Potential for Forecasting UK Summer Grass Growth from the North Atlantic Oscillation

The North Atlantic Oscillation (NAO) is a large-scale atmospheric circulation pattern which is well-known to influence the UK winter climate (Wilby et al., 1997). Recently, it has been shown that the winter NAO also affects summer rainfall in the UK (Kettlewell et al., 2003). Since water supply is an important limitation to summer grass growth in many parts of the UK, the winter NAO may influence summer growth. The objective of this study was to test the hypothesis that there is a relationship between the winter NAO and summer grass growth using data from reference plots at North Wyke in Devon

Developing health-related indicators of climate change: Australian stakeholder perspectives

Published: 22 May 2017Climate-related health indicators are potentially useful for tracking and predicting the adverse public health effects of climate change, identifying vulnerable populations, and monitoring interventions. However, there is a need to understand stakeholders' perspectives on the identification, development, and utility of such indicators. A qualitative approach was used, comprising semi-structured interviews with key informants and service providers from government and non-government stakeholder organizations in South Australia. Stakeholders saw a need for indicators that could enable the monitoring of health impacts and time trends, vulnerability to climate change, and those which could also be used as communication tools. Four key criteria for utility were identified, namely robust and credible indicators, specificity, data availability, and being able to be spatially represented. The variability of risk factors in different regions, lack of resources, and data and methodological issues were identified as the main barriers to indicator development. This study demonstrates a high level of stakeholder awareness of the health impacts of climate change, and the need for indicators that can inform policy makers regarding interventions.Maryam Navi, Alana Hansen, Monika Nitschke, Scott Hanson-Easey and Dino Pisaniell

Non-linear effect of temperature variation on childhood rotavirus infection: A time series study from Kathmandu, Nepal

Available online 30 July 2020Introduction: This study aimed to investigate the effects of temperature variability on rotavirus infections among children under 5 years of age in Kathmandu, Nepal. Findings may informinfection control planning, especially in relation to the role of environmental factors in the transmission of rotavirus infection. Methods: Generalized linear Poisson regression equationswith distributed lag non-linearmodelwere fitted to estimate the effect of temperature (maximum,mean and minimum) variation onweekly counts of rotavirus infections among children under 5 years of age living in Kathmandu, Nepal, over the study period (2013 to 2016). Seasonality and long-term effects were adjusted in the model using Fourier terms up to the seventh harmonic and a time function, respectively. We further adjusted the model for the confounding effects of rainfall and relative humidity. Results: During the study period, a total of 733 cases of rotavirus infection were recorded, with amean of 3 cases per week. We detected an inverse non-linear association between rotavirus infection and average weekly mean temperature, with increased risk (RR: 1.52; 95% CI: 1.08–2.15) at the lower quantile (10th percentile) and decreased risk (RR: 0.64; 95% CI: 0.43–0.95) at the higher quantile (75th percentile). Similarly, we detected an increased risk [(RR: 1.93; 95% CI: 1.40–2.65) and (RR: 1.42; 95% CI: 1.04–1.95)] of rotavirus infection for both maximum and minimum temperature at their lower quantile (10th percentile). We estimated that 344 (47.01%) cases of rotavirus diarrhoea among the children under 5 years of age were attributable to minimum temperature. The significant effect of temperature on rotavirus infectionwas not observed beyond lag zero week. Conclusion: An inverse non-linear association was estimated between rotavirus incidence and all three indices of temperature, indicating a higher risk of infection during the cooler times of the year, and suggesting that transmission of rotavirus in Kathmandu, Nepal may be influenced by temperature.Dinesh Bhandari, Peng Bi, Meghnath Dhimal, Jeevan Bahadur Sherchand, Scott Hanson-Ease

Climate change and infectious disease research in Nepal: Are the available prerequisites supportive enough to researchers?

Available online 10 January 2020Although Nepal has been identified as a country highly vulnerable to adverse health and socioeconomic impacts arising from climate change, extant research on climate sensitive infectious diseases has yet to develop the evidence base to adequately address these threats. In this opinion paper we identify and characterise basic requirements that are hindering the progress of climate change and infectious disease research in Nepal. Our opinion is that immediate attention should be given to strengthening Nepal's public health surveillance system, promoting inter-sectoral collaboration, improving public health capacity, and enhancing community engagement in disease surveillance. Moreover, we advocate for greater technical support of public health researchers, and data sharing among data custodians and epidemiologists/researchers, to generate salient evidence to guide relevant public health policy formulation aimed at addressing the impacts of climate change on human health in Nepal. International studies on climate variability and infectious diseases have clearly demonstrated that climate sensitive diseases, namely vector-borne and food/water-borne diseases, are sensitive to climate variation and climate change. This research has driven the development and implementation of climate-based early warning systems for preventing potential outbreaks of climate-sensitive infectious diseases across many European and African countries. Similarly, we postulate that Nepal would greatly benefit from a climate-based early warning system, which would assist in identification or prediction of conditions suitable for disease emergence and facilitate a timely response to reduce mortality and morbidity during epidemics.Dinesh Bhandari, Peng Bi, Jeevan Bahadur Sherchand, Meghnath Dhimal, Scott Hanson-Ease

Heatwave and work-related injuries and illnesses in Adelaide, Australia: a case-crossover analysis using the Excess Heat Factor (EHF) as a universal heatwave index

Purpose: Heatwaves, or extended periods of extreme heat, are predicted to increase in frequency, intensity and duration with climate change, but their impact on occupational injury has not been extensively studied. We examined the relationship between heatwaves of varying severity and work-related injuries and illnesses. We used a newly proposed metric of heatwave severity, the Excess Heat Factor (EHF), which accounts for local climate characteristics and acclimatization and compared it with heatwaves defined by daily maximum temperature. Methods: Work-related injuries and illnesses were identified from two administrative data sources: workers' compensation claims and work-related ambulance call-outs for the years 2003-2013 in Adelaide, Australia. The EHF metrics were obtained from the Australian Bureau of Meteorology. A time-stratified case-crossover regression model was used to examine associations between heatwaves of three levels of severity, workers' compensation claims, and work-related ambulance call-outs. Results: There was an increase in work-related ambulance call-outs and compensation claims during low and moderately severe heatwaves as defined using the EHF, and a non-significant decline during high-severity heatwaves. Positive associations were observed during moderate heatwaves in compensation claims made by new workers (RR 1.31, 95% CI 1.10-1.55), workers in medium-sized enterprises (RR 1.15, 95% CI 1.01-1.30), indoor industries (RR 1.09, 95% CI 1.01-1.17), males (RR 1.13, 95% CI 1.03-1.23) and laborers (RR 1.21, 95% CI 1.04-1.39). Conclusions: Workers should adopt appropriate precautions during moderately severe heatwaves, when the risks of work-related injuries and illnesses are increased. Workplace policies and guidelines need to consider the health and safety of workers during heatwaves with relevant prevention and adaptation measures.Blesson M. Varghese, Alana Hansen, Monika Nitschke, John Nairn, Scott Hanson, Easey, Peng Bi, Dino Pisaniell

Juvenile idiopathic arthritis polygenic risk scores are associated with cardiovascular phenotypes in early adulthood: a phenome-wide association study

Background: There is growing concern about the long-term cardiovascular health of patients with juvenile idiopathic arthritis (JIA). In this study we assessed the association between JIA polygenic risk and cardiovascular phenotypes (cardiovascular risk factors, early atherosclerosis/arteriosclerosis markers, and cardiac structure and function measures) early in life. Methods: JIA polygenic risk scores (PRSs) were constructed for 2,815 participants from the Avon Longitudinal Study of Parents and Children, using the single nucleotide polymorphism (SNP) weights from the most recent JIA genome wide association study. The association between JIA PRSs and cardiovascular phenotypes at age 24 years was assessed using linear and logistic regression. For outcomes with strong evidence of association, further analysis was undertaken to examine how early in life (from age seven onwards) these associations manifest. Results: The JIA PRS was associated with diastolic blood pressure (β 0.062, 95% CI 0.026 to 0.099, P = 0.001), insulin (β 0.050, 95% CI 0.011 to 0.090, P = 0.013), insulin resistance index (HOMA2_IR, β 0.054, 95% CI 0.014 to 0.095, P = 0.009), log hsCRP (β 0.053, 95% CI 0.011 to 0.095, P = 0.014), waist circumference (β 0.041, 95% CI 0.007 to 0.075, P = 0.017), fat mass index (β 0.049, 95% CI 0.016 to 0.083, P = 0.004) and body mass index (β 0.046, 95% CI 0.011 to 0.081, P = 0.010). For anthropometric measures and diastolic blood pressure, there was suggestive evidence of association with JIA PRS from age seven years. The findings were consistent across multiple sensitivity analyses. Conclusions: Genetic liability to JIA is associated with multiple cardiovascular risk factors, supporting the hypothesis of increased cardiovascular risk in JIA. Our findings suggest that cardiovascular risk is a core feature of JIA, rather than secondary to the disease activity/treatment, and that cardiovascular risk counselling should form part of patient care

Nicotine preloading for smoking cessation: the Preloading RCT

Background: Nicotine preloading means using nicotine replacement therapy prior to a quit date while smoking normally. The aim is to reduce the drive to smoke, thereby reducing cravings for smoking after quit day, which are the main cause of early relapse. A prior systematic review showed inconclusive and heterogeneous evidence that preloading was effective and little evidence of the mechanism of action, with no cost-effectiveness data. Objectives: To assess (1) the effectiveness, safety and tolerability of nicotine preloading in a routine NHS setting relative to usual care, (2) the mechanisms of the action of preloading and (3) the cost-effectiveness of preloading. Design: Open-label randomised controlled trial with examination of mediation and a cost-effectiveness analysis. Setting: NHS smoking cessation clinics. Participants: People seeking help to stop smoking. Interventions: Nicotine preloading comprised wearing a 21 mg/24 hour nicotine patch for 4 weeks prior to quit date. In addition, minimal behavioural support was provided to explain the intervention rationale and to support adherence. In the comparator group, participants received equivalent behavioural support. Randomisation was stratified by centre and concealed from investigators. Main outcome measures: The primary outcome was 6-month prolonged abstinence assessed using the Russell Standard. The secondary outcomes were 4-week and 12-month abstinence. Adverse events (AEs) were assessed from baseline to 1 week after quit day. In a planned analysis, we adjusted for the use of varenicline (Champix®; Pfizer Inc., New York, NY, USA) as post-cessation medication. Cost-effectiveness analysis took a health-service perspective. The within-trial analysis assessed health-service costs during the 13 months of trial enrolment relative to the previous 6 months comparing trial arms. The base case was based on multiple imputation for missing cost data. We modelled long-term health outcomes of smoking-related diseases using the European-study on Quantifying Utility of Investment in Protection from Tobacco (EQUIPT) model. Results: In total, 1792 people were eligible and were enrolled in the study, with 893 randomised to the control group and 899 randomised to the intervention group. In the intervention group, 49 (5.5%) people discontinued preloading prematurely and most others used it daily. The primary outcome, biochemically validated 6-month abstinence, was achieved by 157 (17.5%) people in the intervention group and 129 (14.4%) people in the control group, a difference of 3.02 percentage points [95% confidence interval (CI) –0.37 to 6.41 percentage points; odds ratio (OR) 1.25, 95% CI 0.97 to 1.62; p = 0.081]. Adjusted for use of post-quit day varenicline, the OR was 1.34 (95% CI 1.03 to 1.73; p = 0.028). Secondary abstinence outcomes were similar. The OR for the occurrence of serious AEs was 1.12 (95% CI 0.42 to 3.03). Moderate-severity nausea occurred in an additional 4% of the preloading group compared with the control group. There was evidence that reduced urges to smoke and reduced smoke inhalation mediated the effect of preloading on abstinence. The incremental cost-effectiveness ratio at the 6-month follow-up for preloading relative to control was £710 (95% CI –£13,674 to £23,205), but preloading was dominant at 12 months and in the long term, with an 80% probability that it is cost saving. Limitations: The open-label design could partially account for the mediation results. Outcome assessment could not be blinded but was biochemically verified. Conclusions: Use of nicotine-patch preloading for 4 weeks prior to attempting to stop smoking can increase the proportion of people who stop successfully, but its benefit is undermined because it reduces the use of varenicline after preloading. If this latter effect could be overcome, then nicotine preloading appears to improve health and reduce health-service costs in the long term. Future work should determine how to ensure that people using nicotine preloading opt to use varenicline as cessation medication. Trial registration: Current Controlled Trials ISRCTN33031001.NIHR Health Technology Assessment programm