahmoo, Afzal, and Bi, Peng

Subjects
Adult, Male, 0301 basic medicine, China, medicine.medical_specialty, Attitude of Health Personnel, infectious disease, Climate Change, 030106 microbiology, Climate change, Context (language use), Disease, lcsh:Infectious and parasitic diseases, Dengue fever, Dengue, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, Environmental health, medicine, Humans, lcsh:RC109-216, public health professional, 030212 general & internal medicine, Demography, Descriptive statistics, lcsh:Public aspects of medicine, Public health, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, General Medicine, medicine.disease, climate change, Cross-Sectional Studies, Infectious Diseases, Geography, Female, dengue control, Climate change in China
Abstract

Background: Dengue is a significant climate-sensitive disease. Public health professionals play an important role in prevention and control of the disease. This study aimed to explore dengue control and prevention in the context of climate change in China. Methods: A cross-sectional survey was conducted among 630 public health professionals in 2015. Descriptive analysis and logistic regression were performed. Results: More than 80% of participants from southwest and central China believed climate change would affect dengue. However, participants from northeast China were less likely to believe so (65%). Sixty-nine percent of participants in Yunnan perceived that dengue had emerged/re-emerged in recent years, compared with 40.6% in Henan and 23.8% in Liaoning. Less than 60% of participants thought current prevention and control programs had been effective. Participants believed mosquitoes in high abundance, imported cases and climate change were main risk factors for dengue in China. Conclusion: There were varying views of dengue in China. Professionals in areas susceptible to dengue were more likely to be concerned about climate change and dengue. Current prevention and control strategies need to be improved. Providing more information for staff in lower levels of Centers for Disease Control and Prevention may help in containing a possible increase of dengue. Keywords: Climate change, Dengue control, Infectious disease, Public health professional, China

Published
2019

5. Health professionals' perceptions of hemorrhagic fever with renal syndrome and climate change in China

Author

Scott J. Cameron, Gil-Soo Han, Michael Xiaoliang Tong, Yehuan Sun, Jianjun Xiang, Alana Hansen, Xiaobo Liu, Peng Bi, Scott Hanson-Easey, Philip Weinstein, Craig R. Williams, Qiyong Liu, Tong, Michael Xiaoliang, Hansen, Alana, Hanson-Easey, Scott, Cameron, Scott, Xiang, Jianjun, Liu, Qiyong, Liu, Xiaobo, Sun, Yehuan, Weinstein, Philip, Han, Gil Soo, Williams, Craig, and Bi, Peng

Subjects
medicine.medical_specialty, 030231 tropical medicine, Disease, Population health, perception, infectious diseases, Oceanography, 03 medical and health sciences, 0302 clinical medicine, Environmental protection, health professionals, Environmental health, hemorrhagic fever with renal syndrome, Medicine, 030212 general & internal medicine, Global and Planetary Change, business.industry, Transmission (medicine), Public health, Incidence (epidemiology), virus diseases, climate change, Health promotion, Hantavirus Infection, business, Climate change in China
Abstract

Background Hemorrhagic fever with renal syndrome (HFRS) is a serious public health problem in China. Although the incidence of HFRS sharply reduced towards the end of the twentieth century, there has been a re-emergence of the disease after 2008 in some parts of China. The aim of this study was to gauge the perceptions of health professionals in China concerning HFRS control and climate change. Methods A cross-sectional survey about HFRS and climate change was conducted among staff in the Centers for Disease Control and Prevention (CDC) in Liaoning and Anhui Provinces, where HFRS is still a public health concern. Descriptive analyses were performed to assess survey results. Results In total, 412 questionnaires were distributed, and 381 participants completed the survey. > 80% of participants thought climate change would have an influence on population health and infectious diseases. However, fewer participants (

Published
2017

6. Is there an association between hot weather and poor mental health outcomes? A systematic review and meta-analysis.

Author

Liu, Jingwen, Varghese, Blesson M., Hansen, Alana, Xiang, Jianjun, Zhang, Ying, Dear, Keith, Gourley, Michelle, Driscoll, Timothy, Morgan, Geoffrey, Capon, Anthony, and Bi, Peng

Subjects
*HEAT waves (Meteorology), *META-analysis, *NEUROBEHAVIORAL disorders, *HOT weather conditions, *MENTAL health, *SCIENTIFIC literature, *PUBLIC health
Abstract

• Evaluated short-term associations of heat on mental health-related outcomes. • A 2.2% increase in mental health-related mortality per 1 °C rise in temperature. • A 0.9% increase in mental health-related morbidity per 1 °C rise in temperature. • Heatwaves increase the risk of mental health-related outcomes. • Higher risks for elderly, and those living in Tropical and Subtropical climates. Mental health is an important public health issue globally. A potential link between heat exposure and mental health outcomes has been recognised in the scientific literature; however, the associations between heat exposure (both high ambient temperatures and heatwaves) and mental health-related mortality and morbidity vary between studies and locations. To fill gaps in knowledge, this systematic review aims to summarize the epidemiological evidence and investigate the quantitative effects of high ambient temperatures and heatwaves on mental health-related mortality and morbidity outcomes, while exploring sources of heterogeneity. A systematic search of peer-reviewed epidemiological studies on heat exposure and mental health outcomes published between January 1990 and November 2020 was conducted using five databases (PubMed, Embase, Scopus, Web of Science and PsycINFO). We included studies that examined the association between high ambient temperatures and/or heatwaves and mental health-related mortality and morbidity (e.g. hospital admissions and emergency department visits) in the general population. A range of mental health conditions were defined using ICD-10 classifications. We performed random effects meta-analysis to summarize the relative risks (RRs) in mental health outcomes per 1 °C increase in temperature, and under different heatwaves definitions. We further evaluated whether variables such as age, sex, socioeconomic status, and climate zone may explain the observed heterogeneity. The keyword search yielded 4560 citations from which we identified 53 high temperatures/heatwaves studies that comprised over 1.7 million mental health-related mortality and 1.9 million morbidity cases in total. Our findings suggest associations between heat exposures and a range of mental health-related outcomes. Regarding high temperatures, our meta-analysis of study findings showed that for each 1 °C increase in temperature, the mental health-related mortality and morbidity increased with a RR of 1.022 (95%CI: 1.015–1.029) and 1.009 (95%CI: 1.007–1.015), respectively. The greatest mortality risk was attributed to substance-related mental disorders (RR, 1.046; 95%CI: 0.991–1.101), followed by organic mental disorders (RR, 1.033; 95%CI: 1.020–1.046). A 1 °C temperature rise was also associated with a significant increase in morbidity such as mood disorders, organic mental disorders, schizophrenia, neurotic and anxiety disorders. Findings suggest evidence of vulnerability for populations living in tropical and subtropical climate zones, and for people aged more than 65 years. There were significant moderate and high heterogeneities between effect estimates in overall mortality and morbidity categories, respectively. Lower heterogeneity was noted in some subgroups. The magnitude of the effect estimates for heatwaves varied depending on definitions used. The highest effect estimates for mental health-related morbidity was observed when heatwaves were defined as "mean temperature ≥90th percentile for ≥3 days" (RR, 1.753; 95%CI: 0.567–5.421), and a significant effect was also observed when the definition was "mean temperature ≥95th percentile for ≥3 days", with a RR of 1.064 (95%CI: 1.006–1.123). Our findings support the hypothesis of a positive association between elevated ambient temperatures and/or heatwaves and adverse mental health outcomes. This problem will likely increase with a warming climate, especially in the context of climate change. Further high-quality studies are needed to identify modifying factors of heat impacts. [ABSTRACT FROM AUTHOR]

Published
2021
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7. Infectious Diseases, Urbanization and Climate Change: Challenges in Future China

Author

Gil-Soo Han, Michael Xiaoliang Tong, Philip Weinstein, Qiyong Liu, Alana Hansen, Jianjun Xiang, Yehuan Sun, Peng Bi, Scott J. Cameron, Craig R. Williams, Scott Hanson-Easey, Tong, Michael Xiaoliang, Hansen, Alana, Hanson-Easey, Scott, Cameron, Scott, Xiang, Jianjun, Liu, Qiyong, Sun, Yehuan, Weinstein, Philip, Han, Gil-Soo, Williams, Craig, and Bi, Peng

Subjects
China, medicine.medical_specialty, infectious disease, Health, Toxicology and Mutagenesis, Population, lcsh:Medicine, urbanization, challenges, Population health, Communicable Diseases, Communicable Diseases, Emerging, Disease Outbreaks, Environmental protection, Urbanization, Development economics, medicine, Humans, Population growth, Population Growth, education, disease control and prevention, education.field_of_study, Disease surveillance, business.industry, Public health, lcsh:R, Public Health, Environmental and Occupational Health, Outbreak, climate change, Infectious disease (medical specialty), Epidemiological Monitoring, Commentary, Public Health, disease surveillance, business
Abstract

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

Published
2015
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8. Perceptions of malaria control and prevention in an era of climate change: a cross-sectional survey among CDC staff in China

Author

Jianjun Xiang, Xiaobo Liu, Scott J. Cameron, Michael Xiaoliang Tong, Alana Hansen, Gil-Soo Han, Scott Hanson-Easey, Peng Bi, Qiyong Liu, Craig R. Williams, Philip Weinstein, Yehuan Sun, Tong, Michael Xiaoliang, Hansen, Alana, Hanson-Easey, Scott, Cameron, Scott, Xiang, Jianjun, Liu, Qiyong, Liu, Xiaobo, Sun, Yehuan, Weinstein, Philip, Han, Gil-Soo, Williams, Craig, and Bi, Peng

Subjects
Male, Veterinary medicine, Health Knowledge, Attitudes, Practice, Capacity building, perception, infectious diseases, 0302 clinical medicine, Government Agencies, Surveys and Questionnaires, 030212 general & internal medicine, imported cases, capacity building, Middle Aged, climate change, Community health, Infectious diseases, Female, Adult, medicine.medical_specialty, China, lcsh:Arctic medicine. Tropical medicine, lcsh:RC955-962, Attitude of Health Personnel, Climate Change, Health Personnel, 030231 tropical medicine, Climate change, Population health, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, Young Adult, Environmental health, parasitic diseases, medicine, Disease Transmission, Infectious, Humans, lcsh:RC109-216, business.industry, Imported cases, Public health, Research, Outbreak, medicine.disease, Malaria, Cross-Sectional Studies, Communicable Disease Control, Parasitology, Perception, sense organs, business, Climate change in China
Abstract

Background Though there was the significant decrease in the incidence of malaria in central and southwest China during the 1980s and 1990s, there has been a re-emergence of malaria since 2000. Methods A cross-sectional survey was conducted amongst the staff of eleven Centers for Disease Control and Prevention (CDC) in China to gauge their perceptions regarding the impacts of climate change on malaria transmission and its control and prevention. Descriptive analysis was performed to study CDC staff’s knowledge, attitudes, perceptions and suggestions for malaria control in the face of climate change. Results A majority (79.8%) of CDC staff were concerned about climate change and 79.7% believed the weather was becoming warmer. Most participants (90.3%) indicated climate change had a negative effect on population health, 92.6 and 86.8% considered that increasing temperatures and precipitation would influence the transmission of vector-borne diseases including malaria. About half (50.9%) of the surveyed staff indicated malaria had re-emerged in recent years, and some outbreaks were occurring in new geographic areas. The main reasons for such re-emergence were perceived to be: mosquitoes in high-density, numerous imported cases, climate change, poor environmental conditions, internal migrant populations, and lack of health awareness. Conclusions This study found most CDC staff endorsed the statement that climate change had a negative impact on infectious disease transmission. Malaria had re-emerged in some areas of China, and most of the staff believed that this can be managed. However, high densities of mosquitoes and the continuous increase in imported cases of malaria in local areas, together with environmental changes are bringing about critical challenges to malaria control in China. This study contributes to an understanding of climate change related perceptions of malaria control and prevention amongst CDC staff. It may help to formulate in-house training guidelines, community health promotion programmes and policies to improve the capacity of malaria control and prevention in the face of climate change in China. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1790-3) contains supplementary material, which is available to authorized users.

Published
2017

9. Perceptions of capacity for infectious disease control and prevention to meet the challenges of dengue fever in the face of climate change: A survey among CDC staff in Guangdong Province, China

Author

Peng Bi, Michael Xiaoliang Tong, Jianjun Xiang, Qiyong Liu, Craig R. Williams, Alana Hansen, Scott Hanson-Easey, Scott J. Cameron, Yehuan Sun, Philip Weinstein, Xiaobo Liu, Gil-Soo Han, Tong, Michael Xiaoliang, Hansen, Alana, Hanson-Easey, Scott, Xiang, Jianjun, Cameron, Scott, Liu, Qiyong, Liu, Xiaobo, Sun, Yehuan, Weinstein, Philip, Han, Gil-Soo, Williams, Craig, and Bi, Peng

Subjects
Adult, Male, medicine.medical_specialty, Veterinary medicine, China, Climate Change, Health Personnel, 030231 tropical medicine, Population, Population health, Disease, Biochemistry, Communicable Diseases, Dengue fever, Dengue, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Government Agencies, Environmental health, Surveys and Questionnaires, medicine, dengue fever, Humans, 030212 general & internal medicine, education, General Environmental Science, education.field_of_study, business.industry, Public health, capacity building, Outbreak, Middle Aged, medicine.disease, Health promotion, climate change, Infectious disease (medical specialty), Communicable Disease Control, Female, Perception, business, infectious disease control and prevention
Abstract

Background: Dengue fever is an important climate-sensitive mosquito-borne viral disease that poses a risk to half the world's population. The disease is a major public health issue in China where in 2014 a major outbreak occurred in Guangdong Province. This study aims to gauge health professionals'; perceptions about the capacity of infectious disease control and prevention to meet the challenge of dengue fever in the face of climate change in Guangdong Province, China. Methods: A cross-sectional questionnaire survey was administered among staff in the Centers for Disease Control and Prevention (CDCs) in Guangdong Province. Data analysis was undertaken using descriptive methods and logistic regression. Results: In total, 260 questionnaires were completed. Most participants (80.7%) thought climate change would have a negative effect on population health, and 98.4% of participants reported dengue fever had emerged or re-emerged in China in recent years. Additionally, 74.9% of them indicated that the capability of the CDCs to detect infectious disease outbreak/epidemic at an early stage was excellent; 86.3% indicated laboratories could provide diagnostic support rapidly; and 83.1% believed levels of current staff would be adequate in the event of a major outbreak. Logistic regression analysis showed higher levels of CDCs were perceived to have better capacity for infectious disease control and prevention. Only 26.8% of participants thought they had a good understanding of climate change, and most (85.4%) thought they needed more information about the health impacts of climate change. Most surveyed staff suggested the following strategies to curb the public health impact of infectious diseases in relation to climate change: primary prevention measures, strengthening the monitoring of infectious diseases, the ability to actively forecast disease outbreaks by early warning systems, and more funding for public health education programs. Conclusion: Vigilant disease and vector surveillance, preventive practice and health promotion programs will likely be significant in addressing the threat of dengue fever in the future. Further efforts are needed to strengthen the awareness of climate change among health professionals, and to promote relevant actions to minimize the health burden of infectious diseases in a changing climate. Results will be critical for policy makers facing the current and future challenges associated with infectious disease prevention and control in China. Refereed/Peer-reviewed

Published
2015

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