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Background Ross River virus (RRV) disease is Australia's most widespread vector-borne disease causing significant public health concern. The aim of this study was to identify the ecological covariates of RRV risk and to develop epidemic forecasting models in a disease hotspot region of South Australia. Methods Seasonal autoregressive integrated moving average models were used to predict the incidence of RRV disease in the Riverland region of South Australia, an area known to have a high incidence of the disease. The model was developed using data from January 2000 to December 2012 then validated using disease notification data on reported cases for the following year. Results Monthly numbers of the mosquito Culex annulirostris (β=0.033, p<0.001) and total rainfall (β=0.263, p=0.002) were significant predictors of RRV transmission in the study region. The forecasted RRV incidence in the predictive model was generally consistent with the actual number of cases in the study area. Conclusions A predictive model has been shown to be useful in forecasting the occurrence of RRV disease, with increased vector populations and rainfall being important factors associated with transmission. This approach may be useful in a public health context by providing early warning of vector-borne diseases in other settings. [ABSTRACT FROM AUTHOR]

Background: Extremely high temperatures over many consecutive days have been linked to an increase in renal disease in several cities. This is becoming increasingly relevant with heatwaves becoming longer, more intense, and more frequent with climate change. This study aimed to extend the known relationship between daily temperature and kidney disease to include the incidence of eight temperature-prone specific renal disease categories - total renal disease, urolithiasis, renal failure, acute kidney injury (AKI), chronic kidney disease (CKD), urinary tract infections (UTIs), lower urinary tract infections (LUTIs) and pyelonephritis.Methods: Daily data was acquired for maximum, minimum and average temperature over the period of 1 July 2003 to 31 March 2014 during the warm season (October to March) in Adelaide, South Australia. Data for daily admissions to all metropolitan hospitals for renal disease, including 83,519 emergency department admissions and 42,957 inpatient admissions, was also obtained. Renal outcomes were analyzed using time-stratified negative binomial regression models, with the results aggregated by day. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated for associations between the number of admissions and daily temperature.Results: Increases in daily temperature per 1 °C were associated with an increased incidence for all renal disease categories except for pyelonephritis. Minimum temperature was associated with the greatest increase in renal disease followed by average temperature and then maximum temperature. A 1°C increase in daily minimum temperature was associated with an increase in daily emergency department admissions for AKI (IRR 1.037, 95% CI: 1.026-1.048), renal failure (IRR 1.030, 95% CI: 1.022-1.039), CKD (IRR 1.017, 95% CI: 1.001-1.033) urolithiasis (IRR 1.015, 95% CI: 1.010-1.020), total renal disease (IRR 1.009, 95% CI: 1.006-1.011), UTIs (IRR 1.004, 95% CI: 1.000-1.007) and LUTIs (IRR 1.003, 95% CI: 1.000-1.006).Conclusions: An increased frequency of renal disease, including urolithiasis, acute kidney injury and urinary tract infections, is predicted with increasing temperatures from climate change. These results have clinical and public health implications for the management of renal diseases and demand tailored health services. Future research is warranted to analyze individual renal diseases with more comprehensive information regarding renal risk factors, and studies examining mortality for specific renal diseases. [ABSTRACT FROM AUTHOR]

Increasing the frequency of HIV testing is crucial for effective HIV prevention and care. The aim of the present study was to determine whether there has been a change in HIV testing among men who have sex with men (MSM) at the South Australia Specialist Sexual Health (SASSH) clinic over the past two decades.Methods: Computerised medical records of MSM who attended the SASSH at their first visit between 1994 and 2015 were used to determine whether HIV testing had changed among MSM. First HIV tests in each calendar year and return tests within 12 months were analysed. Factors associated with recent HIV testing were also examined.Results: There were 24036 HIV tests conducted among 8163 individual MSM over the study period. The proportion of newly registered MSM who reported ever being tested for HIV declined (Ptrend=0.030), the proportion who reported recent HIV testing did not change (Ptrend=0.955) and the proportion who have had current HIV testing increased (Ptrend=0.008). The proportion of MSM who returned to the clinic for HIV testing within 12 months did not change (Ptrend >0.05), with less than 40% of MSM returning for HIV testing. Factors independently associated with recent HIV testing included MSM aged ≥20 years, (odds ratio (OR) 1.79; 95% confidence interval (CI) 1.53-2.10), higher education (OR 1.28; 95% CI 1.12-1.45), non-Caucasian (African OR 1.68; 95% CI 1.30-2.17), having multiple sex partners (OR 1.47; 95% CI 1.29-1.69), having had sex interstate (OR 1.61; 95% CI 1.42-1.82) or overseas (OR 1.53; 95% CI 1.33-1.76) and injecting drug use (OR 1.56; 95% CI 1.29-1.88).Conclusions: HIV testing rate among MSM attending SASSH was suboptimal. New approaches are needed to increase the uptake and early detection of HIV infection among the high-priority MSM population. [ABSTRACT FROM AUTHOR]

Exposure to extreme heat is a familiar seasonal experience for many rural communities across Australia, which is projected to increase in frequency and intensity with climate change. This has wide-ranging implications for community health and well-being, livelihoods, recreation, and the natural and built environments. In this study, we have examined how rural and remote communities in South Australia experience and respond to extreme heat, and how this is influenced by physical, social and psychological aspects of place. Interviews with participants across different climatic regions of South Australia were analysed using a broad thematic framework that included physical aspects of place, human activities, social and community aspects, and relationships with place; providing a descriptive account of heat impacts and responses. We further suggest that some narratives expressed the construction of a rural or remote identity, with climate being a part of this relationship; suggesting that place identity may be a subjective aspect underpinning appraisals of extreme heat. We discuss the implications for adaptation choices in a warming climate. [ABSTRACT FROM AUTHOR]

Background: Occupational exposure to extreme heat without sufficient protection may not only increase the risk of heat-related illnesses and injuries but also compromise economic productivity. With predictions of more frequent and intense bouts of hot weather, workplace heat exposure is presenting a growing challenge to workers' health and safety. This study aims to investigate workers' perceptions and behavioural responses towards extreme heat exposure in a warming climate.Methods: A cross-sectional questionnaire survey was conducted in 2012 in South Australia among selected outdoor industries. Workers' heat risk perceptions were measured in the following five aspects: concerns about heat exposure, attitudes towards more training, policy and guideline support, the adjustment of work habits, and degree of satisfaction of current preventive measures. Bivariate and multivariate logistic regression analyses were used to identify factors significantly associated with workers' heat perceptions.Results: A total of 749 respondents participated in this survey, with a response rate of 50.9 %. A little more than half (51.2 %) of respondents were moderately or very much concerned about workplace heat exposure. Factors associated with workers' heat concerns included age, undertaking very physically demanding work, and the use of personal protective equipment, heat illness history, and injury experience during hot weather. Less than half (43.4 %) of the respondents had received heat-related training. Workers aged 25-54 years and those with previous heat-related illness/injury history showed more supportive attitudes towards heat-related training. The provision of cool drinking water was the most common heat prevention measure. A little more than half (51.4 %) of respondents were satisfied with the current heat prevention measures. About two-thirds (63.8 %) of respondents agreed that there should be more heat-related regulations and guidelines for working during very hot weather. More than two-thirds (68.8 %) of the respondents were willing to adjust their current work habits to adapt to the likely increasing extreme heat, especially those with previous heat illness experience.Conclusions: The findings suggest a need to strengthen workers' heat risk awareness and refine current heat prevention strategies in a warming climate. Further heat educational programmes and training should focus on those undertaking physically demanding work outdoors, in particular young workers and those over 55 years with low education levels. [ABSTRACT FROM AUTHOR]

Aim: A major heatwave occurred in Australia in early 2009 with considerable and varied health impacts in South Australia (SA) and Victoria. The aim of this study was to investigate the heat-adaptive behaviours of older people in these states. Methods: A computer-assisted telephone survey of 1000 residents of SA and Victoria aged 65 years or older was conducted at the end of summer 2010-2011. Results: The majority of respondents reported undertaking heat-adaptive behaviours. In SA, there was a significantly higher proportion of households with air conditioning compared to Victoria, and a higher recall of heat-health messages. In both states, self-reported morbidity during heatwaves was higher in women, persons with poorer health and those with cardiovascular conditions. Conclusion: An increase in global temperatures in conjunction with an ageing population is a concern for public health. Our findings suggest acclimatisation to hot weather may influence behaviours and health outcomes in older people. [ABSTRACT FROM AUTHOR]

Background: A review of historical trends in gonococcal diagnoses made at the Adelaide Sexual Health Clinic (ASHC), South Australia, identified a substantial rise in diagnoses among heterosexuals between 2006 and 2010. Sex work is illegal in South Australia, regulated in Victoria and legal in New South Wales. This and other factors that could have influenced the epidemic were explored in this analysis.Methods: Retrospective analyses of gonorrhoea diagnoses made by sexual health services between 1990 and 2012 in three Australian state capitals, Melbourne (Victoria) and Sydney (New South Wales) were undertaken.Results: At the ASHC the proportion of gonorrhoea diagnoses was higher between 2006 and 2010 among heterosexual men (5.34% vs 0.84%, p<0.001), non-sex worker women (0.64% vs 0.28%, p<0.001) and female sex workers (FSWs) (1.75% vs 0.24%, p<0.001) compared with other years. This relationship was not seen at the Melbourne Sexual Health Clinic and corresponding data from the Sydney Sexual Health Centre showed that FSWs were less likely to have gonorrhoea between 2006 and 2010 than the other groups (p=0.746, p=0.522, p=0.024, respectively). At ASHC FSWs were significantly more likely to be diagnosed between 2006 and 2010 (OR 2.8, 95% CI 1.48 to 5.27, p=0.002). Charges against sex workers peaked in 2007/2008.Conclusions: A substantial, self-limiting rise in diagnoses of heterosexual gonorrhoea was seen in Adelaide FSWs between 2006 and 2010. Removing barriers to condom use is vital to the prevention of HIV and STI transmission. [ABSTRACT FROM AUTHOR]

Summary: Objectives: To determine entry antibody seroprevalence and seroconversion to hepatitis C virus (HCV) and associated risk factors in newly incarcerated prisoners. Methods: Males and females entering South Australian prisons completed risk factor surveys and were offered HCV-antibody testing. Participants completed additional surveys and, if HCV-negative at last test, underwent further antibody tests at 3-monthly intervals for up to 15 months. Data were analyzed using univariate and multivariate techniques. Results: HCV seroprevalence among 662 prison entrants was estimated at 42%. Previous injecting history was highly prevalent at entry (64%) and both community and prison injecting independently predicted entry HCV status. Tattooing was not an important risk factor. While community exposure could not be ruled out, three seroconversions were noted in 148 initially HCV-seronegative individuals occurring in a median 121 days – 4.6 per 100 person-years. Prison injecting was infrequently reported, but HCV-seropositive participants were significantly more likely to commence IDU in prison than seronegative participants (p =0.035). Conclusions: Entry HCV seroprevalence in South Australian prisoners is extremely high and may have contributed to a ‘ceiling effect’, minimizing the observable seroconversion rate. Greater frequency of injecting among those already infected with HCV represents a significant threat to other prisoners and prison staff. [Copyright &y& Elsevier]

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]

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]

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., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

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.)

Background: A growing number of studies have investigated the effect of increasing temperatures on morbidity and health service use. However, there is a lack of studies investigating the temperature-attributable cost burden., Objectives: This study examines the relationship of daily mean temperature with hospital admissions, length of hospital stay (LoS), and costs; and estimates the baseline temperature-attributable hospital admissions, and costs and in relation to warmer climate scenarios in Adelaide, South Australia., Method: A daily time series analysis using distributed lag non-linear models (DLNM) was used to explore exposure-response relationships and to estimate the aggregated burden of hospital admissions for conditions associated with temperatures (i.e. renal diseases, mental health, diabetes, ischaemic heart diseases and heat-related illnesses) as well as the associated LoS and costs, for the baseline period (2010-2015) and different future climate scenarios in Adelaide, South Australia., Results: During the six-year baseline period, the overall temperature-attributable hospital admissions, LoS, and associated costs were estimated to be 3915 cases (95% empirical confidence interval (eCI): 235, 7295), 99,766 days (95% eCI: 14,484, 168,457), and AU$159 million (95% eCI: 18.8, 269.0), respectively. A climate scenario consistent with RCP8.5 emissions, and including projected demographic change, is estimated to lead to increases in heat-attributable hospital admissions, LoS, and costs of 2.2% (95% eCI: 0.5, 3.9), 8.4% (95% eCI: 1.1, 14.3), and 7.7% (95% eCI: 0.3, 13.3), respectively by mid-century., Conclusions: There is already a substantial temperature-attributable impact on hospital admissions, LoS, and costs which are estimated to increase due to climate change and an increasing aged population. Unless effective climate and public health interventions are put into action, the costs of treating temperature-related admissions will be high., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction: Ross River virus (RRV) disease is Australia's most common arthropod-borne disease which has an important impact on population health and productivity. The aim of this study was to identify the spatial and temporal distribution of RRV notifications during 2000-2013 in South Australia (SA)., Methods: The epidemiologic patterns of RRV notifications in SA from January 2000 to December 2013 were examined at a statistical local area (SLA) level. Spatial-temporal analyses were conducted using patient-reported place of exposure to characterise the recurrence of RRV infection stratified by age and sex., Results: During the study period, a total of 3,687 RRV disease notifications were recorded in the state with state-wide mean annual rates of 16.8 cases per 100,000 persons and a 1:1.32 male:female ratio. The SLAs reporting cases of RRV disease exhibited spatial and temporal variation. Notified cases of RRV disease occurred more frequently in summer and autumn. A geographic expansion was observed of the area within which RRV cases occur. The comparison of age- and sex-standardised incidence rates, calculated by place of residence and patient-reported place of exposure, highlights the importance of using the latter to accurately display geospatial disease trends over time. Areas with the largest proportion of visitor cases and having the highest risk were mostly along the River Murray, which provides many vector mosquito habitats., Conclusion: Although public health interventions should be considered in all SLAs where RRV occurs, we suggest that priority should be given to the Riverland areas identified as highest risk., (© Commonwealth of Australia CC BY-NC-ND.)

Background: The burden of Q fever on at risk population groups in Australia is substantial, despite the availability of a vaccine. Our objectives were to: (a) describe the epidemiology of notified Q fever cases in South Australia (SA), (b) identify if Q fever infection is associated with occupational exposure, and (c) detect the possible spatial and temporal association of Q fever with livestock density., Methods: Laboratory confirmed Q fever notifications from January 2007 to December 2017 were obtained from the SA Health Department. Q fever notification rates and incidence rate ratios were calculated for gender, notification year, age group, occupation category, and primary exposure suburb. Spatial mapping and analysis of Q fever notifications was undertaken using livestock data, and abattoirs and saleyards located in SA., Results: During the study period 167 Q fever cases were notified. Males predominated (72%), with higher rates observed in the 21-40year age group (1.52/100,000), and eight cases (5%) reported prior Q fever vaccination. Most frequently listed occupation categories were livestock farmers (35%), and abattoir workers (20%), but in 15% of cases, there was no known occupational risk. Highest notifications (22%) were recorded in the suburb containing an abattoir. The number of goats, cattle and sheep was not associated with Q fever notifications., Conclusions: Q fever predominance among males in their twenties and thirties may indicate vaccination under-coverage among the young workforce possibly due to high turnover of workers. Q fever among those vaccinated raises concerns about vaccine efficacy or potential waning immunity. Our findings are consistent with previous studies highlighting abattoir workers as a high-risk occupational group because of its transient workforce, and low vaccination coverage. Q fever notifications in SA may be unrelated with spatial livestock density. Further One Health research involving veterinary, public health and environmental data is required., (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

To characterise the burden of work-related injuries in South Australia, workers' compensation claim data were obtained from SafeWork South Australia between 2000 and 2014. Descriptive analyses were performed to investigate the burden of work-related injuries by age, gender, occupation, industry, and nature and mechanism of injury. Dunn's test was used to compare the injury costs and working days lost by industry and occupation. Ordinary linear regression was used to investigate the age-injury cost association. A total of 464,139 workers' compensation claims were reported during the 15-year period in South Australia, with an overall rate of 4.6 claims per 100 employees, resulting in a total of 20,861,001 working days lost and AU$14.9 billion dollars of compensation payment. Between 2000 to 2014, the annual claim rates, compensation payments, working days lost, and number of work-related death reduced by 59.3, 73.8, 87.1, and 78.6 percent, respectively, while the median compensation payment increased by 67.3% from AU$968 to AU$1620. A 1-year increase in age was associated with a 2.1% (Rate Ratio, RR = 1.021, 95% CI: 1.020-1.022) increase in compensation costs and a 1.3% (RR = 1.013, 95% CI: 1.012-1.020) increase in working days lost. Work-related injury rates are declining in most sectors, however some workers, especially young male technicians and labourers in the community services industry, remain at higher risk. Challenges for workers' health and safety include the aging labour force, vehicle incidents, and severe injuries among new and foreign-born workers., Competing Interests: The authors declare no conflict of interest.

The excess heat factor (EHF) is being adopted nationally for heatwave forecasting in Australia, but there is limited research utilizing it as a predictor for heat-related morbidity from diseases of the urinary system (urinary diseases). In this study, the incidence of eight temperature-prone specific urinary disease categories was analyzed in relation to the EHF. Daily data for maximum and minimum temperature and data for metropolitan hospital emergency department presentations and inpatient admissions for urinary disease were acquired in Adelaide, South Australia, from 1 July 2003 to 31 March 2014. An increased incidence for urolithiasis, acute kidney injury (AKI), chronic kidney disease, and lower urinary tract infections was associated with the EHF. Using the Australian national heatwave definition with the EHF, emergency department presentations increased on heatwave days compared to non-heatwave days for total urinary disease (IRR 1.046, 95% CI 1.016-1.076), urolithiasis (IRR 1.106, 95% 1.046-1.169), and acute kidney injury (AKI) (IRR 1.416, 95% CI 1.258-1.594). Likewise, inpatient admissions increased for total urinary disease (IRR 1.090, 95% CI 1.048-1.133) and AKI (IRR 1.335, 95% CI 1.204-1.480). The EHF is a reliable metric for predicting heat-induced morbidity from urinary disease. Climate change-related elevations in temperature can increase morbidity from urinary disease, especially AKI and urolithiasis. Diseases of the urinary system should be highlighted when providing public health guidance during heatwaves indicated by the EHF.

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., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To investigate the profile of occupational heat-induced illness costs in South Australia and to examine the association with high temperature., Methods: Workers' compensation claim data were used to quantify the associations between maximum temperature (Tmax) and occupational heat illness (OHI)-related costs, using time-series analysis after controlling for confounding factors., Results: Four hundred thirty-eight OHI claims in 2000 to 2014 resulted in total medical costs of AU$6,002,840 and 5,036 work days lost. Relatively higher OHI burdens were found in men, those aged 25 to 44 years, new workers, medium-size businesses, and those employed in the mining industry. A 1 °C increase in Tmax above about 33 °C was associated with a 41.6% increase in medical costs and a 74.8% increase in days lost due to OHI, respectively., Conclusions: The cost profile of OHI may be used to justify interventions for particular industries, occupations, and worker categories.

Increasing the frequency of HIV testing is crucial for effective HIV prevention and care. The aim of the present study was to determine whether there has been a change in HIV testing among men who have sex with men (MSM) at the South Australia Specialist Sexual Health (SASSH) clinic over the past two decades., Methods: Computerised medical records of MSM who attended the SASSH at their first visit between 1994 and 2015 were used to determine whether HIV testing had changed among MSM. First HIV tests in each calendar year and return tests within 12 months were analysed. Factors associated with recent HIV testing were also examined., Results: There were 24036 HIV tests conducted among 8163 individual MSM over the study period. The proportion of newly registered MSM who reported ever being tested for HIV declined (P trend =0.030), the proportion who reported recent HIV testing did not change (P trend =0.955) and the proportion who have had current HIV testing increased (P trend =0.008). The proportion of MSM who returned to the clinic for HIV testing within 12 months did not change (P trend >0.05), with less than 40% of MSM returning for HIV testing. Factors independently associated with recent HIV testing included MSM aged ≥20 years, (odds ratio (OR) 1.79; 95% confidence interval (CI) 1.53-2.10), higher education (OR 1.28; 95% CI 1.12-1.45), non-Caucasian (African OR 1.68; 95% CI 1.30-2.17), having multiple sex partners (OR 1.47; 95% CI 1.29-1.69), having had sex interstate (OR 1.61; 95% CI 1.42-1.82) or overseas (OR 1.53; 95% CI 1.33-1.76) and injecting drug use (OR 1.56; 95% CI 1.29-1.88)., Conclusions: HIV testing rate among MSM attending SASSH was suboptimal. New approaches are needed to increase the uptake and early detection of HIV infection among the high-priority MSM population.

Background: Heatwave warning systems aim to assist in reducing health effects during extreme heat. Evaluations of such systems have been limited. This study explored the effect of a heatwave warning programme on morbidity and mortality in Adelaide, South Australia, by comparing extreme events in 2009 and 2014, the latter with exposure to the preventive programme., Methods: The health outcomes during the two heatwaves were compared using the incidence rate ratios (IRRs) of daily ambulance call-outs, emergency presentations and mortality data during the heatwaves compared with non-heatwave periods during the warm seasons. Excess or reduced numbers of cases were calculated and the differences in cases between the two heatwaves were estimated., Results: IRRs for total ambulance call-outs and emergency presentations were lower during the 2014 heatwaves compared with the 2009 event. The estimated differences in health-specific outcomes between 2009 and 2014 were statistically significant with 207 (59%) for cardiac-related call-outs, 134 (30%) for renal and 145 (56%) for heat-related emergency presentations. Mortality was not reduced in 2014. There were an estimated 34.5 excess deaths in 2009 and 38.2 in 2014., Conclusions: Morbidity outcomes were reduced significantly during the 2014 event. The fact that cardiac, renal and heat-related diagnoses were significantly reduced is likely to be associated with the intervention in 2014, which comprised a public warning through media and intense preventive measures directed to individual populations at risk. Further analysis of risk factors of mortality during heatwaves should be explored., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objectives: This study aims to examine the epidemiological characteristics of occupational heat illnesses in South Australia, to quantify the association between ambient temperature and occupational heat illnesses, and to investigate the impact of heatwaves on occupational heat illnesses., Methods: Workers' compensation claims data and weather data were obtained from SafeWork South Australia and the Bureau of Meteorology, respectively, for 2001-2010. Time series analysis with generalised estimation equation models and linear spline functions was used to quantify the temperature-heat illness claims association. A case-crossover design was applied to investigate the impact of heatwaves on occupational heat illnesses., Results: There were 306 heat illness claims during the study period, with an incidence rate of 4.5 per 100,000 employees. The overall risk of occupational heat illness was positively associated with maximum temperature (Tmax), especially when Tmax was over the threshold of 35.5 °C. One degree increase of Tmax was associated with a 12.7% (incidence rate ratio 1.127, 95% CI 1.067 to 1.190) increase of occupational heat illness claims. During heatwave periods, the risk of occupational heat illness was about 4-7 times higher than that of non-heatwave periods., Conclusions: There is a need to develop or refine current heat-related regulations and guidelines to minimise the risk of occupational heat illnesses in vulnerable workers in a warming climate., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

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., (Copyright © 2014 Elsevier Inc. All rights reserved.)

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

Older people had a high incidence of hospitalisation during the 2009 heat wave in South Australia. We sought to explore resilience, behaviours, health risk factors and health outcomes during recent heat waves for a representative sample of independently living residents. A telephone survey of 499 people aged 65 years and over was conducted, and included both metropolitan and rural residences. A variety of adaptive strategies were reported, with 75% maintaining regular appointments and activities during the heat. However, 74% took medication for chronic disease and 25% assessed their health status to be fair to poor. In a multivariate model, factors associated with heat health outcomes included medication for mental health, heart failure, diabetes or respiratory health, reporting a reduced health status, use of mobility aids and being female. Compared with younger participants, those over 75 had more check-up calls and visits by family, friends and neighbours. However, confidence to call on support was associated with indicators of social isolation. The study indicates that older people are generally resilient, but interventions addressing multi-morbidity and medication interactions and social isolation should be developed.

Among the challenges for rural communities and health services in Australia, climate change and increasing extreme heat are emerging as additional stressors. Effective public health responses to extreme heat require an understanding of the impact on health and well-being, and the risk or protective factors within communities. This study draws on lived experiences to explore these issues in eleven rural and remote communities across South Australia, framing these within a socio-ecological model. Semi-structured interviews with health service providers (n = 13), and a thematic analysis of these data, has identified particular challenges for rural communities and their health services during extreme heat. The findings draw attention to the social impacts of extreme heat in rural communities, the protective factors (independence, social support, education, community safety), and challenges for adaptation (vulnerabilities, infrastructure, community demographics, housing and local industries). With temperatures increasing across South Australia, there is a need for local planning and low-cost strategies to address heat-exacerbating factors in rural communities, to minimise the impact of extreme heat in the future.

Heat waves are considered a health risk and they are likely to increase in frequency, intensity and duration as a consequence of climate change. The effects of heat waves on human health could be reduced if individuals recognise the risks and adopt healthy behaviours during a heat wave. The purpose of this study was to determine the predictors of risk perception using a heat wave scenario and identify the constructs of the health belief model that could predict adaptive behaviours during a heat wave. A cross-sectional study was conducted during the summer of 2012 among a sample of persons aged between 30 to 69 years in Adelaide. Participants' perceptions were assessed using the health belief model as a conceptual frame. Their knowledge about heat waves and adaptive behaviours during heat waves was also assessed. Logistic regression analyses were performed to determine the predictors of risk perception to a heat wave scenario and adaptive behaviours during a heat wave. Of the 267 participants, about half (50.9%) had a high risk perception to heat waves while 82.8% had good adaptive behaviours during a heat wave. Multivariate models found that age was a significant predictor of risk perception. In addition, participants who were married (OR = 0.21; 95% CI, 0.07-0.62), who earned a gross annual household income of ≥$60,000 (OR = 0.41; 95% CI, 0.17-0.94) and without a fan (OR = 0.29; 95% CI, 0.11-0.79) were less likely to have a high risk perception to heat waves. Those who were living with others (OR = 2.87; 95% CI, 1.19-6.90) were more likely to have a high risk perception to heat waves. On the other hand, participants with a high perceived benefit (OR = 2.14; 95% CI, 1.00-4.58), a high "cues to action" (OR = 3.71; 95% CI, 1.63-8.43), who had additional training or education after high school (OR = 2.65; 95% CI, 1.25-5.58) and who earned a gross annual household income of ≥$60,000 (OR = 2.66; 95% CI, 1.07-6.56) were more likely to have good adaptive behaviours during a heat wave. The health belief model could be useful to guide the design and implementation of interventions to promote adaptive behaviours during heat waves.

Adelaide experienced an extreme and prolonged 13 days 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 © 2012 Elsevier B.V. All rights reserved.)

Heat waves are a public health concern in Australia and unprecedented heat waves have been recorded in Adelaide over recent years. The aim of this study was to examine the perception and attitudes towards heat waves in the context of climate change among a group of residents in Adelaide, an Australian city with a temperate climate. A cross-sectional study was conducted in the summer of 2012 among a sample of 267 residents. The results of the survey found that television (89.9%), radio (71.2%), newspapers (45.3%) were the main sources from which respondents received information about heat waves. The majority of the respondents (73.0%) followed news about heat waves very or somewhat closely. About 26.6% of the respondents were extremely or very concerned about the effects of heat waves on them personally. The main issues that were of personal concern for respondents during a heat wave were their personal comfort (60.7%), their garden (48.7%), and sleeping well (47.6%). Overall, respondents were more concerned about the impacts of heat waves to the society than on themselves. There was a significant association between gender (χ² = 21.2, df = 3, p = 0.000), gross annual household income (p = 0.03) and concern for the societal effects of heat waves. Less than half (43.2%) of the respondents believed that heat waves will extremely or very likely increase in Adelaide according to climate projections. Nearly half (49.3%) believed that the effects of heat waves were already being felt in Adelaide. These findings may inform the reframing and communication strategies for heat waves in Adelaide in the context of climate change.

Background: Continuous prevention efforts for human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) are recommended among those men who have sex with men (MSM). Creative use of e-technologies coupled with a better understanding of social networks could lead to improved health interventions among this risk population., Objective: The aims of the study were to (1) compare the impact of various advertising strategies on recruiting MSM participants to an online HIV/AIDS survey, and (2) explore the feasibility of using a social network service (SNS) for study advertising., Methods: A cross-sectional online survey was conducted in 2009. South Australian men over 18 years were invited to participate if they had had sexual intercourse with men in the previous year. A short questionnaire was used to collect demographics and information on sexual behavior, HIV history, use of the Internet for dating purposes, and sources of health information. The survey was promoted in community settings and online, including advertisements through social networks., Results: A total of 243 men completed the online survey during the 8-week data collection period. Online advertisements recruited 91.7% (220/240) of the sample. Conversely, traditional advertisements in the community recruited only 5.8% (14/240) of the sample. Ten volunteers were asked to advertise on their personal SNS application, but only 2 effectively did so. Only 18/240 (7.5%) of the respondents reported having learned of our study through the SNS application. In this sample, 19.3% (47/243) of participants had never been tested for HIV. Among the participants who had been tested, 12.8% (25/196) reported being HIV-positive. Regarding Internet use, 82.3% (200/243) of participants had dated online in the previous 6 months. Among the participants who had dated online, most (175/200, 87.5%) had found an Internet sexual partner and two-thirds (132/200, 66.0%) had had anal sex with these partner(s). Among men who had anal sex with an Internet partner, 68.2% (90/132) used a condom during sex., Conclusions: The MSM participants in this study had high-risk profiles for HIV and other sexually transmitted diseases (STDs), which highlights the need for ongoing health interventions among this group. In this study, the SNS marketing strategy did not appear to create a viral effect and it had a relatively poor yield.

The increase in the frequency of very hot weather that is a predicted consequence of climate change poses an emerging threat to public health. Extreme heat can be harmful to the health of older persons who are known to be amongst the most vulnerable in the community. This study aimed to investigate factors influencing the ability of older persons to adapt to hot conditions, and barriers to adaptation. A qualitative study was conducted in Adelaide, Australia, involving focus groups and interviews with stakeholders including key personnel involved in aged care, community services, government sectors, emergency services and policy making. Findings revealed a broad range of factors that underpin the heat-susceptibility of the aged. These were categorized into four broad themes relating to: physiology and an age-related decline in health; socioeconomic factors, particularly those influencing air conditioning use; psychological issues including fears and anxieties about extreme heat; and adaptive strategies that could be identified as both enablers and barriers. As a consequence, the ability and willingness to undertake behavior change during heatwaves can therefore be affected in older persons. Additionally, understanding the control panels on modern air conditioners can present challenges for the aged. Improving heat-health knowledge and addressing the social and economic concerns of the older population will assist in minimizing heat-related morbidity and mortality in a warming climate.

Issue Addressed: The high mortality and morbidity associated with the 2009 heat wave across South Eastern Australia highlighted the need for effective heat-related health promotion and preventive strategies. The adverse health effects of extreme heat are largely preventable, and heat-related health promotion can advise the public about the dangers of hot weather and how to reduce health risks. The South Australian State Emergency Service has outlined a co-ordinated response system in their Extreme Heat Arrangements for South Australia. This paper evaluates the health impacts at the temperature trigger levels incorporated in this plan., Methods: Heat events in Adelaide between 1994 and 2009 were compared in terms of heat duration, heat intensity and their impact on mortality and ambulance call-outs.The health impacts for events meeting specific temperature triggers were estimated., Results: Individual heat events varied in terms of estimated excess mortality and ambulance call-outs. Increased mortality was associated with heat events of 3 or more consecutive days with maximum temperature (T(max)) > or = 43 degrees C or average daily temperature (ADT) > or = 34 degrees C, while ambulance call-outs increased significantly at lower T(max) levels.The two events reaching the temperature triggers for an extreme heat warning were associated with a 44% (95% CI 26-63%) increase in mortality., Conclusions: The results support the temperature trigger for an extreme heat warning within the Extreme Heat Arrangements for Adelaide, and indicate a limited health impact at lower temperature triggers.

This is the first study to identify appropriate regression models for the association between climate variation and salmonellosis transmission. A comparison between different regression models was conducted using surveillance data in Adelaide, South Australia. By using notified salmonellosis cases and climatic variables from the Adelaide metropolitan area over the period 1990-2003, four regression methods were examined: standard Poisson regression, autoregressive adjusted Poisson regression, multiple linear regression, and a seasonal autoregressive integrated moving average (SARIMA) model. Notified salmonellosis cases in 2004 were used to test the forecasting ability of the four models. Parameter estimation, goodness-of-fit and forecasting ability of the four regression models were compared. Temperatures occurring 2 weeks prior to cases were positively associated with cases of salmonellosis. Rainfall was also inversely related to the number of cases. The comparison of the goodness-of-fit and forecasting ability suggest that the SARIMA model is better than the other three regression models. Temperature and rainfall may be used as climatic predictors of salmonellosis cases in regions with climatic characteristics similar to those of Adelaide. The SARIMA model could, thus, be adopted to quantify the relationship between climate variations and salmonellosis transmission.

Objective: To investigate morbidity and mortality associated with heatwaves in metropolitan Adelaide using ambulance, hospital admission, and mortality data., Design, Participants and Setting: Case-series study comparing health risks in the Adelaide metropolitan population during heatwaves and non-heatwave periods., Main Outcome Measures: Daily observations for ambulance transports (1993-2006), hospital admissions (1993-2006), and mortality (1993-2004), categorised using International classification of diseases (ninth and tenth revisions) codes for the relevant disease groups., Results: During heatwaves, total ambulance transport increased by 4% (95% CI, 1%-7%), including significant assault-related increases for people aged 15-64 years. Reductions were observed in relation to cardiac, sports- and falls-related events. Total hospital admissions increased by 7% (95% CI, - 1% to 16%). Total mental health admissions increased by 7% (95% CI, 1%-13%), and total renal admissions by 13% (95% CI, 3%-25%). Ischaemic heart disease admissions increased by 8% (95% CI, 1%-15%) among people aged 65-74 years. Total mortality, disease- and age-specific mortality did not increase, apart from a small increase in mental health-related mortality in people aged 65-74 years. Significant decreases were observed in cardiovascular-related mortality., Conclusion: In contrast to evidence from extreme heatwaves in the northern hemisphere, we found no excess mortality during heatwaves in metropolitan Adelaide, perhaps because of adaptive behaviour to regular hot weather spells. Projected temperature increases and evidence of modest increases in morbidity during heatwaves indicate the need for a heatwave response plan for Adelaide.

Ross River virus (RRV) disease is the most frequently notified arboviral disease in Australia, and the burden of this disease to Australian society is significant. We have studied the incidence of RRV disease between 1992 and 2003 in South Australia. Our findings suggest that the incidence of the disease in South Australia over the study period was relatively stable. There were four epidemics in the study period, with the majority of cases acquired from regions along the River Murray. There was some evidence of spread of the disease to regions in which activity of RRV had not been previously recognised, such as the Mid-North and the South-East. In terms of disease distribution amongst the population, it was found that the highest rates occurred in the 30-49 year age range. There was no significant difference in disease rates between males and females. In order to facilitate further research into RRV disease transmission, we recommend that the suspected region of acquisition be a mandatory component of the national notification dataset.