Ambient Temperature Effects on Hospitalization Risk Among Farmers: A Time-Series Study on Multiple Diseases in Vietnam

OBJECTIVE

The aim of the study is to assess the effect of high temperatures on hospitalization for all causes and heat-sensitive diseases among Vietnamese farmers.

METHODS

The Poisson generalized linear model and distributed lag nonlinear model were used to investigate the temperature-hospitalization association for all causes and seven cause-specific disease groups.

RESULTS

Every 1°C increase in daily mean temperature above the threshold increased the estimated relative risk (95% CI) of all-cause hospitalization by 1.022 (0.998-1.047) at the country level, 1.047 (1.007-1.089) in the south, and 0.982 (0.958-1.006) in the north. Infectious disease hospitalization was most affected by high temperatures (1.098 [1.057-1.140]). High temperatures significantly increased the risk of all-cause hospitalization for farmers 60 years and younger in three of the six provinces.

CONCLUSIONS

The findings emphasized the need for health promotion programs to prevent heat-related health issues.

The 2023 report of the MJA-Lancet Countdown on health and climate change: sustainability needed in Australia's health care sector

The MJA-Lancet Countdown on health and climate change in Australia was established in 2017 and produced its first national assessment in 2018 and annual updates in 2019, 2020, 2021 and 2022. It examines five broad domains: health hazards, exposures and impacts; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. In this, the sixth report of the MJA-Lancet Countdown, we track progress on an extensive suite of indicators across these five domains, accessing and presenting the latest data and further refining and developing our analyses. Our results highlight the health and economic costs of inaction on health and climate change. A series of major flood events across the four eastern states of Australia in 2022 was the main contributor to insured losses from climate-related catastrophes of $7.168 billion - the highest amount on record. The floods also directly caused 23 deaths and resulted in the displacement of tens of thousands of people. High red meat and processed meat consumption and insufficient consumption of fruit and vegetables accounted for about half of the 87 166 diet-related deaths in Australia in 2021. Correction of this imbalance would both save lives and reduce the heavy carbon footprint associated with meat production. We find signs of progress on health and climate change. Importantly, the Australian Government released Australia's first National Health and Climate Strategy, and the Government of Western Australia is preparing a Health Sector Adaptation Plan. We also find increasing action on, and engagement with, health and climate change at a community level, with the number of electric vehicle sales almost doubling in 2022 compared with 2021, and with a 65% increase in coverage of health and climate change in the media in 2022 compared with 2021. Overall, the urgency of substantial enhancements in Australia's mitigation and adaptation responses to the enormous health and climate change challenge cannot be overstated. Australia's energy system, and its health care sector, currently emit an unreasonable and unjust proportion of greenhouse gases into the atmosphere. As the Lancet Countdown enters its second and most critical phase in the leadup to 2030, the depth and breadth of our assessment of health and climate change will be augmented to increasingly examine Australia in its regional context, and to better measure and track key issues in Australia such as mental health and Aboriginal and Torres Strait Islander health and wellbeing.

Indoor air pollution is associated with respiratory symptoms in children in urban Vietnam

Exposure to indoor air pollution (IAP) is a leading environmental risk for respiratory diseases. We investigated the relationship between respiratory symptoms and polluting indoor activities such as smoking, cooking and contact with pets among children in Ho Chi Minh City (HCMC), Vietnam. A cross-sectional survey applied a multistage sampling method in 24 randomly selected secondary schools across the city. Approximately 15,000 students completed self-administrated questionnaires on risk factors and respiratory health outcomes within the preceding 12 months. Data were analyzed using a multivariable logistic regression model with robust standard errors. Wheeze was the most common respiratory symptom (39.5 %) reported, followed by sneezing and runny nose (28.3 %). A small percentage of students self-reported asthma (8.6 %). Approximately 56 % of participants lived with family members who smoked. A positive association between exposure to indoor secondhand smoke and respiratory symptoms was observed, with adjusted odds ratios (aOR) of 1.41 (95 % CI: 1.25-1.60, p < 0.001) for wheezing and 1.64 (95 % CI: 1.43-1.87, p < 0.001) for sneezing and runny nose, respectively. Using an open stove fuelled by coal, wood, or kerosene for cooking was associated with wheeze (aOR: 1.36, CI 95 %: 1.10-1.68, p = 0.01) and sneezing and runny nose (aOR: 1.36, CI 95 %: 1.09-1.69, p = 0.01). In the present study, IAP was associated with adverse health outcomes, as evidenced by an increase in respiratory symptoms reported within the previous 12 months.

Preparing for a hotter climate: A systematic review and meta-analysis of heatwaves and ambulance callouts in Australia

OBJECTIVE

The objective of this study was to quantify the impact of heatwaves on likelihood of ambulance callouts for Australia.

METHODS

A systematic review and meta-analysis was conducted to retrieve and synthesise evidence published from 1 January 2011 to 31 May 2023 about the association between heatwaves and the likelihood of ambulance callouts in Australia. Different heatwave definitions were used ranging from excess heat factor to heatwave defined as a continuous period with temperatures above certain defined thresholds (which varied based on study locations).

RESULTS

We included nine papers which met the inclusion criteria for the review. Eight were eligible for the meta-analyses. The multilevel meta-analyses revealed that the likelihood of ambulance callouts for all causes and for cardiovascular diseases increased by 10% (95% confidence interval: 8%, 13%) and 5% (95% confidence interval: 1%, 3%), respectively, during heatwave days.

CONCLUSIONS

Exposure to heatwaves is associated with an increased likelihood of ambulance callouts, and there is a dose-response association between heatwave severity and the likelihood of ambulance callouts.

IMPLICATIONS FOR PUBLIC HEALTH

The number of heatwave days are going to increase, and this will mean an increase in the likelihood of ambulance callouts, thereby, spotlighting the real burden that heatwaves place on our already stressed healthcare system. The findings of this study underscore the critical need for proactive measures, including the establishment of research initiatives and holistic heat health awareness campaigns, spanning from the individual and community levels to the healthcare system, in order to create a more resilient Australia in the face of heatwave-related challenges.

The effects of diurnal temperature range on mortality and emergency department presentations in Victoria state of Australia: A time-series analysis

State of Victoria, Australia (SVA) has a wide variation of diurnal temperatures (DTR). DTR has been reported to be associated with risk of mortality and morbidity. We examined the association between exposure to DTR and risk of all-cause mortality and emergency department (ED) presentations in the SVA. We obtained data on daily counts of deaths and ED presentations, and weather data from 1 st January 2000─2019. We applied a quasi-Poisson time-series regression analysis to examine the association between daily DTR exposures and risk of mortality and ED presentations. The analyses were queried by age, sex, seasons, ED presentations triages, and departure status. Risk of mortality and ED presentation increased by 0.33% (95% CI: 0.24%-0.43%), and 0.094% (95% CI: 0.077%-0.11%) in relation to one degree increase in the daily DTR. The association between DTR and ED presentations was stronger in children (0-15 years) (0.38% [95% CI: 0.34%-0.42%]) and the elderly (75+ years) (0.34% [95% CI: 0.29%-0.39%]). Resuscitation, which was consistently accounted for the highest vulnerability to DTR variation, increased by 0.79% (95% CI: 0.60%-0.99%). This study suggests that the risk of mortality and ED presentations associates with the increase of DTR. Children, the elderly, and their caregivers need to be made aware of the health risk posed by DTR.

Climate change and human health in Vietnam: a systematic review and additional analyses on current impacts, future risk, and adaptation

This study aims to investigate climate change's impact on health and adaptation in Vietnam through a systematic review and additional analyses of heat exposure, heat vulnerability, awareness and engagement, and projected health costs. Out of 127 reviewed studies, findings indicated the wider spread of infectious diseases, and increased mortality and hospitalisation risks associated with extreme heat, droughts, and floods. However, there are few studies addressing health cost, awareness, engagement, adaptation, and policy. Additional analyses showed rising heatwave exposure across Vietnam and global above-average vulnerability to heat. By 2050, climate change is projected to cost up to USD1-3B in healthcare costs, USD3-20B in premature deaths, and USD6-23B in work loss. Despite increased media focus on climate and health, a gap between public and government publications highlighted the need for more governmental engagement. Vietnam's climate policies have faced implementation challenges, including top-down approaches, lack of cooperation, low adaptive capacity, and limited resources.

Heat, heatwaves, and ambulance service use: a systematic review and meta-analysis of epidemiological evidence

Ambulance data has been reported to be a sensitive indicator of health service use during hot days, but there is no comprehensive summary of the quantitative association between heat and ambulance dispatches. We conducted a systematic review and meta-analysis to retrieve and synthesise evidence published up to 31 August 2022 about the association between heat, prolonged heat (i.e. heatwaves), and the risk of ambulance dispatches. We initially identified 3628 peer-reviewed papers and included 48 papers which satisfied the inclusion criteria. The meta-analyses showed that, for each 5 °C increase in mean temperature, the risk of ambulance dispatches for all causes and for cardiovascular diseases increased by 7% (95% confidence interval (CI): 5%, 10%) and 2% (95% CI: 1%, 3%), respectively, but not for respiratory diseases. The risk of ambulance dispatches increased by 6% (95% CI: 4%, 7%), 7% (95% CI: 5%, 9%), and 18% (95% CI: 12%, 23%) under low-intensity, severe, and extreme heatwaves, respectively. We observed two potential sources of bias in the existing literature: (1) bias in temperature exposure measurement; and (2) bias in the ascertainment of ambulance dispatch causes. This review suggests that heat exposure is associated with an increased risk of ambulance dispatches, and there is a dose-response relationship between heatwave intensity and the risk of ambulance dispatches. For future studies assessing the heat-ambulance association, we recommend that (1) using data on spatially refined gridded temperature that is either very well interpolated or derived from satellite imaging may be an alternative to reduce exposure measurement bias; and (2) linking ambulance data with hospital admission data can be useful to improve health outcome classification.

Wearing masks as a protective measure for children against traffic-related air pollution: A comparison of perceptions between school children and their caregivers in Ho Chi Minh City, Vietnam

BACKGROUND

Traffic-related air pollution (TRAP) problems are unlikely to be solved in the short term, making it imperative to educate children on protective measures to mitigate the negative impact on their health. Children and their caregivers may hold differing views on wearing a face mask as a safeguard against air pollution. While many studies have focused on predicting children's health-protective behaviours against air pollution, few have explored the differences in perceptions between children and their caregivers.

OBJECTIVES

To examine this, we conducted a study that compared the health beliefs of two generations and evaluated the factors that influence the use of masks by children to reduce air pollution exposure.

METHODS

The study was conducted in 24 secondary schools and involved 8420 children aged 13-14 and their caregivers. We used a Health Belief Model (HBM)-based instrument containing 17-item self-administered health beliefs questionnaires to gather data. The results were analysed using hierarchical logistic regression to determine the probability of children frequently wearing masks to protect against TRAP.

RESULTS

Our study showed both children and caregivers recognised that several factors could influence mask-wearing among children: discomfort or difficulty breathing while wearing a mask and forgetting to bring a mask when going outside; perceived threats of the poor quality of air and children's respiratory health problems; and cues to mask use (i.e., seeing most of their friends wearing facemasks and ease of finding masks in local stores). However, only children were significantly concerned with public perception of their appearance while wearing a mask. Females were more likely to wear masks, and caregivers with higher levels of education were more likely to encourage their children to wear masks. Children who commuted to schools by walking, biking, or motorbiking were also more accepting of mask-wearing than those who travelled by car or bus.

CONCLUSIONS

Children and their caregivers hold different perceptions of wearing masks to protect against air pollution. Children are more susceptible to social judgements regarding their appearance when wearing a mask.

Short-term residential exposure to air pollution and risk of acute myocardial infarction deaths at home in China

Air pollution remains a major threat to cardiovascular health and most acute myocardial infarction (AMI) deaths occur at home. However, currently established knowledge on the deleterious effect of air pollution on AMI has been limited to routinely monitored air pollutants and overlooked the place of death. In this study, we examined the association between short-term residential exposure to China's routinely monitored and unmonitored air pollutants and the risk of AMI deaths at home. A time-stratified case-crossover analysis was undertaken to associate short-term residential exposure to air pollution with 0.1 million AMI deaths at home in Jiangsu Province (China) during 2016-2019. Individual-level residential exposure to five unmonitored and monitored air pollutants including PM1 (particulate matter with an aerodynamic diameter ≤ 1 μm) and PM2.5 (particulate matter with an aerodynamic diameter ≤ 2.5 μm), SO2 (sulfur dioxide), NO2 (nitrogen dioxide), and O3 (ozone) was estimated from satellite remote sensing and machine learning technique. We found that exposure to five air pollutants, even below the recently released stricter air quality standards of the World Health Organization (WHO), was all associated with increased odds of AMI deaths at home. The odds of AMI deaths increased by 20% (95% confidence interval: 8 to 33%), 22% (12 to 33%), 14% (2 to 27%), 13% (3 to 25%), and 7% (3 to 12%) for an interquartile range increase in PM1, PM2.5, SO2, NO2, and O3, respectively. A greater magnitude of association between NO2 or O3 and AMI deaths was observed in females and in the warm season. The greatest association between PM1 and AMI deaths was found in individuals aged ≤ 64 years. This study for the first time suggests that residential exposure to routinely monitored and unmonitored air pollutants, even below the newest WHO air quality standards, is still associated with higher odds of AMI deaths at home. Future studies are warranted to understand the biological mechanisms behind the triggering of AMI deaths by air pollution exposure, to develop intervention strategies to reduce AMI deaths triggered by air pollution exposure, and to evaluate the cost-effectiveness, accessibility, and sustainability of these intervention strategies.

Evaluation of S201086/GLPG1972, an ADAMTS-5 inhibitor, for the treatment of knee osteoarthritis in ROCCELLA: a phase 2 randomized clinical trial

OBJECTIVE

To evaluate the efficacy and safety of the anti-catabolic ADAMTS-5 inhibitor S201086/GLPG1972 for the treatment of symptomatic knee osteoarthritis.

DESIGN

ROCCELLA (NCT03595618) was a randomized, double-blind, placebo-controlled, dose-ranging, phase 2 trial in adults (aged 40-75 years) with knee osteoarthritis. Participants had moderate-to-severe pain in the target knee, Kellgren-Lawrence grade 2 or 3 and Osteoarthritis Research Society International joint space narrowing (grade 1 or 2). Participants were randomized 1:1:1:1 to once-daily oral S201086/GLPG1972 75, 150 or 300 mg, or placebo for 52 weeks. The primary endpoint was change from baseline to week 52 in central medial femorotibial compartment cartilage thickness (cMFTC) assessed quantitatively by magnetic resonance imaging. Secondary endpoints included change from baseline to week 52 in radiographic joint space width, Western Ontario and McMaster Universities Osteoarthritis Index total and subscores, and pain (visual analogue scale). Treatment-emergent adverse events (TEAEs) were also recorded.

RESULTS

Overall, 932 participants were enrolled. No significant differences in cMFTC cartilage loss were observed between placebo and S201086/GLPG1972 therapeutic groups: placebo vs 75 mg, P = 0.165; vs 150 mg, P = 0.939; vs 300 mg, P = 0.682. No significant differences in any of the secondary endpoints were observed between placebo and treatment groups. Similar proportions of participants across treatment groups experienced TEAEs.

CONCLUSIONS

Despite enrolment of participants who experienced substantial cartilage loss over 52 weeks, during the same time period, S201086/GLPG1972 did not significantly reduce rates of cartilage loss or modify symptoms in adults with symptomatic knee osteoarthritis.

Burden of asthma-like symptoms and a lack of recognition of asthma in Vietnamese children

OBJECTIVE

Lack of recognition of asthma in childhood results in unmet asthma treatment needs and leads to the risk of sub-optimal respiratory health. The present study assessed the prevalence of asthmatic under-recognition in middle school children in Vietnam.

METHODS

We conducted a school-based survey among 15,112 Vietnamese children. Most of them are aged from 13 to 14. Schools and students were recruited using multi-stage sampling. Respiratory symptoms were collected via self-report using a standardized tool from the International Study of Asthma and Allergies in Childhood. Under-recognition of asthma was defined as a presence of at least one asthma-like symptom but a negative response to having ever asthma. Associations were investigated using logistic regression.

RESULTS

Prevalence of asthma-like symptoms was 27.3% and prevalence of physician-diagnosed asthma was 8.5%. Over 80% of symptomatic children were not diagnosed with asthma. Under-recognition of asthma was found more in girls (adjusted odds ratio; aOR = 1.75; 95%CI: 1.54 to 1.98).

CONCLUSIONS

Asthma is significantly under-recognized in Vietnamese middle-school children. Urgent action is required to improve the recognition of asthma in Vietnam.

Air pollution and risk of respiratory and cardiovascular hospitalizations in a large city of the Mekong Delta Region

It is important to explore air pollution and health effects in developing cities for early prevention rather than waiting for conditions to deteriorate as in the current megacities. This study aims to investigate the short-term health effects of air pollution in a large city in the Mekong Delta Region (MDR) of Vietnam. Air pollution data from January 2015 to December 2018 were collected from the Environmental Monitoring Centre of Can Tho City. The data of respiratory and cardiovascular disease (CVD) admissions in 18 hospitals and medical centers were collected. A time-series regression analysis was conducted using distributed lag models to examine the relationship between the air pollutants and hospitalizations including the delayed effect up to 7 days. The research findings reveal that a 10 μg increase in PM₁₀ was associated with an increase of 2.5% in the risk of respiratory admission for all people and 2.2% in the risk of CVD admission for the elderly on the same day. The analysis stratified by age and sex indicates that PM10 resulted in a higher risk of respiratory admission among children (0-5 years old) and males compared with other groups. PM10 and NO₂ were significantly associated with CVD admission among the elderly at lag 4 and 6 days. The effects of other air pollutants (SO₂, O₃) were not observed in this study. As development continues in this region, there is an urgent need for intervention measures to minimize the health impacts associated with the expected increases in air pollution in the MDR.

The protective effect of green space on heat-related respiratory hospitalization among children under 5 years of age in Hanoi, Vietnam

Combined effects of global warming and rapid urbanization replace green spaces with urban facilities. Children in urban areas are at a higher risk of heat-related adverse health effects. Our study aimed to examine the protective effect of urban green space on heat-related respiratory hospitalization among children under 5 years of age in Hanoi, the capital city of Vietnam. We estimated district-specific meteorological conditions from 2010 to 2014 by using a dynamic downscaling approach with a fine-resolution numerical climate model. The green space in each district was calculated using satellite data. The attributable fraction of heat-related respiratory hospitalization was estimated using a two-stage model, including a distributed lag non-linear model (DLNM) coupled with multivariate meta-analysis. The association between heat-related respiratory hospitalization and green spaces at the district level was explored using a linear regression model. The central districts were more crowded and hotter, with less green spaces than the outer districts. At temperatures > 34 °C (extreme heat threshold), the hospitalizations in the central districts increased significantly; however, in the outer districts, the hospitalization rate was insignificant. On average, extreme heat attributed 0.33% to citywide hospitalization, 0.35% in the center, and 0.32% in the outer region. Every 1% increase in the green space fraction will reduce heat-related respiratory hospitalization risk by 3.8%. Heat significantly increased the risk of respiratory hospitalization among children under 5 years in Hanoi, Vietnam. These findings are valuable for authorities to consider strategies to protect children's health against the effects of heat, including increasing green space.

Avoidable burden of stomach cancer and potential gains in healthy life years from gradual reductions in salt consumption in Vietnam, 2019-2030: a modelling study

OBJECTIVE

Excess salt consumption is causally linked with stomach cancer, and salt intake among adults in Vietnam is about twice the recommended levels. The aim of this study was to quantify the future burden of stomach cancer that could be avoided from population-wide salt reduction in Vietnam.

DESIGN

A dynamic simulation model was developed to quantify the impacts of achieving the 2018 National Vietnam Health Program (8 g/d by 2025 and 7 g/d by 2030) and the WHO (5 g/d) salt reduction policy targets. Data on salt consumption were obtained from the Vietnam 2015 WHO STEPS survey. Health outcomes were estimated over 6-year (2019-2025), 11-year (2019-2030) and lifetime horizons. We conducted one-way and probabilistic sensitivity analyses.

SETTING

Vietnam.

PARTICIPANTS

All adults aged ≥ 25 years (61 million people, 48·4 % men) alive in 2019.

RESULTS

Achieving the 2025 and 2030 national salt targets could result in 3400 and 7200 fewer incident cases of stomach cancer, respectively, and avert 1900 and 4800 stomach cancer deaths, respectively. Achieving the WHO target by 2030 could prevent 8400 incident cases and 5900 deaths from stomach cancer. Over the lifespan, this translated to 344 660 (8 g/d), 411 060 (7 g/d) and 493 633 (5 g/d) health-adjusted life years gained, respectively.

CONCLUSIONS

A sizeable burden of stomach cancer could be avoided, with gains in healthy life years if national and WHO salt targets were attained. Our findings provide impetus for policy makers in Vietnam and Asia to intensify salt reduction strategies to combat stomach cancer and mitigate pressure on the health systems.

Gaps and Directions in Addressing Non-Communicable and Chronic Diseases in China: A Policy Analysis

OBJECTIVE

Non-communicable and chronic diseases (NCDs) have become a public health problem that seriously threatens the population's health, especially in rapidly industrialized countries. Given the complexity of managing NCDs, there is growing evidence that interventions embedding or incorporating health promotion strategies can help reduce the disease burden of NCDs. This review aims to identify and map existing control and prevention policies for NCDs in China and identify gaps or opportunities for policy modifications and development, to transfer evidence-based guidelines into empirical public health intervention practices and research.

DESIGN

A review was conducted to evaluate the policy documents to manage NCDs in China. Keywords "chronic disease", "health", and "policy" were used to search documents published on the Chinese official national websites. Nvivo 12.0 was used to conduct a content analysis of the policy documents.

RESULTS

Fifty-six NCD prevention policies were retrieved from the search, and ten documents that incorporated the health promotion component were analyzed. The Healthy China 2030 Plan and Recommendations on Implementing the Healthy China Action are the core health policies of China's Central Government. These, coupled with three nationwide community-based projects, have provided a foundational transformation platform for health promotion implementation.

CONCLUSION

This review revealed the Chinese Government's determination and commitment toward the prevention and control of NCDs and the promotion public health. Additional efforts and a focus on accelerating policy transformation and strengthening policy evaluation are required to achieve this commitment.

Main and added effects of heatwaves on hospitalizations for mental and behavioral disorders in a tropical megacity of Vietnam

Vietnam is highly vulnerable to climate change-related extreme weather events such as heatwaves. This study assesses the association between heatwaves and hospitalizations due to mental and behavioral disorders (MBDs) in Ho Chi Minh City (HCMC). We collected daily MBD hospital admissions data at the HCMC Mental Health Hospital from 2017 to 2019. Heatwaves effects were characterized into the main effect (i.e., the intensity of temperature during heatwaves) and the added effect (i.e., the duration of heatwaves). Time series Poisson regression coupled with a distributed lag linear model (DLM) was used to quantify the 14-day lags effect of heatwaves. Confounders including long-term trend, seasonality, days of the week, holidays, and relative humidity were included in the model. Heatwaves increased all-cause MBD hospitalization by 62% (95%Cl, 36-93%) for the main effect and by 8% (95% Cl, - 3% to 19%) for the added effect. Noticeably, the group aged 18-60 years old was affected by the main effect of the heatwave, while the group aged 61 years and older was affected by the added effect of the heatwave. The effects of heatwaves differed among groups of MBD hospitalizations. The mental and behavioral disorder group due to psychoactive substance use was significantly affected by the main effect of heatwaves (RR:2.21; 95%Cl:1.55-3.15). The group of schizophrenia, schizotypal and delusional disorders were highly vulnerable towards both the main and the added effect of heatwaves with RR = 1.50 (95%CI, 1.20-1.86) and RR = 1.14 (95%CI, 1.01-1.30), respectively.

Relationships between short-term ambient temperature exposure and kidney disease hospitalizations in the warm season in Vietnam: A case-crossover study

BACKGROUND

Under a warming climate, adverse health effects of heat are an increasing concern. We evaluated associations between short-term ambient temperature exposure and hospital admission for kidney disease in Vietnam.

METHODS

We linked province-level meteorologic data with admission data from 14 province-level hospitals (2003-2015). We used a case-crossover design to evaluate associations between daily ambient temperature metrics (mean, maximum, and minimum temperature and mean heat index) and risk of hospitalization for four kidney disease subtypes: glomerular diseases, renal tubulo-interstitial diseases, chronic kidney disease, and urolithiasis, including lagged (≤lag 14 days) and cumulative (≤lag 0-6 days) associations, during the warm season. We also evaluated independent associations with extreme heat days (defined as days with daily maximum temperature >95^th percentile of the provincial daily maximum temperature distribution). Akaike's information criterion and patterns of risk estimates across cumulative exposure time windows and single-day lags informed our selection of final models.

RESULTS

We included 58,330 hospital admissions during the warm season. Daily mean temperature averaged over the same day and the previous six days (lag 0-6 days) was associated with risk of hospitalization for each kidney disease outcome with odds ratios (per 1 °C increase in daily mean temperature) of 1.07 (95% confidence interval [CI]: 0.99, 1.16) for glomerular diseases, 1.06 (95% CI: 0.96, 1.17) for renal tubulo-interstitial diseases, 1.12 (95% CI: 1.00, 1.24) for chronic kidney disease, and 1.09 (95% CI: 1.02, 1.16) for urolithiasis. We found no additional independent associations with extreme heat. Results for the four temperature metrics were similar.

CONCLUSIONS

High ambient temperature was associated with increased risk of hospitalization for each kidney disease subtype, with the most convincing associations for chronic kidney disease and urolithiasis. Further laboratory and epidemiologic research is needed to confirm the findings and disentangle the underlying mechanisms.

The relationship between team dynamics with healthcare coordination and clinical work satisfaction among Commune Health Workers: A Bayesian model averaging study

OBJECTIVE

To determine the relationship between team dynamics with healthcare coordination and clinical job satisfaction of the community health workers (CHWs).

METHODS

A cross-sectional study was conducted among 133 health workers (including doctors, nurses, or midwives) at 21 Commune Health Cent in Quoc Oai District, Vietnam, from July 2015 to May 2017. A self-administered questionnaire consisting of 5-Likert items regarding team dynamics and healthcare coordination clinical work satisfaction was utilised. Descriptive statistics and correlation matrix were applied for seven factors of team dynamic, clinical work satisfaction, and patient care coordination queried by primary care providers. Bayesian model averaging (BMA) was used to identify the predictors of the level of team dynamics and healthcare coordination.

RESULTS

The mean score of overall team dynamics among the study participants was 4.08. Clinical work satisfaction and patient care coordination scores among resident physicians were higher than those of attending clinicians; however, the differences were not statistically significant. The results of BMA analysis indicated that team dynamics significantly associated with clinical work satisfaction, and it explains 9% of the total variance in clinical work satisfaction. Team dynamics level was also positively associated with patient care coordination. Patient care coordination was not a significant mediator between team dynamics and clinical work satisfaction.

CONCLUSION

Team dynamics is a potential contributor to improving patient care coordination and clinical job satisfaction of CHWs. As no significant correlation between patient care coordination and clinical job satisfaction was observed, to improve team performance, providing conditions that facilitate team building and teamwork should be conducted for CHWs in CHCs.

Prevalence of metabolic syndrome and its related factors among Vietnamese people: A systematic review and meta-analysis

BACKGROUND AND AIMS

Metabolic risk factors are the leading causes of mortality and morbidity in recent decades, yet the burden of metabolic syndrome (MetS) has not been carefully assessed in Vietnam. This review thus aims to examine the prevalence of MetS and its related factors in Vietnam.

METHODS

A systematic review was conducted using literature retrieved from PubMed/Medline, Web of Science, Embase, Scopus, and Google Scholar up until July 2021. We selected descriptive and analytical studies which reported the prevalence of MetS and related factors among healthy people aged less than 65 years old rather than morbid people in Vietnam. A meta-analysis with a random-effects model was applied to estimate the pooled prevalence from the included studies.

RESULTS

Eighteen studies with 35421 participants were included in the final analysis. The pooled MetS prevalence among the adult population in Vietnam was 16.1% (95% Confidence Interval (CI): 14.1%-18.1%). Higher prevalence was seen among females (17.3%, 95% CI: 13.8%-20.8%). Low level of High Density Lipoprotein-Cholesterol (HDL-C) was the most prevalent component (34.1%), followed by high triglycerides (33.3%). Being female, living in urban areas, having obesity, and having a higher body mass index or body fat percentage were associated with an increased likelihood of having MetS.

CONCLUSIONS

MetS was common in the Vietnamese population. Low HDL-C should be considered as an early detectable indicator for MetS screening programs at the population level. Appropriate interventions should be conducted for high-risk groups such as females, those living in urban areas, and obesity.

Effect of Elevated Ambient Temperature on Maternal, Foetal, and Neonatal Outcomes: A Scoping Review

This scoping review provides an overview of the published literature, identifies research gaps, and summarises the current evidence of the association between elevated ambient temperature exposure during pregnancy and adverse maternal, foetal, and neonatal outcomes. Following the PRISMA extension for scoping reviews reporting guidelines, a systematic search was conducted on CINAHL, PubMed, and Embase and included original articles published in the English language from 2015 to 2020 with no geographical limitations. A total of seventy-five studies were included, conducted across twenty-four countries, with a majority in the USA (n = 23) and China (n = 13). Study designs, temperature metrics, and exposure windows varied considerably across studies. Of the eighteen heat-associated adverse maternal, foetal, and neonatal outcomes identified, pre-term birth was the most common outcome (n = 30), followed by low birth weight (n = 11), stillbirth (n = 9), and gestational diabetes mellitus (n = 8). Overall, papers reported an increased risk with elevated temperature exposures. Less attention has been paid to relationships between heat and the diverse range of other adverse outcomes such as congenital anomalies and neonatal mortality. Further research on these less-reported outcomes is needed to improve understanding and the effect size of these relationships with elevated temperatures, which we know will be exacerbated by climate change.

The effect of high temperatures on risk of hospitalization in northern Vietnam

Vietnam is one Southeast Asian country most vulnerable to climate change. By the end of the twenty-first century, temperature could rise above 5°C across Vietnam according to the IPCC highest emission pathway scenario. However, research on the temperature-health effects from the geographically diverse sub-tropical northern region of Vietnam is limited making location specific health system preparedness difficult. This study examines the elevated temperature-hospitalization relationship for the seven provinces in northern Vietnam by using generalized linear and distributed lag models. A random-effect meta-analysis was used to estimate the pooled temperature hospitalizations risks for all causes, and for infectious, cardiovascular, and respiratory diseases. The pooled estimates show a significant effect of high temperature on hospitalizations for the same day (lag 0), when a 1°C increase in temperature above 24°C was significantly associated with 1.1% (95% CI, 0.9-1.4%) increased risk for all-cause hospital admissions, 2.4% (95% CI, 1.9-2.9%) increased risk for infectious disease admissions, 0.5% (95% CI, 0.1-0.9%) increased risk for cardiovascular disease admissions, and 1.3% (95% CI, 0.9-1.6%) increased risk for respiratory disease admissions. This research adds to the scant evidence examining heat and health morbidity effects in sub-tropical climates and has important implications for better understanding and preparing for the future impacts of climate change related temperature on Vietnam residents.

Sociodemographic, lifestyle, behavioral, and parental factors associated with sugar-sweetened beverage consumption in children in China

Objective

Evidence shows sugar-sweetened beverage (SSB) consumption is a risk factor for obesity and non-communicable diseases (NCDs) in children. Investigating the influential profiles, which have been examined insufficiently, will help to inform the reduction of SSB consumption. The present research examines the current trend in SSB consumption and associated factors among children in China, in order to inform policy development.

Methods

Secondary data was extracted from China’s Health and Nutrition Survey (CHNS; 2004, 2006, 2009, and 2011), a repeated cross-sectional research, and a Chi-squared test was applied to compare SSB consumption in the last year, queried by social demographical, `environmental, behavioral, and parental factors. Multilevel mixed-effects logistic regression was employed to examine the trend and effects of the multiple factors.

Results

A total of 6015 Chinese children aged 6–17 years were investigated. From 2004 to 2011, the percentage of SSB consumption in children increased from 72.6% to 90.3%. The prevalence in urban areas was higher than the prevalence in rural areas, higher in high schools than primary and middle schools, higher in east coast affluent provinces than other provinces, and higher in high-income households than low-income households. Other associated factors include children’s fast food and salty snacks preference, level of physical activity, sedentariness, and parental education. The strongest association with SSB consumption in children was the mother’s SSB consumption (adjusted odds ratio: 5.54, 95% CI: 3.17–9.67).

Conclusion

Children’s SSB consumption has increased significantly in China, and is associated with socio-economic, demographic, level of physical activity, food preference, and parental factors. Future strategies aimed at reducing SSB consumption among children need to consider these factors.

Analysis of crisis communication by the Prime Minister of Australia during the COVID-19 pandemic

Leadership and communication capabilities of federal leaders during crises are imperative to support and guide citizens' behaviors and emotions. The following content analysis examines crisis communication delivered by the Australian Prime Minister (PM), Scott Morrison during the COVID-19 pandemic. Communication delivered over seven months starting from the first reported case of COVID-19 in Australia, was analyzed through a process of coding to identify central organizing crisis communication frames and themes and measured against eleven main themes based on principles of Crisis and Emergency Risk Communication (CERC) recommended by the WHO and US Centers for Disease Control and Prevention. Transcripts were sourced from the PM's official website and 91 communiques were analyzed. Key epidemiological indicators and public health measures were reviewed over timeframe to examine changes in communication over the pandemic. Findings indicated that PM Morrison included many features of CERC within his official messaging. Our analysis revealed that the original framework was limited in its scope to encompass certain messages and thus the allocation of new frames,'public health and medical advice' and 'assuring and commending the public and institutions', allowed for a more thorough analysis of communication during a novel global health pandemic. The temporal analysis demonstrated that the government's policy and communication temporally followed case numbers and relative threat of the virus. This study has provided an in-depth review of CERC during the first phase of the COVID-19 pandemic. New frames and themes for the current CERC framework are suggested which can be transferable to other crises in Australia and other countries.

Impact of temperature on hospital admission for acute lower respiratory infection (ALRI) among pre-school children in Ho Chi Minh City, Vietnam

Changes in ambient temperature have been reported as an important risk factor for respiratory diseases among pre-school children. However, there have been few studies so far on the effects of temperature on children respiratory health in developing countries including Vietnam. This study examined the impact of short-term changes in ambient temperature on hospital admissions for acute lower respiratory infection (ALRI) among children aged less than 5 years old in Ho Chi Minh City (HCMC), Vietnam. Data on daily hospital admissions from 2013 to 2017 were collected from two large paediatric hospitals of the city. Daily meteorological data of the same period were also collected. Time series analysis was performed to evaluate the association between risk of hospitalisations and temperatures categorised by seasons, age, and causes. We found that a 1 °C increase in maximum temperature was associated with 4.2 and 3.4% increase in hospital admission for ALRI among children 3-5 years old during the dry season and the rainy season, respectively. Surprisingly, in the rainy season, a rise of 1°C diurnal temperature range (DTR) was significantly associated with a decrease from 2.0 to 2.5% risk of hospitalisation for ALRI among children <3 years old. These findings suggested that although high temperature is a risk factor for hospital admissions among children in general, other modifiable factors such as age, exposure time, air conditioning usage, wearing protective clothing, socioeconomic status, and behaviour may influence the overall effect of high temperature on hospital admissions of children <5 years old in HCMC. The findings of this study have provided evidence for building public health policies aimed at preventing and minimizing the adverse health effects of temperature on children in HCMC.

Using the health beliefs model to explore children's attitudes and beliefs on air pollution

OBJECTIVES

Traffic-related air pollution (TRAP) negatively impacts children's health. Self-protective measures are available, but population uptake is variable. It is essential to understand human beliefs and behaviours related to air pollution in order to understand the lack of self-protection in communities. As a prelude to undertaking a comprehensive assessment of children's attitudes and beliefs on the health effects of TRAP exposure, we sought to develop and validate an appropriate instrument.

STUDY DESIGN

This study used exploratory sequential mixed methods.

METHODS

This instrument, based on the constructs of the health belief model (HBM), aimed to determine factors predicting wearing a mask to protect against TRAP exposure. An initial literature-based questionnaire was modified using in-depth interviews, focus group discussions, and a quantitative survey pilot. This study included 121 school students and nine professional experts in Vietnam. The questionnaire was tested for content validity, agreement, test-retest reliability, and internal consistency.

RESULTS

The concordance of questionnaire items between two repeated assessments ranged from 47.2% to 78.3%, intraclass correlation coefficients ranged from 0.16 to 0.87 and Cronbach's internal reliability coefficient for the instrument was 0.60.

CONCLUSION

The self-administered instrument, based on the HBM, is suitable to understand health attitudes and beliefs related to self-protective behaviours to reduce TRAP exposure.

Dietary Salt Reduction, Prevalence of Hypertension and Avoidable Burden of Stroke in Vietnam: Modelling the Health and Economic Impacts

Dietary salt reduction has been recommended as a cost-effective population-wide strategy to prevent cardiovascular disease. The health and economic impact of salt consumption on the future burden of stroke in Vietnam is not known.

Objective: To estimate the avoidable incidence of and deaths from stroke, as well as the healthy life years and healthcare costs that could be gained from reducing salt consumption in Vietnam.

Methods: This was a macrosimulation health and economic impact assessment study. Data on blood pressure, salt consumption and stroke epidemiology were obtained from the Vietnam 2015 STEPS survey and the Global Burden of Disease study. A proportional multi-cohort multistate lifetable Markov model was used to estimate the impact of achieving the Vietnam national salt targets of 8 g/day by 2025 and 7 g/day by 2030, and to the 5 g/day WHO recommendation by 2030. Probabilistic sensitivity analysis was conducted to quantify the uncertainty in our projections.

Results: If the 8 g/day, 7 g/day, and 5 g/day targets were achieved, the prevalence of hypertension could reduce by 1.2% (95% uncertainty interval [UI]: 0.5 to 2.3), 2.0% (95% UI: 0.8 to 3.6), and 3.5% (95% UI: 1.5 to 6.3), respectively. This would translate, respectively, to over 80,000, 180,000, and 257,000 incident strokes and over 18,000, 55,000, and 73,000 stroke deaths averted. By 2025, over 56,554 stroke-related health-adjusted life years (HALYs) could be gained while saving over US$ 42.6 million in stroke healthcare costs. By 2030, about 206,030 HALYs (for 7 g/day target) and 262,170 HALYs (for 5 g/day target) could be gained while saving over US$ 88.1 million and US$ 122.3 million in stroke healthcare costs respectively.

Conclusion: Achieving the national salt reduction targets could result in substantial population health and economic benefits. Estimated gains were larger if the WHO salt targets were attained and if changes can be sustained over the longer term. Future work should consider the equity impacts of specific salt reduction programs.

A novel signature predicts recurrence risk and therapeutic response in breast cancer patients

Acetylserotonin O-methyltransferase (ASMT) is a key enzyme in the synthesis of melatonin. Although melatonin has been shown to exhibit anticancer activity and prevents endocrine resistance in breast cancer, the role of ASMT in breast cancer progression remains unclear. In this retrospective study, we analyzed gene expression profiles in 27 data sets on 7244 patients from 11 countries. We found that ASMT expression was significantly reduced in breast cancer tumors relative to healthy tissue. Among breast cancer patients, those with higher levels of ASMT expression had better relapse-free survival outcomes and longer metastasis-free survival times. Following treatment with tamoxifen, patients with greater ASMT expression experienced longer periods before relapse or distance recurrence. Motivated by these results, we devised an ASMT gene signature that can correctly identify low-risk cases with a sensitivity and specificity of 0.997 and 0.916, respectively. This signature was robustly validated using 23 independent breast cancer mRNA array data sets from different platforms (consisting of 5800 patients) and an RNAseq data set from TCGA (comprising 1096 patients). Intriguingly, patients who are classified as high-risk by the signature benefit from adjuvant chemotherapy, and those with grade II tumors who are classified as low-risk exhibit improved overall survival and distance relapse-free outcomes following endocrine therapy. Together, our findings more clearly elucidate the roles of ASMT, provide strategies for improving the efficacy of tamoxifen treatment and help to identify those patients who may maximally benefit from adjuvant or endocrine therapies.

Who Are the Flourishing Emerging Adults on the Urban East Coast of Australia?

It is increasingly recognised that strategies to treat or prevent mental illness alone do not guarantee a mentally healthy population. Emerging adults have been identified as a particularly vulnerable population when it comes to mental health concerns. While mental illnesses are carefully monitored and researched, less is known about mental wellbeing or flourishing, that is, experience of both high hedonic and eudaimonic wellbeing. This cross-sectional study examined the prevalence of flourishing and its predictors among emerging adults in Australia. 1155 emerging adults aged 18-25 years completed a survey containing measures of wellbeing, social networks, social connectedness, health status, and socio-demographic variables. Most participants (60.4%) experienced moderate levels of wellbeing, 38.6% were flourishing and 1% were languishing (low wellbeing). Flourishers were more likely to be older, identify as Indigenous, be in a romantic relationship, study at university, perceive their family background as wealthy, rate their general health status as excellent, and have higher perceived social resources. The findings show that the majority of emerging adults are not experiencing flourishing and offer an insight into potential target groups and settings, such as vocational education colleges, for emerging adult mental health promotion. Interventions that help strengthen social resources have the potential to improve the mental wellbeing of emerging adults.

Does Flourishing Reduce Engagement in Unhealthy and Risky Lifestyle Behaviours in Emerging Adults?

Emerging adulthood is a transitional life stage with increased probability of risky and unhealthy lifestyle behaviours that are known to have strong links with premature mortality and morbidity. Wellbeing, as a positive subjective experience, is identified as a factor that encourages self-care and may steer individuals away from risky lifestyle behaviours. Investigating wellbeing-behaviour links in the emerging adult population may increase understanding of the factors that lead to, and ways to prevent, engagement in risky behaviours. This study examines the association between flourishing, that is, the experience of both high hedonic and eudaimonic wellbeing, and a broad range of risky and unhealthy lifestyle behaviours among emerging adults in Australia. A cross-sectional survey of 1155 emerging adults aged 18-25 years measured wellbeing, socio-demographics, and six groups of lifestyle behaviours surrounding substance use, physical activity, diet, sex, sun protection, and driving. Bivariate and multivariate statistics were used to analyse the data. The findings revealed that flourishing was negatively associated with more dangerous types of risk behaviours, such as driving under the influence of drugs, and positively associated with self-care behaviours, such as healthier dietary behaviour and sun protection. If enabling emerging adults to flourish can contribute to reduced engagement in risky/unhealthy lifestyle behaviours, then promoting it is an important goal for health promotion efforts not only because flourishing is desirable in its own right, but also to bring about sustainable change in behaviour. Further research is needed to inform the designs of such interventions.

The effectiveness of workplace health promotion in low- and middle-income countries

Although many literature reviews synthesize literature regarding workplace health promotion (WHP) interventions, systematic reviews on the effectiveness of and factors influencing the operation of WHP activities in low- and middle-income countries (LMIC) are scarce. Therefore, we systematically reviewed evaluation studies to examine the effectiveness and factors related to the implementation of WHP programmes in LMIC. Twenty-six peer-reviewed and grey evaluation studies, published before November 2017, were included from electronic databases (PubMed, The Cochrane Library, PsycINFO, EMBASE and Web of Science) and manual searching. The results revealed that WHP intervention in LMIC was effective in reducing health risks in a wide range of industries and settings, including in resource-poor contexts such as small enterprises and the manufacturing industry. The main factors positively influencing the effectiveness of the intervention are long intervention time period, and needs-based and active intervention strategies. In addition, commitment from workplace leaders, the involvement of workers and support from authorities and professionals are factors contributing to a successful WHP programme. However, the evidence regarding the effectiveness of WHP in LMIC regarding the health outcomes and business productivity is inconclusive due to the several remaining methodological limitations. Future developments of more rigorous methods of evaluating the effectiveness of WHP activities should be addressed to produce higher-quality evidence that would inform future practice.

FRI0393 BASELINE CHARACTERISTICS OF THE STUDY POPULATION IN ROCCELLA, A PHASE 2 CLINICAL TRIAL EVALUATING THE EFFICACY AND THE SAFETY OF S201086/GLPG1972 IN PATIENTS WITH KNEE OSTEOARTHRITIS

Background:

Osteoarthritis (OA) is a degenerative joint disease involving structural pathology of all joint tissues, and most commonly affecting the knee, hip and hand. Degradation of the cartilage extracellular matrix represents a central feature of OA and is widely thought to be mediated by proteinases that degrade primarily aggrecan and collagen. ADAMTS-5, a Disintegrin And Metalloproteinase with ThromboSpondin-motif-5, is a key aggrecan-cleaving enzyme involved in cartilage degradation. S201086/GLPG1972, a potent and highly selective inhibitor of ADAMTS-5, is an oral Disease-Modifying OsteoArthritis Drug (DMOAD) candidate.

Objectives:

The primary objective of the ROCCELLA phase 2 clinical trial (NCT03595618) is to evaluate the effect of S201086/GLPG1972 over 52 weeks of treatment (3 dose groups compared to placebo) in reducing cartilage loss. Cartilage thickness of the knee is being measured quantitatively by Magnetic Resonance Imaging. Here, we describe the baseline characteristics of patients included in the ROCCELLA clinical trial.

Methods:

The main inclusion criteria were: male or female, aged 40 to 75, with a diagnosis of knee OA according to the clinical and radiological criteria of the American College of Rheumatology. The target knee had to meet a pain score between 40 and 90 mm on a 100 mm Visual Analog Scale (VAS), and the following radiographic feature upon central radiographic readings: Kellgren/Lawrence (KL) 2 or 3 and OARSI medial joint space narrowing (JSN) 1 or 2 (for more details see Deckxet al. OARSI 2020). The rationale for these specific radiographic inclusion criteria was to ensure sufficient cartilage loss over 12 months to assess the efficacy of S201086/GLPG1972.

Results:

Across 12 countries, 3319 patients were screened and 932 were finally included in the study. The screen failure of 72% is mainly due to the radiological criteria. The age of the patients was 62.9 ± 7.3 years (mean ± SD) with a majority of women (69.3%). The BMI was 30.5 ± 4.7 kg/m2. The duration of knee OA was 7.2 ± 6.9 years. Five hundred and one (53.8%) patients reported a medical history of musculoskeletal and connective tissue disorders, mainly osteoarthritis in other sites (20.2%), back pain (13.6%), and arthralgia (9.8%). At inclusion, 97.2% of the patients were taking different types of drug treatments, mainly anti-inflammatory and anti-rheumatic products (69.4%) and analgesics (42%). At baseline, 11% of the target knees were KL2 and 89% were KL3; 32% were OARSI medial JSN grade 1 and 68% grade 2. Target knees at inclusion had a pain score on the VAS of 63.5 ± 11.4 mm (range 0-100, with 0 for no and 100 for extreme pain) and a total WOMAC (Likert 3.1) score of 48.0 ± 15.0 (range 0-96). The WOMAC subscores for pain, stiffness and physical function were 10.0 ± 3.2 (range 0-20), 4.2 ± 1.6 (range 0-8) and 33.8 ± 11.2 (range 0-68, indicating functional limitation), respectively.

Conclusion:

For this clinical trial, patients were selected to present radiological criteria (i.e.OARSI JSN 1 and 2) to ensure sufficient structural progression (cartilage loss) over 12 months, as well as clinical symptoms. These stringent selection criteria were the main cause for the high screen failure rate. These baseline characteristics should warrant the ability to evaluate the efficacy of S201086/GLPG1972 as a DMOAD candidate. The search for an effective pharmacological treatment that can prevent or cure OA remains a major challenge and unmet medical need.

Disclosure of Interests:

Katy Bernard Employee of: Institut de Recherches Internationales Servier, Sergey GRANKOV Employee of: Institut de Recherches Internationales Servier, Marjolijne van der Stoep Employee of: Galapagos, Agnès Lalande Employee of: Institut de Recherches Internationales Servier, Olivier Imbert Employee of: Institut de Recherches Internationales Servier, De Phung Employee of: Galapagos, Damien Chimits Employee of: Institut de Recherches Internationales Servier, Karine Muller Employee of: Galapagos, Ellen van der Aar Employee of: Galapagos, Henri Deckx Employee of: Galapagos, Maria Pueyo Employee of: Institut de Recherches Internationales Servier, Felix Eckstein Grant/research support from: Merck, Orthotrphix, Servier, Galapagos, Kolon Tissuegene, Samumed, Novartis, Consultant of: Merck, Bioclinica, Servier, Samumed, Roche, Kolon Tissuegene, Galapagos and Novartis, Employee of: co-owner and employment with Chondrometrics

Spatial patterns of health vulnerability to heatwaves in Vietnam

The increasing frequency and intensity of heat events have weighty impacts on public health in Vietnam, but their effects vary across regions. In this study, we have applied a vulnerability assessment framework (VAF) to systematically assess the spatial pattern of health vulnerability to heatwaves in Vietnam. The VAF was computed as the function of three dimensions: exposure, sensitivity, and adaptive capacity, with the indicators for each dimension derived from the relevant literature, consultation with experts, and available data. An analytic hierarchy process (AHP) was used to determine the weight of indicators. Each province in Vietnam's vulnerability to the health impacts of heatwaves was evaluated by applying the vulnerability index, computed using 13 indicators (sensitivity index, 9; adaptive capacity index, 3; and exposure index, 1). As a result of this analysis, this study has identified heatwave vulnerability 'hotspots', primarily in the Southeast, Central Highlands, and South Central Coast of Vietnam. However, these hotspots are not necessarily the same as the area most vulnerable to climate change, because some areas that are more sensitive to heatwaves may have a higher capacity to adapt to them due to a host of factors including their population characteristics (e.g. rates of the elderly or children), socio-economic and geographical conditions, and the availability of air-conditioners. This kind of information, provided by the vulnerability index framework, allows policymakers to determine how to more efficiently allocate resources and devise appropriate interventions to minimise the impact of heatwaves with strategies tailored to each region of Vietnam.

Temporal relationships between climate variables and hand-foot-mouth disease: a multi-province study in the Mekong Delta Region, Vietnam

Hand-foot-mouth disease (HFMD) is an emerging infectious disease that affects thousands of children every year in Vietnam, especially in the Mekong Delta Region (MDR). This study aims to analyse both provincial and regional level effects of climate factors on HFMD in multiple provinces of this high-risk region. Generalized linear models were used to analyse the daily effects of average temperature, humidity and rainfall on HFMD incidence in each province (provincial-level effects), and random-effect meta-analysis was used to estimate the pooled effect size of these climate-HFMD associations (regional-level effects). Daily effects of the climate factors on HFMD were found at both provincial level and regional level. At provincial level, temperature and humidity had statistically significant positive associations with HFMD while rainfall had both positive and negative associations with HFMD at different lag days. At regional level, temperature and humidity were positively associated with HFMD at lag 0 days (1.7%; 95%CI 0.1%-3.3%) and at lag 3 days (0.3%; 95%CI 0.1%-0.5%), respectively. In contrast, rainfall was found to be negatively associated with HFMD at lag 5 days (- 0.3%; 95%CI - 0.4% to - 0.1%). Heterogeneities of the effects of rainfall on HFMD were found to be higher than those of temperature or humidity. This is the first study to address the climate-HFMD associations in multiple provinces of the MDR. These associations draw attention to climate-related health issues and will help in developing an environment-based early warning system for HFMD prevention and control.

Particulate air pollution in Ho Chi Minh city and risk of hospital admission for acute lower respiratory infection (ALRI) among young children

High levels of air pollutants in Vietnam, especially particulate matters including PM_2.5, can be important risk factors for respiratory diseases among children of the country. However, few studies on the effects of ambient air pollution on human health have been conducted in Vietnam so far. The aim of this study is to examine the association between PM_2.5 and hospital admission due to acute lower respiratory infection (ALRI) among children aged < 5 years old in Ho Chi Minh city, the largest city of Vietnam. Data relating PM_2.5 and hospital admission were collected from February 2016-December 2017 and a time series regression analysis was performed to examine the relationship between PM_2.5 and hospital admission including the delayed effect up to three days prior to the admission. We found that each 10 μg/m³ increase in PM_2.5 was associated with an increase of 3.51 (95%CI: 0.96-6.12) risk of ALRI admission among children. According to the analysis, male children are more sensitive to exposure to PM_2.5 than females, while children exposed to PM_2.5 are more likely to be infected with acute bronchiolitis than with pneumonia. The study demonstrated that young children in HCMC are at increased risk of ALRI admissions due to the high level of PM_2.5 concentration in the city's ambient air.

Development and validation of a prognostic model for overall survival in chemotherapy-naïve men with metastatic castration-resistant prostate cancer

Background

Prognostic models are needed that reflect contemporary practice for men with metastatic castration-resistant prostate cancer (mCRPC). We sought to identify predictive and prognostic variables for overall survival (OS) in chemotherapy-naïve men with mCRPC treated with enzalutamide.

Patients and methods

Patients from the PREVAIL trial database (enzalutamide versus placebo) were randomly split 2 : 1 into training (n = 1159) and testing (n = 550) sets. Using the training set, 23 predefined variables were analyzed and a multivariable model predicting OS was developed and validated in an independent testing set.

Results

Patient characteristics and outcomes were well balanced between training and testing sets; median OS was 32.7 months in each. The final validated multivariable model included 11 independent prognostic variables. Median OS for low-, intermediate-, and high-risk groups (testing set) defined by prognostic risk tertiles were not yet reached (NYR) (95% CI NYR-NYR), 34.2 months (31.5-NYR), and 21.1 months (17.5-25.0), respectively. Hazard ratios (95% CI) for OS in the low- and intermediate-risk groups versus high-risk group were 0.20 (0.14-0.29) and 0.40 (0.30-0.53), respectively. Secondary outcomes of response and progression differed widely in model-defined risk groups. Enzalutamide improved outcomes in all prognostic risk groups.

Conclusions

Our validated prognostic model incorporates variables routinely collected in chemotherapy-naïve men with mCRPC treated with enzalutamide, identifying subsets of patients with widely differing survival outcomes that provide useful information for external validation, patient care, and clinical trial design.

Trial registration

ClinicalTrials.gov: NCT01212991.

Association between salinity and hospital admission for hypertension: an ecological case-control study in the Mekong Delta Region in Vietnam

Background

Drinking water in the Mekong Delta Region (MDR) is highly vulnerable to salinity intrusion and this problem is expected to increase with the projected climate change and sea level rise. Despite this, research on health effects of saline contaminated water is scarce in this region. This study examines the risk of hospital admission for hypertension in salinity-affected areas of the MDR.

Methods

Cases and controls were obtained from national/provincial hospital admission records for 2013. The cases were adult patients whom hypertension (ICD10-code: I10-I15) was primary diagnosis for admission. Of the 13 provinces in the MDR, we identified seven as 'salinity exposed' and the remaining as 'non-exposed' areas. A multi-level logistic regression model was used to examine the association between salinity exposure and hypertension outcome.

Results

Of the total 573 650 hospital admissions, 22 382 (~3.9%) were hypertensive cases. The multi-level logistic model combining both individual and ecological factors showed a 9% increase in risk (95% CI: 3-14%) of hypertension admission among individuals in exposed areas compared to those in non-exposed areas.

Conclusion

In order to develop and promote appropriate adaptation strategies, further research is recommended to identify the salt exposure pathways and consumption behaviours in the salinity exposed areas.

Characteristics of neonicotinoid imidacloprid in urine following exposure of humans to orchards in China

Imidacloprid (IMI) is a typical neonicotinoid with the largest usage in agricultural orchards in China. The long-term repeated use and the lack of proper protective measures may result in rural farmers and people living near orchards to be inevitably exposed to IMI. Excessive exposure may cause potential adverse effects on human health. To explore the characteristics of human exposure to IMI in urine, different groups of people, including pesticide applicators and their family members, and kindergarten children near IMI-applied orchards were investigated. The IMI and metabolite, 6-chloronicotinic acid (6-CNA), concentrations in urine were creatinine-adjusted to compensate for a possible dilution effect. Target analytes were detected in 100% of 1926 urine samples. The results showed that the IMI concentration in the 1-d urine from the rural residents significantly increased after a spraying event (p < 0.05) and reached the highest concentration (Geomean: 16.42 μg/g creatinine for IMI; 7.33 μg/g creatinine for 6-CNA) in the 2-d urine samples. The pesticide applicators of different genders had almost the same exposure environment (IMI Geomean of 13.25 μg/g creatinine for males and 14.71 μg/g creatinine for females) (p > 0.05). Females had higher exposure concentrations than that of males. People from different villages demonstrated diverse exposure levels with Geomean differences of 1.13-3.28 fold. For 3-6 years-old children, urinary concentrations from the rural group (Geomean: 3.73 μg/g creatinine for IMI; 3.95 μg/g creatinine for 6-CNA) were significantly higher than that of the urban group (Geomean: 1.13 μg/g creatinine for IMI; 0.88 μg/g creatinine for 6-CNA) (p = 0.00001), and the younger children tended to have higher exposure risk. Our findings showed that people in the Henan orchard areas were likely exposed to IMI to varying degrees. Further research on the health risk evaluation of IMI and controlling the exposure risks is needed.

Understanding the Operational Concept of a Flood-Resilient Urban Community in Jakarta, Indonesia, from the Perspectives of Disaster Risk Reduction, Climate Change Adaptation and Development Agencies

Climate change-related extreme events such as floods have and will continue to present a great challenge to disaster risk management. There is a pressing need to develop a robust management strategy via enhancing the resiliency of the community, particularly in the context of complex urban environments, like Jakarta. Resilience is conceptualized within specific contexts and uniquely tailored to the targeted setting, yet research regarding the operational concept of a flood-resilient community in the context of Jakarta remains limited. This paper will elaborate this operational concept through understanding the desirable features and influential barriers of a flood-resilient community through the lenses of three main stakeholder groups: disaster risk reduction (DRR), climate change adaptation (CCA), and development. It will also discuss the ways in which the synergies that exist across these groups can be enhanced. Both quantitative and qualitative approaches were applied in this study, and multiple sources of data were used. The findings indicate that these groups share common views regarding the importance of human aspects being central to resilience building efforts. We argue there is an urgent need to shift the flood resilience building paradigm towards building community resilience from the people and to apply a collaborative governance approach to facilitate effective partnership between the actors involved.

297Seeing is believing: the feasibility and acceptability of using wearable cameras to enhance self-management of heart failure

Introduction

For people with heart failure (HF), self-management (e.g., adhering to prescribed medication, management of fluid restrictions and daily weighing) and dietary management is critical for disease management. The rise of technologies (mobile phones, wearable cameras) for healthcare use offers potential support for people to better manage their disease. We aimed to test the feasibility and utility of wearable cameras for identifying self-management practices and to determine if these images can be used to enhance self-management in people with HF.

Methods

Participants wore the “narrative clip”, a small wearable camera for one month during waking hours; still images were taken every 30 seconds. Using state-of-the-art artificial intelligence techniques, we investigated automated image analysis of daily life activities to determine the potential of these systems to identify four categories of human activities: medication management, dietary intake, meal preparation and physical activity. Participants also completed a semi-structured questionnaire about acceptability and feasibility.

Results

30 participants (mean age 73.6 years, 60% male) with HF NYHA Class II-III were recruited. A total of 629,603 images were available for analysis. Higher order analyses were conducted to determine precision of identifying correct images for the pre-defined self-management categories. Precision of identifying the correct images was highest in dietary intake (average 49%, range 13–94%) followed by meal preparation (average 40%, range 1–99%) and physical activity (average 31%, range 0–95%). Medication management had the lowest precision (average 6%, range 6–22%). Manual review of images revealed substantial periods of sedentary time, typically paired with screen time (watching television, playing cards on a computer). All participants agreed the camera was easy to use and felt they had privacy when using the camera. The majority of participants felt comfortable wearing the camera (93%) and thought this technique will help people with HF in the future (93%).

Conclusions

Images from wearable cameras provided rich contextual data to better understand the lived experiences of people with HF and the device was acceptable to participants. Automated machine learning tools require more annotated data for training to enhance precision, which will be achieved via further annotation, fine-tuning and retraining the data analysis model. Despite these challenges, the data collected can be used as an adjunct to traditional data collection methods such as self-report. Once data analysis techniques are refined, objective data from wearable cameras may also prove useful for nurses to provide tailored education for self-management.

Acknowledgement/Funding

Heart Foundation Vanguard Grant, Australia (101348)

Impact of ambient air pollution and wheeze-associated disorders in children in Southeast Asia: a systematic review and meta-analysis

Several systematic reviews have been conducted so far to examine the effect of air pollution on respiratory diseases, but there has not been a corresponding meta-analysis to estimate the effect sizes for wheeze-associated diseases/disorders, which is one of the leading causes of emergency department visits and hospitalizations for children worldwide. The aim of this review is to systematically evaluate the relationship between air pollution and risk of wheeze-associated disorders in children in Southeast Asia. We searched the relevant computerized databases (PubMed, EMBASE, Web of Science, Scopus and Cochrane library) for indexed publications up to July 2018. Finally, eight studies were qualified for performing a random-effect meta-analysis to compute the pooled effect sizes. The results show that each increase of 10 μg/m3 in concentrations of PM2.5, PM1 was associated with 1-2% increase in risk of wheeze-associated disorders. Positive associations were found for PM10, SO2, NO2, NOx but no association was found for CO and O3. We confirmed the strong effect of fine particulate matters on respiratory health and recommend an updated meta-analysis should be done when more studies are available.

Urinary monitoring of neonicotinoid imidacloprid exposure to pesticide applicators

Neonicotinoid pesticides have recently drawn attention worldwide owing to their potential adverse effects on non-target organisms and ecosystems. Exposure to imidacloprid, the most widely used neonicotinoid insecticide, is of particular concern among rural populations because of its ubiquitous use in agriculture. Hence, biological monitoring of urinary imidacloprid and its major metabolite 6-chloronicotinic acid (6-CNA) was performed using Polar Enhanced Polymer solid-phase extraction by LC-MS/MS with mean recoveries of 78.3-109.8% and limits of quantitation at 0.029-0.038 ng/mL. Imidacloprid was detected in 100% of urine samples from rural applicators at concentrations of 0.21-8.91 ng/mL (0.06-9.60 μg/g creatinine) and 0.11-24.58 ng/mL (0.66-57.40 μg/g creatinine) before and after pesticide application, respectively. Significant increase in urine concentration (3.52- to 3.77-fold) of imidacloprid and 6-CNA was observed after local imidacloprid field application (p ≤ 0.001). The estimated absorbed daily dose (ADD) for imidacloprid was 0.52-248.05 μg/kg/d, indicating that attention should be paid to potential health risks for applicators because of increased imidacloprid exposure at level of significance (p < 0.05). This study is the first to report ADD estimation for imidacloprid, thereby providing an important reference for further human health risk evaluation.

Impacts of helmet law on the changes in potential years of life lost due to traffic injury: a multiple-province evaluation in Vietnam

INTRODUCTION

This study aimed to evaluate the impact of the helmet law on the changes in potential years of life lost (PYLL) due to traffic mortality and to examine modification effects of socioeconomic factors on the impacts in Vietnam.

METHODS

We applied an interrupted time series design using the Bayesian framework to estimate the impact of the law at the provincial level. Then, we used random effects meta-analysis to estimate the impact of the law at the country level and to examine the modification effects of socioeconomic factors.

RESULTS

The results indicate that the impacts varied among the provinces. These impacts could be classified by four main groups comprising positive impact, and positive impact without sustainability, possible positive impact, negative or inconsistent impact. For the country-level impact, the results reveal a significantly consistent change in monthly PYLLs at the level of 18 per 100 000 persons, and the post-trend was stable without significant change. The results of meta-regression show that 1 unit increase in the population density (persons/km²), migration rate (%) and income (×1000 dong) are non-significantly associated with increases of PYLLs at 1.3, 27 and 27 per 100 000 person-months, respectively, whereas 1% increase in literacy associated with a decrease of PYLL at 44 per 100 000 person-months.

DISCUSSION

Further studies should be warranted to provide a comprehensive evaluation of the law implementation, including its acceptability, adoption, appropriateness, feasibility, cost-effectiveness and sustainability.

Health professionals in a changing climate: protocol for a scoping review

INTRODUCTION

Climate change will impose significant health impacts. Although we know health professionals should play a critical role in protecting human health from climate change, their preparedness to engage with these issues worldwide is unclear. This study aims to map the range and nature of existing evidence regarding health professionals' knowledge, attitudes, perceptions and practices regarding climate change and health impacts and the challenges they face, and identify knowledge gaps to guide future development of research, policy and practices.

METHODS AND ANALYSIS

We will perform a scoping review based on the six-stage framework proposed by Arksey and O'Malley. Our study includes peer-reviewed literature focusing on any aspect of health professionals' work regarding climate change and health since 2002 and indexed in MEDLINE/Pubmed, Web of Science, Scopus or Embase. Identified papers will be described and assessed. Thematic analysis will be applied to evaluate and categorise the study findings.

IMPLICATIONS AND DISSEMINATION

This is the first scoping review of health professionals' activities to anticipate and prepare for health impacts attributable to climate change. It will provide evidence regarding the current situations worldwide and gaps in preparedness. The findings can be used to highlight accomplishments to date, identify gaps and further develop good practices for health professionals' engagement. The results will be published in the peer-reviewed literature and shared at health professional society meetings.

Effects of Extreme Temperatures on Mortality and Hospitalization in Ho Chi Minh City, Vietnam

There is a lack of research focusing on the association of temperature with mortality and hospitalization in developing countries with tropical climates and a low capacity to cope with the influences of extreme weather events. This study aimed to examine and compare the effect of temperature, including heat waves, on mortality and hospitalization in the most populous city of Vietnam. We used quasi-Poisson time series regression coupled with the distributed lag non-linear model (DLNM) to examine the overall pattern and compare the temperature-health outcome relationship. The main and added effects of heat waves were evaluated. The main effect of heat waves significantly increased the risk of all cause-specific mortality. Significant main effects of heat waves on hospitalization were observed only for elderly people and people with respiratory diseases (elderly, relative risk (RR) = 1.28, 95% confidence interval (CI) = 1.14–3.45; respiratory diseases, RR = 1.3, 95% CI = 1.19–1.42). The RRs of the main effect were substantially higher than those of the added effect in mortality; the same was applicable for hospitalizations of people with respiratory diseases and elderly people. The findings of this study have important implications for public health adaptation and prevention program implementation in the protection of residents from the adverse health effects of temperature.

Is the World Health Organization predicted exposure assessment model for space spraying of insecticides applicable to agricultural farmers?

Agricultural farmers in developing countries are at high risk of pesticide exposure and adverse effects because of unsafe practices and inappropriate legislation. Biological monitoring is considered a useful tool for pesticide exposure assessment; however, its use is limited in developing countries due to a lack of techniques and resources such as laboratory analysis, trained staff and budgets. This study examines whether the World Health Organization predicted exposure assessment model (WHO-PEAM) is a suitable alternative tool for assessing insecticide exposure among agricultural farmers. WHO-PEAM was used to predict daily doses (PDD) of chlorpyrifos for a group of Vietnamese rice farmers using a set of exposure parameters obtained from a questionnaire survey of participant famers during a field study. These results were compared to absorbed daily doses (ADD) of chlorpyrifos for the farmers measured using a biological monitoring program, in which 24-h urine samples were collected and analysed for the chlorpyrifos metabolite, 3,5,6-trichloro-2-pyridinol (TCP) using LC/MS. Validation of the model results was tested using the Wilcoxon signed-rank test (WSR) and two-way mixed-model intraclass correlation coefficient (ICC). The mean of total ADD was 20 μg/kg/day while that of total PDD was 22 μg/kg/day. The WSR test revealed no statistically significant difference in the average values of ADD_T and PDD_T. ICC indicated substantial agreement for both single and average measures between ADD_T and PDD_T (ICC, 0.62 and 0.77, respectively). The results demonstrate that a refined WHO-PEAM model can be readily used as a field method, without biological monitoring, to evaluate chlorpyrifos exposure among agricultural farmers in Vietnam and similar developing countries.

Effects of temperature on hospitalisation among pre-school children in Hanoi, Vietnam

This study examined the effect of short-term changes in ambient temperature on hospital admissions among children aged less than 5 years old in Hanoi, Vietnam. Data on daily hospital admissions from January 2010 to June 2014 were collected from two hospitals. Daily meteorological data were obtained for the same period. We applied time series analysis to evaluate the risk of hospitalisation related to hot and cold weather by age and causes. We found that a 1 °C decrease in minimum temperature during the cold weather months was associated with 2.2% increase in hospital admission for respiratory infection among children 3-5 years old. A 1 °C increase in diurnal temperature range (DTR) in cold weather was associated with an increase of 1.9% and 1.7% in hospitalisation for all causes and respiratory infection, respectively, among children < 3 years old and an increase of 1.8% and 3.4% in hospitalisation for all causes and respiratory infection, respectively, among children of 3-5 years old. Negative associations between hot weather and hospital admissions were demonstrated. These findings suggested that low temperature and DTRs in winter are important risk factors for hospital admissions among children aged < 5 years old in Hanoi. Other factors may have modified the effect of high temperature on hospital admissions of children in Hanoi.

Mortality burden attributable to heatwaves in Thailand: A systematic assessment incorporating evidence-based lag structure

BACKGROUND

Available information on the acute and cumulative effects of heatwaves on cause-specific mortality in Thailand is scarce.

OBJECTIVES

To quantify the acute and cumulative effects of heatwaves on mortality in Thailand, and assess heatwave-related mortality burden.

METHODS

Thirty heatwave definitions were used and categorized into three groups: low intensity heatwaves (HW_low), middle intensity heatwaves (HW_middle), and high intensity heatwaves (HW_high). Time-series analyses were conducted to examine the acute and cumulative effects of HW_low, HW_middle, and HW_high on total and cause-specific mortality in 60 provinces of Thailand, incorporating an optimal lag for each cause and each province. Random-effects meta-analyses were performed to pool provincial estimates to national estimates for both acute and cumulative effects. Meta-regressions were conducted to identify the possible factors contributing to the spatial heterogeneity of heatwave vulnerability.

RESULTS

The cumulative effects of HW_low and HW_middle on total and cause-specific mortality were greater than HW_high. Both acute and cumulative effects of HW_low, HW_middle and HW_high on neoplasms and certain infectious and parasitic diseases were among the highest across all death causes. Effects of heatwaves on deaths from endocrine, nutritional and metabolic diseases appeared to be longer-lasting, and effects of heatwaves on deaths from ischaemic heart diseases and pneumonia occurred more rapidly. Northern and Central Thailand were the regions vulnerable to heatwaves, and proportion of elderly population was the major driver behind the spatial heterogeneity of heatwave vulnerability.

CONCLUSIONS

More attention needs to be paid to mild heatwaves. Future heatwave-related mortality burden due to neoplasms and infectious diseases in Thailand may increase as climate change continues.