Hot temperatures and morbidity : a systematic review and meta–analysis

Extreme temperatures have been shown to have a detrimental effect on health. Hot temperatures can increase the risk of mortality, particularly in people suffering from cardiorespiratory diseases. Given the onset of climate change, it is critical that the impact of temperature on health is understood, so that effective public health strategies can correctly identify vulnerable groups within the population. However, while effects on mortality have been extensively studied, temperature–related morbidity has received less attention. This study applied a systematic review and meta–analysis to examine the current literature relating to hot temperatures and morbidity.

Evaluating the economics of the Australian National Hand Hygiene Initiative

The National Hand Hygiene Initiative, implemented in Australia in 2009, is currently being evaluated for effectiveness and cost-effectiveness by a multidisciplinary team of researchers. Data from a wide range of sources are being harvested to address the research questions. The data are observational and appropriate statistical and economic modelling methods are being used. Decision makers will be provided with new knowledge about how hand hygiene interventions should be organised and what investment decisions are justified. This is novel research and the authors are unaware of any other evaluation of hand hygiene improvement initiatives. This paper describes the evaluation currently underway.

Computer planning of stereotactic iodine-125 seed brachytherapy for recurrent malignant gliomas

At St Thomas' Hospital, we have developed a computer program on a Titan graphics supercomputer to plan the stereotactic implantation of iodine-125 seeds for the palliative treatment of recurrent malignant gliomas. Use of the Gill-Thomas-Cosman relocatable frame allows planning and surgery to be carried out at different hospitals on different days. Stereotactic computed tomography (CT) and positron emission tomography (PET) scans are performed and the images transferred to the planning computer. The head, tumour and frame fiducials are outlined on the relevant images, and a three-dimensional model generated. Structures which could interfere with the surgery or radiotherapy, such as major vessels, shunt tubing etc., can also be outlined and included in the display. Catheter target and entry points are set using a three-dimensional cursor controlled by a set of dials attached to the computer. The program calculates and displays the radiation dose distribution within the target volume for various catheter and seed arrangements. The CT co-ordinates of the fiducial rods are used to convert catheter co-ordinates from CT space to frame space and to calculate the catheter insertion angles and depths. The surgically implanted catheters are after-loaded the next day and the seeds left in place for between 4 and 6 days, giving a nominal dose of 50 Gy to the edge of the target volume. 25 patients have been treated so far.

A roadside survey of unlicensed driving in Queensland

Unlicensed driving remains a serious problem in many jurisdictions, and while it does not play a direct causative role in road crashes, it undermines driver licensing systems and is linked to other high risk driving behaviours. Roadside licence check surveys represent the most direct means of estimating the prevalence of unlicensed driving. The current study involved the Queensland Police Service (QPS) checking the licences of 3,112 drivers intercepted at random breath testing operations across Queensland between February and April 2010. Data was matched with official licensing records from Transport and Main Roads (TMR) via the drivers’ licence number. In total, 2,914 (93.6%) records were matched, with the majority of the 198 unmatched cases representing international or interstate licence holders (n = 156), leaving 42 unknown cases. Among the drivers intercepted at the roadside, 20 (0.6%) were identified as being unlicensed at the time, while a further 11 (0.4%) were driving unaccompanied on a Learner Licence. However, the examination of TMR licensing records revealed that an additional 9 individuals (0.3%) had a current licence sanction but were not identified as unlicensed by QPS. Thus, in total 29 of the drivers were unlicensed at the time, representing 0.9% of all the drivers intercepted and 1% of those for whom their licence records could be checked. This is considerably lower than the involvement of unlicensed drivers in fatal and serious injury crashes in Queensland, which is consistent with other research confirming the increased crash risk of the group. However, the number of unmatched records suggest that it is possible the on-road survey may have under-estimated the prevalence of unlicensed driving, so further development of the survey method is recommended.

The Prehistory of Potyviruses: Their Initial Radiation Was during the Dawn of Agriculture

Background: Potyviruses are found world wide, are spread by probing aphids and cause considerable crop damage. Potyvirus is one of the two largest plant virus genera and contains about 15% of all named plant virus species. When and why did the potyviruses become so numerous? Here we answer the first question and discuss the other. Methods and Findings: We have inferred the phylogenies of the partial coat protein gene sequences of about 50 potyviruses, and studied in detail the phylogenies of some using various methods and evolutionary models. Their phylogenies have been calibrated using historical isolation and outbreak events: the plum pox virus epidemic which swept through Europe in the 20th century, incursions of potyviruses into Australia after agriculture was established by European colonists, the likely transport of cowpea aphid-borne mosaic virus in cowpea seed from Africa to the Americas with the 16th century slave trade and the similar transport of papaya ringspot virus from India to the Americas. Conclusions/Significance: Our studies indicate that the partial coat protein genes of potyviruses have an evolutionary rate of about 1.1561024 nucleotide substitutions/site/year, and the initial radiation of the potyviruses occurred only about 6,600 years ago, and hence coincided with the dawn of agriculture. We discuss the ways in which agriculture may have triggered the prehistoric emergence of potyviruses and fostered their speciation.

Ambient temperature and cardiorespiratory morbidity : a systematic review and meta-analysis

BACKGROUND: The effect of extreme temperature has become an increasing public health concern. Evaluating the impact of ambient temperature on morbidity has received less attention than its impact on mortality. METHODS: We performed a systematic literature review and extracted quantitative estimates of the effects of hot temperatures on cardiorespiratory morbidity. There were too few studies on effects of cold temperatures to warrant a summary. Pooled estimates of effects of heat were calculated using a Bayesian hierarchical approach that allowed multiple results to be included from the same study, particularly results at different latitudes and with varying lagged effects. RESULTS: Twenty-one studies were included in the final meta-analysis. The pooled results suggest an increase of 3.2% (95% posterior interval = -3.2% to 10.1%) in respiratory morbidity with 1°C increase on hot days. No apparent association was observed for cardiovascular morbidity (-0.5% [-3.0% to 2.1%]). The length of lags had inconsistent effects on the risk of respiratory and cardiovascular morbidity, whereas latitude had little effect on either. CONCLUSIONS: The effects of temperature on cardiorespiratory morbidity seemed to be smaller and more variable than previous findings related to mortality.

Benefits of publicly available data

The National Morbidity, Mortality, and Air Pollution Study (NMMAPS) was designed to examine the health effects of air pollution in the United States. The primary question was whether particulate matter was responsible for the associations between air pollution and daily mortality. Secondary questions concerned measurement error in air pollution and mortality displacement.1 Since then, NMMAPS has been used to answer many important questions in environmental epidemiology...

Simulating a latent susceptible pool to examine the impact on cardiovascular mortality

The health effects of cold and hot temperatures are strongest in the frail and elderly. A large number of deaths in this "susceptible pool" after heat waves and cold snaps can cause mortality displacement, where an immediate increase in mortality is somewhat offset by a subsequent decrease in the following weeks. There may also be longer-term implications, as reductions in the pool caused by hot summers can reduce cold-related mortality in the following winter. A state-space model was used to simulate the numbers in the susceptible pool over time. We simulated the effects of harsh winters and heat waves, and varied the size of the susceptible pool. The larger the susceptible pool the smaller the mortality displacement. When 1% of the population were susceptible a harsh winter lead to an average of just 3 months of life lost per cold-related death, whereas a pool size of 10% meant that 24 months of life were lost per death. The impact of a cold spell on months of life lost was greater when the increased risk of death also applied to healthy people. The number of deaths caused by an August heat wave were reduced when there was a prior heat wave in June which reduced the susceptible pool. We were able to mimic some observed seasonal patterns in mortality using a simple state-space model. A better understanding of the size and dynamics of the susceptible pool will improve our understanding of the health effects of temperature.

Health status and use of health services among recently arrived men with refugee backgrounds: A comparative analysis of urban and regional settlement in South-east Queensland

Approximately one-third of refugee and humanitarian entrants to Australia are adult men. Many of these men and their families settle in regional areas. Little is known about the health status of refugee men and the use of health services, and whether or not there are differences between those living in urban and regional areas. This paper reports on the cross-sectional differences in health status and use of health services among a group of 233 recently arrived refugee men living in urban and regional areas of South-east Queensland. Overall, participants reported good levels of subjective health status, moderate to good levels of well-being, and low prevalence of mental illness. Men living in urban areas were more likely to have a longstanding illness and report poorer health status than those settled in regional areas. In contrast, men living in regional areas reported poorer levels of well-being in the environment domain and were more likely to visit hospital emergency departments. Targeted health promotion programs will ensure that refugee men remain healthy and develop their full potential as members of the Australian community. Programs that facilitate refugees’ access to primary health care in regional areas may promote more appropriate use of hospital emergency departments by these communities.

Detecting common dynamics in transitory components

This paper considers VECMs for variables exhibiting cointegration and common features in the transitory components. While the presence of cointegration between the permanent components of series reduces the rank of the long-run multiplier matrix, a common feature among the transitory components leads to a rank reduction in the matrix summarizing short-run dynamics. The common feature also implies that there exists linear combinations of the first-differenced variables in a cointegrated VAR that are white noise and traditional tests focus on testing for this characteristic. An alternative, however, is to test the rank of the short-run dynamics matrix directly. Consequently, we use the literature on testing the rank of a matrix to produce some alternative test statistics. We also show that these are identical to one of the traditional tests. The performance of the different methods is illustrated in a Monte Carlo analysis which is then used to re-examine an existing empirical study. Finally, this approach is applied to provide a check for the presence of common dynamics in DSGE models.