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Public health risks associated with the intensification of dairy farming are an emerging concern. Dairy cattle are a reservoir for a number of pathogens that can cause human illness. This study examined the spatial distribution of dairy cattle density and explored temporal patterns of human campylobacteriosis and cryptosporidiosis notifications in New Zealand from 1997 to 2015. Maps of dairy cattle density were produced, and temporal patterns of disease rates were assessed for urban versus rural areas and for areas with different dairy cattle densities using descriptive temporal analyses. Campylobacteriosis and cryptosporidiosis rates displayed strong seasonal patterns, with highest rates in spring in rural areas and, for campylobacteriosis, summer in urban areas. Increases in rural cases often preceded increases in urban cases. Furthermore, disease rates in areas with higher dairy cattle densities tended to peak before areas with low densities or no dairy cattle. Infected dairy calves may be a direct or indirect source of campylobacteriosis or cryptosporidiosis infection in humans through environmental or occupational exposure routes, including contact with animals or feces, recreational contact with contaminated waterways, and consumption of untreated drinking water. These results have public health implications for populations living, working, or recreating in proximity to dairy farms.

Taumata Arowai, the new independent water services regulator, recently consulted publicly on the drinking water rules for water suppliers. We use a case study on nitrate and official information requests to demonstrate the current weaknesses in the drinking water monitoring and reporting systems and why the reforms proposed by Taumata Arowai seem unlikely to substantively address many of these deficiencies. To ensure sufficient public health surveillance and robust epidemiological research into the potential health impacts of drinking water contaminants, Taumata Arowai should: 1) establish a national database for water supply and quality; 2) mandate the standardisation of reporting requirements across water suppliers; 3) increase the frequency and range of water quality testing; and 4) maintain a national map of water supplies. These upgrades are particularly important in an era of rapid land use changes and climate change.

A 2016 drinking water-related campylobacteriosis outbreak in Aotearoa New Zealand made much of an entire town sick leading to reforms colloquially called "Three Waters", which aims to improve the management and delivery of waste, storm and drinking water systems. Public discourse on the Three Waters reforms has been dominated by anti-co-governance rhetoric, concerns around privatisation and loss of local control and alternative less comprehensive reform models. This debate has drowned out the fundamental problem statement justifying the reforms, that is, the management of drinking water resources is currently: 1) demonstrably inadequate to protect public health and promote health equity; and 2) economically inefficient. We discuss four areas where the proposed Three Waters reforms are likely to address current and future challenges and improve public health. We conclude by outlining four areas of remaining contention.

Background: Mortality due to enteric infections is projected to increase because of global warming; however, the different temperature sensitivities of major enteric pathogens have not yet been considered in projections on a global scale. We aimed to project global temperature-attributable enteric infection mortality under various future scenarios of sociodemographic development and climate change. Methods: In this modelling study, we generated global projections in two stages. First, we forecasted baseline mortality from ten enteropathogens (non-typhoidal salmonella, Shigella, Campylobacter, cholera, enteropathogenic Escherichia coli, enterotoxigenic E coli, typhoid, rotavirus, norovirus, and Cryptosporidium) under several future sociodemographic development and health investment scenarios (ie, pessimistic, intermediate, and optimistic). We then estimated the mortality change from baseline attributable to global warming using the product of projected annual temperature anomalies and pathogen-specific temperature sensitivities. Findings: We estimated that in the period 2080–95, the global mean number of temperature-attributable deaths due to enteric infections could be as low as 6599 (95% empirical CI 5441–7757) under the optimistic sociodemographic development and climate change scenario, or as high as 83 888 (67 760–100 015) under the pessimistic scenario. Most of the projected temperature-attributable deaths were from shigellosis, cryptosporidiosis, and typhoid fever in sub-Saharan Africa and South Asia. Considerable reductions in the number of attributable deaths were from viral infections, such as rotaviral and noroviral enteritis, which resulted in net reductions in attributable enteric infection mortality under optimistic scenarios for Latin America and the Caribbean and East Asia and the Pacific. Interpretation: Temperature-attributable mortality could increase under warmer climate and unfavourable sociodemographic conditions. Mitigation policies for limiting global warming and sociodemographic development policies for low-income and middle-income countries might help reduce mortality from enteric infections in the future. Funding: Japan Society for the Promotion of Science, Japan Science and Technology Agency, and Spanish Ministry of Economy, Industry, and Competitiveness., The Lancet Planetary Health, 5(7), pp. e436-e445; 2021

There has been no local transmission of arbovirus disease recorded in New Zealand to date. However, in the past two decades, there have been increasing numbers of overseas-acquired cases of arbovirus infections in New Zealand, mainly dengue, Zika, chikungunya and Ross River viruses. The repeated introduction of these viruses to the immunologically naïve New Zealand population through viraemic travellers represents a potential risk for local transmission by resident or new mosquito vectors. This study assessed the extent to which these imported arbovirus disease cases used the bite-avoidance measures recommended by the New Zealand Ministry of Health between 2001–2017. The majority of notified cases reported making little effort to avoid mosquito bites even during high-risk periods and outbreaks. This suggests that the infection of New Zealand travellers might be due to underestimation or unawareness of the risk of travel-related mosquito-borne diseases. New Zealand travellers to endemic or epidemic areas, mainly in the Asia-Pacific region, should be informed about ongoing risks according to season and epidemic activity at the destination and updated on the latest disease situation and new trends. This would reduce the likelihood of pathogen introduction and, therefore, local transmission of arbovirus infection in New Zealand.

Legionnaires' disease (LD) (

The Climate Change Commission's draft report and recommendations provide a pathway towards achieving the New Zealand Government's commitment to net zero emissions by 2050. However, the Commission has not adequately considered the health co-benefits of climate change mitigation. In this viewpoint, we assess how the Commission has considered health co-benefits in the key response domains. Extrapolating UK evidence to the New Zealand context suggests climate change mitigation strategies that reduce air pollution, transition the population towards plant-based diets and increase physical activity via active transport could prevent thousands of deaths per year in coming decades. Substantial health co-benefits would also arise from improved housing, cleaner water, noise reductions, afforestation and more compact cities. The Commission's draft report only briefly mentions many of these health co-benefits, and some are completely absent. We recommend the Commission's final report: (i) use health co-benefits as an explicit frame; (ii) ensure the government's Treaty of Waitangi obligations are met in all the domains covered to maximise benefits for Māori health and wellbeing; (iii) build on the successful COVID-19 response that demonstrated rapid, science-informed and vigorous government action can address major global health threats; (iv) include both public health expertise and Māori health expertise among its commissioners; (v) explain how health co-benefits are likely to generate major cost-savings to the health system.

Background Epidemiological evidence in multiple jurisdictions has shown an association between nitrate exposure in drinking water and an increased risk of colorectal cancer (CRC). Objective We aimed to review the extent of nitrate contamination in New Zealand drinking water and estimate the health and financial burden of nitrate-attributable CRC. Methods We collated data on nitrate concentrations in drinking water for an estimated 85% of the New Zealand population (∼4 million people) who were on registered supplies. We estimated nitrate levels for the remaining population (∼600,000 people) based on samples from 371 unregistered (private) supplies. We used the effective rate ratio from previous epidemiological studies to estimate CRC cases and deaths attributable to nitrate in drinking water. Results Three-quarters of New Zealanders are on water supplies with less than 1 mg/L NO3-N. The population weighted average for nitrate exposure for people on registered supplies was 0.49 mg/L NO3-N with 1.91% (95%CI 0.49, 3.30) of CRC cases attributable to nitrates. This correlates to 49.7 cases per year (95%CI 14.9, 101.5) at a cost of 21.3 million USD (95% 6.4, 43.5 million USD). When combining registered and unregistered supplies, we estimated 3.26% (95%CI 0.84, 5.57) of CRC cases were attributable to nitrates, resulting in 100 cases (95%CI 25.7, 171.3) and 41 deaths (95%CI 10.5, 69.7) at a cost of 43.2 million USD (95%CI 10.9, 73.4). Conclusion A substantial minority of New Zealanders are exposed to high or unknown levels of nitrates in their drinking water. Given the international epidemiological studies showing an association between cancer and nitrate ingestion from drinking water, this exposure may cause an important burden of preventable CRC cases, deaths, and economic costs. We consider there is sufficient evidence to justify a review of drinking water standards. Protecting public health adds to the strong environmental arguments to improve water management in New Zealand.

Heavy rainfall is associated with increased risk of waterborne disease. However, it is not known whether the risk increment differs between wet and dry regions. We examined this question in New Zealand, which has a wide geographical variation of annual rainfall totals (10th–90th percentile difference ≥3000 mm). We conducted a nested case-crossover study within a prospective child cohort (born in 2009–2010) for assessing transient health effects when modified by longitudinal exposures to rainfall. Short-term heavy rainfall effects on hospitalizations due to enteric bacterial and viral infectious causes at lag of 0–14 days were assessed using a Cox regression model adjusted for daily temperature, relative humidity and evapotranspiration. We derived quantiles of time-weighted long-term rainfall levels at the children’s homes and these were added as an interaction term to the short-term effect model. Hospitalization risks were higher two days after heavy rainfall days (hazard ratio [95% confidence interval]: 1.73 [1.10–2.70]). The lowest-observable-adverse-effect-level was detected at the 94th percentile of daily rainfall total. Hospital admissions 1–2 days after heavy rainfall increased most in locations with the lowest and highest long-term rainfall. An interaction of this kind between short-term weather and long-term climate has not been reported previously. It is relevant to climate change risk assessments given global projections of increasing intensity of precipitation, against a background of more severe, and possibly more frequent, droughts and flooding.

Legionella is a ubiquitous pathogen yet the global occurrence of legionellosis is poorly understood. To address this deficit, this paper summarises the available evidence on the seroprevalence of Legionella antibodies and explores factors that may influence seroprevalence estimates. Through a systematic review, a total of 3979 studies were identified with seroprevalence results published after 1 January 1990. We tabulated findings by World Health Organization (WHO) region, location, study period and design, composition of study population(s) for all ages in terms of exposure, sex, detection methods, IFA titre, Legionella species measured, and present seroprevalence point estimates and 95% confidence intervals. Sampled populations were classified according to income, WHO region, gender, age, occupation and publication date. We conducted a meta-analysis on these subgroups using Comprehensive Meta-Analysis 3.0 software. Heterogeneity across studies was evaluated by the Q test in conjunction with I2 statistics. Publication bias was evaluated via funnel plot and Egger’s test. Fifty-seven studies met our inclusion criteria, giving an overall estimate of seroprevalence for Legionella of 13.7% (95% CI 11.3–16.5), but with substantial heterogeneity across studies.

Strong demand for dairy products has led to a global increase in dairy production. In many parts of the world, dairy systems are undergoing rapid intensification. While increased production may contribute to food security, higher dairy stocking rates in some regions have resulted in increased pressure on natural resources with the potential to affect public health and wellbeing. The aim of this review was to identify and describe the potential health harms and benefits associated with dairy production and consumption. Electronic databases Medline, Embase, Scopus, Web of Science, PubMed, and Google Scholar were searched for published literature that investigated human health impacts of dairy production and consumption. Occupational hazards, environmental health impacts, ecosystem health impacts, foodborne hazards, and diet‐related chronic diseases were identified as potential public health hazards. Some impacts, notably climate change, extend beyond directly exposed populations. Dairy production and consumption are also associated with important health benefits through the provision of nutrients and economic opportunities. As the global dairy sector increases production, exposure to a range of hazards must be weighed with these benefits. The review of impacts presented here can provide an input into decision making about optimal levels of dairy production and consumption, local land use, and identification and management of specific hazards from this sector. Future research should consider multiple exposure routes, socioeconomic implications, and environmental factors, particularly in regions heavily dependent on dairy farming., Key Points Strong demand for dairy products has led to global growth in production through farmland expansion and more intensive farming practicesImpacts include exposure to occupational, environmental, and foodborne hazards, and diet‐related harmsThe range of harms must be weighed with benefits to food security, nutrition, livelihoods, and economic opportunities

Background Campylobacter is the leading cause of bacterial gastroenteritis worldwide, and contaminated chicken is a significant vehicle for spread of the disease. This study aimed to assess consumers’ knowledge of safe chicken handling practices and whether their expectations for food safety labelling of chicken are met, as a strategy to prevent campylobacteriosis. Methods We conducted a cross-sectional survey of 401 shoppers at supermarkets and butcheries in Wellington, New Zealand, and a systematic assessment of content and display features of chicken labels. Results While 89% of participants bought, prepared or cooked chicken, only 15% knew that most (60–90%) fresh chicken in New Zealand is contaminated by Campylobacter. Safety and correct preparation information on chicken labels, was rated ‘very necessary’ or ‘essential’ by the majority of respondents. Supermarket chicken labels scored poorly for the quality of their food safety information with an average of 1.7/5 (95% CI, 1.4–2.1) for content and 1.8/5 (95% CI, 1.6–2.0) for display. Conclusions Most consumers are unaware of the level of Campylobacter contamination on fresh chicken and there is a significant but unmet consumer demand for information on safe chicken preparation on labels. Labels on fresh chicken products are a potentially valuable but underused tool for campylobacteriosis prevention in New Zealand. Electronic supplementary material The online version of this article (10.1186/s12889-018-5322-z) contains supplementary material, which is available to authorized users.

Background Despite their currency, there is little ‘real-world’ evidence for the health co-benefits of policies to reduce carbon dioxide emissions. Objectives To explore whether increases in market petrol and diesel price have a discernible impact on ambient air pollution. Methods A causal diagram informed the analysis. Linear regression was conducted on weekly air pollutant time-series (PM10, NOx, PM2.5 and CO) for four air quality monitoring stations around New Zealand, and diesel and petrol pricing data, from 2001 to 2013. We explored the possible delayed effects of petrol and diesel price changes over 9 weeks. Flexible cubic splines were used to remove seasonal and long-term trends. Meta-analysis of results from the four stations was undertaken, as were sensitivity analyses. Results The unlagged adjusted models for each air quality station and the meta-analyses showed a modest, non-significant reduction in air pollutants (PM10, NOx, PM2.5 and CO) associated with an increase in petrol price. For example, a 1% increase in petrol price was associated with a 0.32% (−1.21 to 0.58) reduction in NOx. All confidence intervals included null. While the lagged adjusted models showed patterns suggestive of an initial drop in air pollutants after a fuel price rise, followed by a rebound increase over the nine-week period studied, the majority of estimates were non-significant. Conclusions The findings are suggestive of a short-term reduction in air pollutants associated with regular petrol or diesel fuel price rises, followed by a rebound increase. Further work could explore the specific pathways between fuel price and air pollution.

Objectives To investigate associations between long-term exposure to PM2.5, NO2, mortality and morbidity in New Zealand, a country with low levels of exposure. Design Retrospective cohort study. Setting The New Zealand resident population. Method The main analyses included all adults aged 30 years and over with complete data on covariates: N = 2,223,507. People who died, or were admitted to hospital, (2013–2016) were linked anonymously to the 2013 census, and to estimates of ambient PM2.5, and NO2 concentration. We fitted Poisson regression models of mortality and morbidity in adults (≥30) for all natural causes of death, and by sub- group of major cause. Person-time of exposure, censored at the time of death, was included as an offset. We adjusted for confounding by age, sex, ethnicity, income, education, smoking status and ambient temperature. Further analyses stratified by ethnic group, and investigated respiratory hospital admissions in children. Results There were statistically significant positive associations between pollutants and natural causes of death: RR (per 10 μg/m3) for PM2.5 1.11 (1.07 to 1.15) and for NO2 1.10 (1.07 to 1.12). For morbidity, the strongest associations were for PM2.5 and ischaemic heart disease in adults, RR: 1.29 (1.23 to 1.35) and for NO2 and asthma in children, RR: 1.18 (1.09 to 1.28). In models restricted to specific ethnic groups, we found no consistent differences in any of the associations. Conclusions The results for NO2 are higher than those published previously. Other studies have reported that the dose-response for PM2.5 may be higher at low concentrations, but less is known about NO2. It is possible NO2 is acting as a proxy for other traffic-related pollutants that are causally related to health impacts. This study underlines the importance of controlling pollution caused by motor vehicles.

Due to the COVID-19 outbreak, the Chinese government implemented nationwide traffic restrictions and self-quarantine measures from January 23 to April 8 (in Wuhan), 2020. We estimated how these measures impacted ambient air pollution and the subsequent consequences on health and the health-related economy in 367 Chinese cities. A random forests modeling was used to predict the business-as-usual air pollution concentrations in 2020, after adjusting for the impact of long-term trend and weather conditions. We calculated changes in mortality attributable to reductions in air pollution in early 2020 and health-related economic benefits based on the value of statistical life (VSL). Compared with the business-as-usual scenario, we estimated 1239 (95% CI: 844-1578) PM2.5-related deaths were avoided, as were 2777 (95% CI: 1565-3995) PM10-related deaths, 1587 (95% CI: 98-3104) CO-related deaths, 4711 (95% CI: 3649-5781) NO2-related deaths, 215 (95% CI: 116-314) O3-related deaths, and 1088 (95% CI: 774-1421) SO2-related deaths. Based on the reduction in deaths, economic benefits for in PM2.5, PM10, CO, NO2, O3, and SO2 were 1.22, 2.60, 1.36, 4.05, 0.20, and 0.95 billion USD, respectively. Our findings demonstrate the substantial benefits in human health and health-related costs due to improved urban air quality during the COVID lockdown period in China in early 2020.

Background/aims Over the last decade and following international trends, cases of mosquito-borne arboviral infections, notably dengue fever, chikungunya and Zika, have increased among travellers arriving in New Zealand, but no locally acquired cases have been identified. Imported cases are characterised and examined to identify trends and features that might assist in reducing transmission risk from travellers. Methods Information on traveller arrivals, notified cases and risk factors for disease acquisition were obtained from national sources. Trends in importation rates, seasonality are described and relationships of notifications with traveller arrivals were examined with a negative binomial regression model. Results There was a significant increase in dengue notifications combined with the emergence of Zika and chikungunya. Most notifications were from arrivals in Auckland from Pacific Islands during summer and early autumn. Conclusion/implications Overseas travel from New Zealand, particularly to the Pacific Islands and Southeast Asia, involves a risk of arboviral infection. The repeated introduction of arboviruses to New Zealand also increases the risk of local transmission in a country that has vector capable and vector potential mosquitoes, as well as an increasingly suitable climate for new vectors to establish.

The Indian Ocean Dipole (IOD) is a global climate phenomenon that influences the spread of human infectious diseases through climate extremes including droughts and floods. The Dipole Mode Index (DMI), which measures the strength of the IOD, is one of the main indicators of rainfall variability across Australia. Using an ecological, time-series approach we examined the short-term and nonlinear relationship between the DMI and weekly cryptosporidiosis reported from 2001 to 2012 across the temperate, subtropical, and tropical climate zones in Australia, controlling for season, long-term trends, and cryptosporidiosis counts from the past week. The association of DMI with cryptosporidiosis was nonlinear and varied in the short term and by climatic zone. Including cryptosporidiosis counts from the previous week improved model fit in all three zones and modified the DMI-disease relationship in the subtropical and temperate regions. In the temperate zone, a 0.1 unit increase in an extreme positive DMI was associated with a higher risk of reported cryptosporidiosis [Relative Risk (RR) 1.23 (95% confidence interval (CI), 1.00-1.52)], compared to the risk associated with mean DMI. This methodology shows the potential for quantifying the short-term and nonlinear response of infections like cryptosporidiosis with climate variability. These findings also suggest that future models that account for lagged disease effects may better represent the time varying environmental exposure-disease relationship. The expected increases in the frequency of positive DMI events will likely result in decreased rainfall across temperate Australia, with potential implications for public health.

The public health risks associated with dairy farming intensification are an emerging concern. We examine the association between dairy cattle density and cryptosporidiosis risk in children

Mosquito vectors are extending their range via international travel and trade. Climate change makes New Zealand an increasingly suitable environment for less tropically adapted exotic mosquito vectors to become established. This shift will add a multiplier effect to existing risks of both the establishment of new species and of resident exotic species extending into new areas. We describe trends in the border interceptions of exotic mosquitoes and evaluate the role of imported goods as a pathway for these introductions. Ae. aegypti and Ae. albopictus, the two most commonly intercepted species, were only intercepted in Auckland. Used tyres and machinery were the main mode of entry for both species. The majority of Ae. albopictus were transported as larvae by sea, while most Ae. aegypti were transported as adults by air. Continuing introductions of these mosquitoes, mainly arriving via Japan or Australia, increase the risk of the local transmission of mosquito-borne diseases in New Zealand in general and in the Auckland region in particular. These findings reinforce the need for a high performing and adequately resourced national biosecurity system, particularly port surveillance and inspection. Recommended biosecurity improvements are described.

A climate change and health vulnerability and adaptation assessment was conducted in Dominica, a Caribbean small island developing state located in the Lesser Antilles. The assessment revealed that the country&rsquo, s population is already experiencing many impacts on health and health systems from climate variability and change. Infectious diseases as well as food and waterborne diseases pose continued threats as climate change may exacerbate the related health risks. Threats to food security were also identified, with particular concern for food production systems. The findings of the assessment included near-term and long-term adaptation options that can inform actions of health sector decision-makers in addressing health vulnerabilities and building resilience to climate change. Key challenges include the need for enhanced financial and human resources to build awareness of key health risks and increase adaptive capacity. Other small island developing states interested in pursuing a vulnerability and adaptation assessment may find this assessment approach, key findings, analysis, and lessons learned useful.

In public health, implementation research is done to improve access to interventions that have been shown to work but have not reached many of the people who could benefit from them. Researchers identify practical problems facing public health programmes and aim to find solutions that improve health outcomes. In operational research, routinely-collected programme data are used to uncover ways of delivering more effective, efficient and equitable health care. As implementation research can address many types of questions, many research designs may be appropriate. Existing reporting guidelines partially cover the methods used in implementation and operational research, so we ran a consultation through the World Health Organization (WHO), the Alliance for Health PolicySystems Research (AHPSR) and the Special Programme for Research and Training in Tropical Diseases (TDR) and developed guidelines to facilitate the funding, conduct, review and publishing of such studies. Our intention is to provide a practical reference for funders, researchers, policymakers, implementers, reviewers and editors working with implementation and operational research. This is an evolving field, so we plan to monitor the use of these guidelines and develop future versions as required.Dans le domaine de la santé publique, des recherches sur la mise en œuvre sont menées pour améliorer l'accès aux interventions qui se sont révélées efficaces, mais qui n'ont pas touché toutes les personnes qui auraient pu en bénéficier. Les chercheurs identifient les difficultés pratiques qui compromettent les programmes de santé publique et s'efforcent de trouver des solutions pour améliorer les résultats sanitaires. Les données de programme systématiquement collectées dans le cadre des recherches opérationnelles, sont utilisées pour mettre en lumière des moyens de rendre les soins de santé plus efficaces, efficients et équitables. D'autre part, comme il est possible que les recherches sur la mise en œuvre portent sur de nombreux types de questions, différents plans de recherche peuvent s'avérer appropriés. Les directives existantes concernant l'établissement de rapports traitent en partie des méthodes utilisées dans le cadre des recherches sur la mise en œuvre et des recherches opérationnelles. Nous avons donc mené une consultation au sein de l'Organisation mondiale de la Santé (OMS), de l'Alliance pour la recherche sur les politiques et les systèmes de santé (AHPSR) et du Programme spécial de recherche et de formation concernant les maladies tropicales (TDR) et élaboré des directives pour faciliter le financement, la conduite, la révision et la publication de ce type de recherches. Notre objectif est de fournir une référence pratique pour les bailleurs de fonds, les chercheurs, les décideurs, les responsables de la mise en œuvre, les réviseurs et les éditeurs associés aux recherches sur la mise en œuvre et aux recherches opérationnelles. Ce domaine étant en constante évolution, nous prévoyons de suivre l'utilisation de ces directives et de rédiger, si besoin est, de futures versions.En la salud pública, las investigaciones sobre la ejecución se llevan a cabo para mejorar el acceso a las intervenciones que se ha demostrado que funcionan pero que no han llegado a una gran parte de las personas que podrían beneficiarse de ellas. Los investigadores identifican los problemas prácticos a los que se enfrentan los programas de salud pública y tratan de encontrar soluciones que mejoren los resultados sanitarios. En las investigaciones operativas, se utilizan datos de programas recopilados rutinariamente para descubrir formas de ofrecer una atención sanitaria más efectiva, eficiente y equitativa. Puesto que una investigación sobre la ejecución puede abordar muchos tipos de cuestiones, pueden ser apropiados muchos diseños de investigación. Las directrices existentes sobre la presentación de informes cubren parcialmente los métodos utilizados en las investigaciones operativas y sobre la ejecución, por lo que se llevó a cabo una consulta a través de la Organización Mundial de la Salud (OMS), la Alianza para la Investigación en Políticas y Sistemas de Salud (Alianza IPSS) y el Programa Especial de Investigaciones y Enseñanzas sobre Enfermedades Tropicales (TDR) y se desarrollaron directrices para facilitar la financiación, realización, revisión y publicación de dichos estudios. El objetivo es proporcionar una referencia práctica para financiadores, investigadores, responsables de la formulación de políticas, implementadores, revisores y editores que trabajen con investigaciones operativas y sobre la ejecución. Se trata de un área en evolución, por lo que prevemos supervisar el uso de estas directrices y desarrollar versiones futuras si fuera necesario.يتم إجراء البحوث التنفيذية في مجال الصحة العمومية لتطوير سبل الوصول إلى برامج التدخل العلاجي، والتي ثبت فعاليتها، لكنها لم تصل إلى العديد من الأفراد ممكن يمكنهم الاستفادة منها. ويحدد الباحثون المشكلات العملية التي تواجه برامج الصحة العمومية، كما يهدفون إلى إيجاد الحلول التي تحسّن من المحصلات الصحية. أما في مجال البحوث الميدانية، فإنه يتم توظيف البيانات الخاصة بالبرامج التي يتم جمعها بشكل روتيني للكشف عن سبل تقديم رعاية صحية تراعي عوامل الكفاءة والفعالية والإنصاف. وبما أنه يمكن للبحوث التنفيذية تناول أنواعًا عديدة من القضايا، فقد يكون من المناسب الاعتماد على العديد من تصاميم البحوث. ونظرًا لأن المبادئ التوجيهية الحالية لرفع التقارير لا تغطي سوى جانب من الوسائل المستخدمة في البحوث التنفيذية والميدانية، فقد طلبنا الاستشارة من خلال منظمة الصحة العالمية، واتحاد سياسات وبحوث النظم الصحية (AHPSR)، والبرنامج التخصصي للبحوث والتدريب المتعلق بالأمراض الاستوائية (TDR)، والمبادئ التوجيهية الموضوعة لتيسير جهود تمويل تلك الدراسات وإجرائها ومراجعتها ونشرها .يتمثل غرضنا في تقديم مرجع عملي للممولين والباحثين وصناع السياسات والقائمين على التنفيذ والمراجعة والمحررين المعنيين بالتعامل مع البحوث التنفيذية والميدانية. وبما أن هذا المجال آخذ في التطور، فإننا نخطط لمراقبة توظيف هذه المبادئ التوجيهية ووضع رؤى مستقبلية حسب الحاجة.公共卫生领域中开展了实施性研究，旨在改善干预措施的普及率，这已表明发挥一定的作用，但是尚未普及到许多本应从中获益的人群。 研究人员确定公共卫生项目所面临的实际问题并且努力寻找改善卫生状况的解决方案。 在操作性研究中，我们使用定期收集的项目数据来揭示提供更加有效、高效和公平的医疗保健的途径。 由于实施性研究可以解决许多类型的问题，因而多种研究设计可能都是适合的。现存的报告指南部分涵盖了实施性和操作性研究中所采用的方法，因此我们通过世界卫生组织 (WHO)、卫生政策与卫生体制研究联盟 (AHPSR)、热带疾病研究特别行动规划 (TDR) 开展了一项咨询，并且制定了指南，旨在为此类研究提供经费、实施、评审和发表支持。我们的目的是为实施性和操作性研究的资助者、研究人员、政策制定者、执行者、评审者和编辑人员提供切实可行的参考。 这是一个不断发展的领域，因此我们计划监测这些指南的使用情况并根据需要制定出新的版本。.Исследования внедрения в здравоохранении проводятся для того, чтобы увеличить доступность тех вмешательств, которые хорошо себя зарекомендовали, но недоступны для многих людей, которым они могли бы быть полезны. Исследователи выявляют практические проблемы, с которыми сталкиваются программы общественного здравоохранения, и преследуют цель обнаружения решений, которые улучшают результаты лечения. В ходе оперативных исследований регулярно собираемые данные о программе используются для того, чтобы раскрыть способы создания более эффективного, действенного и общедоступного здравоохранения. Так как исследования внедрения могут быть посвящены разнообразным вопросам, существует множество приемлемых вариантов построения такого исследования. Существующие рекомендации по составлению отчетности лишь частично охватывают методы, используемые в ходе исследований внедрения и оперативных исследований, поэтому мы провели консультации со Всемирной организацией здравоохранения (ВОЗ), Союзом исследований стратегий и систем здравоохранения (AHPSR) и Специальной программой по научным исследованиям и подготовке специалистов в области тропических болезней (TDR) и разработали рекомендации для содействия финансированию, проведению, анализу и публикации таких исследований. Нашей целью является создание практического справочника для тех, кто финансирует исследования, проводит их, разрабатывает стратегии, занимается осуществлением, анализом и издательской работой в области исследований внедрения и оперативных исследований. Это поле деятельности пока только находится в процессе становления, поэтому мы планируем отслеживать использование данных рекомендаций и будем разрабатывать новые версии по мере необходимости.

Background: The Global Climate Risk Index 2020 ranked Vietnam as the sixth country in the world most affected by climate variability and extreme weather events over the period 1999-2018. Sea level rise and extreme weather events are projected to be more severe in coming decades, which, without additional action, will increase the number of people at risk of climate-sensitive diseases, challenging the health system. This article summaries the results of a health vulnerability and adaptation (V&A) assessment conducted in Vietnam as evidences for development of the National Climate Change Health Adaptation Plan to 2030. Methods: The assessment followed the first 4 steps outlined in the World Health Organization’s Guidelines in conducting “Vulnerability and Adaptation Assessments.” A framework and list of indicators were developed for semi-quantitative assessment for the period 2013 to 2017. Three sets of indicators were selected to assess the level of (1) exposure to climate change and extreme weather events, (2) health sensitivity, and (3) adaptation capacity. The indicators were rated and analyzed using a scoring system from 1 to 5. Results: The results showed that climate-sensitive diseases were common, including dengue fever, diarrheal, influenza, etc, with large burdens of disease that are projected to increase. From 2013 to 2017, the level of “exposure” to climate change–related hazards of the health sector was “high” to “very high,” with an average score from 3.5 to 4.4 (out of 5.0). For “health sensitivity,” the scores decreased from 3.8 in 2013 to 3.5 in 2017, making the overall rating as “high.” For “adaptive capacity,” the scores were from 4.0 to 4.1, which meant adaptive capacity was “very low.” The overall V&A rating in 2013 was “very high risk” (score 4.1) and “high risk” with scores of 3.8 in 2014 and 3.7 in 2015 to 2017. Conclusions: Adaptation actions of the health sector are urgently needed to reduce the vulnerability to climate change in coming decades. Eight adaptation solutions, among recommendations of V&A assessment, were adopted in the National Health Climate Change Adaptation Plan.

(1) Background: Global agricultural production is projected to increase substantially in the coming decades. Agricultural production provides food and materials crucial to human survival and well-being and is a critical source of livelihood, providing employment opportunities and economic benefits. However, industrialized or intensified agricultural systems, in particular, can have adverse effects on public health, place pressure on natural resources, and reduce environmental sustainability. This review attempts to identify and characterize key environmental health assessment methods for examining a broad array of potential impacts; (2) Methods: Electronic databases Medline, Scopus, Web of Science, and GreenLINE were searched for published literature that presented methods for conducting an environmental health assessment of an agricultural system; (3) Results: Fifty-three sources were included in the review. Eight methods were selected to illustrate the wide range of approaches currently available: health risk assessment methods, health impact assessment, environmental impact assessment methods, environmental burden of disease, lifecycle methods, integrated assessment modeling, trade-off analysis, and economic assessment; (4) Conclusions: This review can provide guidance for selecting an existing method or for designing a new method for assessing the environmental health impacts of an agricultural system.

Spatio-temporal disease patterns can provide clues to etiological pathways, but can be complex to model. Using a flexible Bayesian hierarchical framework, we identify previously undetected space-time clusters and environmental and socio-demographic risk factors for reported giardiasis and cryptosporidiosis at the New Zealand small area level. For giardiasis, there was no seasonal pattern in outbreak probability and an inverse association with density of dairy cattle ( β ^ 1 = −0.09, Incidence Risk Ratio (IRR) 0.90 (95% CI 0.84, 0.97) per 1 log increase in cattle/km2). In dairy farming areas, cryptosporidiosis outbreaks were observed in spring. Reported cryptosporidiosis was positively associated with dairy cattle density: β ^ 1 = 0.12, IRR 1.13 (95% CI 1.05, 1.21) per 1 log increase in cattle/km2 and inversely associated with weekly average temperature: β ^ 1 = −0.07, IRR 0.92 (95% CI 0.87, 0.98) per 4 °C increase. This framework can be generalized to determine the potential drivers of sporadic cases and latent outbreaks of infectious diseases of public health importance.

The forecast consequences of climate change on human health are profound, especially in low- and middle-income countries and among the most disadvantaged populations. Innovative policy tools are needed to address the adverse health effects of climate change. Cash transfers are established policy tools for protecting population health before, during and after climate-related disasters. For example, the Ethiopian Productive Safety Net Programme provides cash transfers to reduce food insecurity resulting from droughts. We propose extending cash transfer interventions to more proactive measures to improve health in the context of climate change. We identify promising cash transfer schemes that could be used to prevent the adverse health consequences of climatic hazards. Cash transfers for using emission-free, active modes of transport - e.g. cash for cycling to work - could prevent future adverse health consequences by contributing to climate change mitigation and, at the same time, improving current population health. Another example is cash transfers provided to communities that decide to move to areas in which their lives and health are not threatened by climatic disasters. More research on such interventions is needed to ensure that they are effective, ethical, equitable and cost-effective.Les conséquences attendues du changement climatique sur la santé humaine sont importantes, en particulier dans les pays à revenu faible et intermédiaire et pour les populations les plus défavorisées. Des moyens d'intervention innovants sont nécessaires pour lutter contre les effets néfastes du changement climatique sur la santé. Les transferts d'argent sont des moyens d'intervention éprouvés pour protéger la santé de la population avant, pendant et après les catastrophes climatiques. Le Programme de création de dispositifs de sécurité productifs de l'Éthiopie, par exemple, prévoit des transferts d'argent pour réduire l'insécurité alimentaire découlant des périodes de sécheresse. Nous proposons d'inclure les opérations de transfert d'argent dans des actions plus préventives en vue d'améliorer la santé dans le contexte du changement climatique. Nous avons identifié différents systèmes de transfert d'argent prometteurs qui pourraient être utilisés pour éviter les conséquences néfastes des risques liés au climat sur la santé. Les transferts d'argent visant l'utilisation de moyens de transport actifs et sans émissions – pour se rendre au travail à vélo par ex. – pourraient prévenir les futures conséquences néfastes sur la santé en contribuant à l'atténuation du changement climatique et en améliorant ainsi l'état actuel de la santé de la population. Un autre exemple concerne les transferts d'argent accordés aux communautés qui décident de s'établir dans des régions où leur vie et leur santé ne sont pas menacées par des catastrophes climatiques. Davantage de recherches sur ces opérations sont nécessaires pour prouver leur efficacité, leur caractère éthique et équitable ainsi que leur rentabilité.Las consecuencias previstas del cambio climático en la salud humana son severas, especialmente en los países de ingresos bajos y medios y entre los grupos más desfavorecidos. Se necesitan instrumentos normativos innovadoras para afrontar los efectos adversos sobre la salud que el cambio climático produce. Las transferencias de efectivo son instrumentos normativos establecidos para proteger la salud de la población antes, durante y después de los desastres relacionados con el clima. Por ejemplo, el Programa “Red de Seguridad Productiva” de Etiopía proporciona transferencias de efectivo para reducir la inseguridad alimentaria derivada de las sequías. Nosotros proponemos extender las intervenciones de transferencias de efectivo a medidas más proactivas para mejorar la salud en el contexto del cambio climático. Identificamos planes prometedores de transferencia de efectivo que podrían utilizarse para prevenir las consecuencias adversas sobre la salud provocadas por los riesgos climáticos. Las transferencias de efectivo para usar modos de transporte activos y libres de emisiones (por ejemplo, dinero para ir al trabajo en bicicleta) podrían prevenir futuras consecuencias adversas sobre la salud, contribuyendo a la mitigación del cambio climático y, al mismo tiempo, mejorando la salud actual de la población. Otro ejemplo son las transferencias de efectivo realizadas a comunidades que deciden trasladarse a zonas dónde sus vidas y su salud no estén amenazadas por los desastres climáticos. Es necesario llevar a cabo más investigaciones en estas intervenciones para garantizar que sean efectivas, éticas, equitativas y costoefectivas.إن للتبعات المنظورة لتغير المناخ والتي تمس صحة الإنسان آثارٌ شديدة الخطورة، خاصةً في البلدان منخفضة ومتوسطة الدخل وفي القطاعات السكانية المحرومة. لذا فقد اقتضت الحاجة وجود أدوات مبتكرة لسياسة التصدي للآثار الضارة المترتبة على تغير المناخ فيما يتعلق بالصحة. وتمثل التحويلات النقدية أدوات متبعة للسياسة المعنية بحماية صحة السكان قبل وأثناء وبعد وقوع الكوارث المتعلقة بالمناخ. فعلى سبيل المثال، يقدم برنامج شبكات الأمان الإنتاجية الإثيوبي تحويلات نقدية للتقليل من انعدام الأمن الغذائي الناتج عن موجات الجفاف. ونقترح توسيع نطاق تدخلات التحويل النقدي لتشمل إجراءات تتسم بدرجة أعلى من المبادرة لتحسين الصحة في إطار تغير المناخ. وقد حددنا خططًا واعدة للتحويل النقدي يمكن استخدامها لمنع الآثار الضارة بالصحة والمترتبة على الأخطار المناخية. ويمكن للتحويلات النقدية المخصصة لاستخدام وسائل مواصلات فعالة لا تصدر انبعاثات ضارة – مثل النقد المخصص لاستخدام الدرجات للانتقال إلى العمل – أن تمنع الآثار الصحية الضارة في المستقبل، وذلك من خلال المساهمة في الحد من تغيرات المناخ وفي تحسين صحة السكان الحالية في نفس الوقت. ومثال آخر على ذلك التحويلات النقدية المقدمة للمجتمعات التي قرر أفرادها الانتقال إلى مناطق لا تمثل فيها الكوارث المناخية تهديدًا لأرواحهم أو صحتهم. وتقتضي الحاجة إجراء المزيد من الأبحاث على هذا النوع من التدخلات لضمان أنها فعالة ومراعية للمعايير الأخلاقية ومنصفة ومجدية التكلفة.气候变化对人类健康具有可预测的深远影响，在中低收入的国家和大部分弱势群体中尤为如此。 我们需要使用创新的政策工具来应对气候变化对健康造成的不利影响。 现金资助是已经确立的政策工具，可在与气候有关的灾害发生之前、期间或之后保护全民健康。 例如，埃塞俄比亚的“生产安全网计划”提供现金资助，可降低因干旱造成的粮食不安全性。 我们建议将现金资助干预措施拓展为更加积极的措施，在气候变化的环境下改善健康状况。 我们确定了有价值的现金资助方案，可以用来预防气候灾害对健康造成的不利影响。 为采用零排放、积极的交通模式提供现金资助（例如，骑车上班的现金资助）有助于减缓气候变化，可预防今后对健康造成不利影响，同时还能改善当前的全民健康状况。 另外一个示例是，向决定搬迁到新地区的社区团体提供现金资助，在那里他们的生活和健康不会受到气候灾害的威胁。 我们需要针对该种干预措施开展更多研究，以确保其有效性、伦理性、公平性和成本效益。.Прогнозируемые последствия изменения климата для здоровья человечества являются значительными, особенно в странах с низким и средним уровнем доходов и среди наиболее уязвимых слоев населения. Для преодоления негативного влияния климатических изменений на здоровье людей необходимы новые политические инструменты. Одним из таких инструментов, уже показавших свою эффективность в плане защиты здоровья населения до стихийных бедствий, вызванных климатическими изменениями, во время и после них, являются денежные переводы. Например, денежные переводы используются в рамках программы Productive Safety Net в Эфиопии для снижения риска нехватки продовольствия в результате засухи. Мы предлагаем не ограничиваться мерами по переводу денежных средств и дополнить их более активными упреждающими мероприятиями, направленными на улучшение здоровья людей в контексте изменения климата. Мы определяем перспективные схемы перевода денежных средств, которые могут использоваться для предотвращения неблагоприятных для здоровья последствий стихийных бедствий. Денежные переводы для использования экологически чистых, активных видов транспорта (например, денежное поощрение за использование велосипеда, чтобы добраться до работы) могут предотвратить негативные последствия в будущем, способствуя смягчению изменений климата и одновременно улучшая здоровье населения. Другим примером могут служить денежные переводы общинам, которые решили переехать в регионы, где стихийные бедствия не будут угрожать их здоровью и жизни. Необходимо провести дополнительные исследования, чтобы обеспечить эффективность, этичность, справедливость и экономичность подобных мероприятий.