[Climate change - physical and mental consequences]

From niche topic to inclusion in the curriculum - design and evaluation of the elective course "climate change and health"

Objective

At the Medical Faculty of the Goethe University Frankfurt am Main, the elective course "climate change and health" was offered to students in the clinical phase of their medical studies for the first time in the winter semester 2021/22 (any unfilled places were made available to interested students studying other subjects). Despite attracting considerable attention, this topic has not yet been incorporated into the curriculum of medical studies. Our aim was therefore to teach students about climate change and discuss its effects on human health. The students evaluated the elective in terms of various factors relating to knowledge, attitudes and behavior.

Project description

The elective focused on the concept of Planetary Health, with an emphasis on the health consequences of climate change, as well as possibilities for action and adaptation in clinical and practical settings. The course took place in three live, online sessions (with inputs, discussion, case studies and work in small groups), as well as online preparation and a final written assignment for which students were asked to reflect on the subject. The standardized teaching evaluation questionnaire (=didactic dimension) of Goethe University was used online to evaluate the elective, whereby the questionnaire was extended to include the measurement of changes in students' agreement with items (dimensions) relating to knowledge, attitudes and behavior (personal behavior and behavior as physicians) before and after the course (pre/post comparison).

Results

Students expressed high levels of satisfaction with the course content, the presentation of the course, and the organization of the elective. This was reflected in very good to good overall ratings. The pre/post comparisons further showed a significant, positive shift in agreement ratings in almost all dimensions. The majority of respondents also wanted the topic to be firmly embedded in the medical curriculum.

Conclusion

The evaluation shows that with respect to the impact of climate change on human health, the elective course had a clear influence on the knowledge, attitudes, and behaviors of the students. In view of the relevance of the topic, it is therefore important that this subject is included in medical curricula in the future.

Climate change and health: Changes in student environmental knowledge and awareness due to the implementation of a mandatory elective at the Medical Faculty of Ulm?

Background and objectives

According to the World Health Organization, climate change constitutes the single greatest threat to human health. However, the health care system contributes to climate change worldwide through its high CO₂ emissions. In order to make future physicians more aware of this issue and to expand medical education to include climate-related aspects, the mandatory 28 academic hours elective "Climate Change and Health" for students of human medicine in the preclinical study stage was implemented at the Medical Faculty of Ulm in the 2020/21 winter semester. Our accompanying study investigated 1. in what form the topic of climate change can be successfully integrated into the study of human medicine in a manner that includes student opinions and2. whether being required to take an elective on the topic led to changes in student environmental knowledge and awareness.

Methodology

Personal individual interviews were conducted with all n=11 students after the course in a pilot that was carried out in the 2020/21 winter semester to determine course feasibility and student acceptance. The students were also able to evaluate the course using an evaluation form and were asked to complete a questionnaire on their environmental knowledge and awareness before and after the course. The course was revised on the basis of the results and offered again in the 2021 summer semester with an intervention group (n=16, participation in the mandatory elective) and a comparison group (n=25, no participation in the mandatory elective). The intervention group was asked to evaluate the course on the evaluation form. Both groups completed the environmental questionnaire at the same time.

Results

The positive feedback from students for both semesters indicates a good feasibility and acceptance of the course. Student environmental knowledge was increased in both semesters. However, there were only few observable changes in student environmental awareness.

Conclusion

This paper illustrates how the topic of climate change and health can be embedded into medical studies. The students considered climate change an important topic and drew added value from the course for their future work in healthcare. The study shows that knowledge transfer at the university level is an effective way to educate the young generation on climate change and its impacts.

Planetary health as a main topic for the qualification in digital teaching - a project report

Aim

To do justice to the need for planetary health in medical education, these are the aims of the online elective course "Planetary Health in Medical Education" (ME elective):1. Enable students to plan and realize their own course sessions on planetary health;2. Encourage communication among university medical faculties regarding planetary health in medical education;3. Reinforce competency in digital teaching and amplify the expert role as multiplicator among students pursuing a Master's degree in Medicinal Education (MME).

Method

The development of the ME elective followed Kern's six-step approach to curriculum development by means of cooperation between the German Medical Students' Association (Bundesvertretung der Medizinstudierenden in Deutschland, abbreviated as bvmd), and the MME study program. Based on general and specific needs analyses, core learning objectives regarding planetary health, medical education and digital education were identified in the National Catalogue of Learning Objectives in Undergraduate Medical Education (NKLM) and the MME study program and relevant teaching methods were selected.

Results

The ME elective, consisting of two contact hours per week per semester, was established at 13 medical schools as a four-phase course:1. Introduction to medical education using examples from planetary health;2. Lesson planning on a topic in planetary health under the supervision of MME students;3. Course sessions held by the undergraduate students; and4. Networking with the MME study program through participation in digital courses on planetary health and the pilot OSCE on planetary health.A total of 24 students attended the pilot in the 2022 summer semester.

Conclusion

The topic of planetary health combines interests that span many subjects and semester levels. As a collaborative, interdisciplinary and interprofessional subject, it lends itself to training students in a trans-institutional elective course to become multiplicators.

[The Climate Change Challenge: How to get research into society through an online workshop]

BACKGROUND

According to the World Health Organisation, climate change poses the greatest health threat to humanity. At the same time, an environmentally friendly lifestyle has a positive impact on our health, such as a plant-based diet. In order to counter climate change, society needs to be informed about climate-friendly and health-promoting measures. Therefore, an online workshop was initiated at the Medical Faculty of Ulm. In an accompanying study, it was determined whether this leads to changes in environmental knowledge and awareness among the participants.

METHODS

The online workshop consisted of four 2-hour sessions. Scientific basics on climate change and possible solutions were discussed. Other focuses were on health and the health system as well as environmental psychology and climate change denial. Participants could take part in an anonymous and voluntary online survey before (pretest) and after (posttest) the workshop.

RESULTS

86 participants took part in the workshop, of whom 24 attended all appointments and completed both surveys. While hardly any changes were observed in the subsection of environmental emotion, perception and behavior, there was a significant increase in environmental knowledge in the posttest. The workshop was evaluated very positively. Furthermore, many participants were motivated to make a personal contribution to climate protection after the workshop.

CONCLUSION

The workshop serves as a good example of how medical scientific findings can be shared at a societal level. The participants already showed a high level of environmental awareness in the pretest, which is why the question remains open as to how people can be sensitized to the (health) threats posed by climate change who do not proactively sign up for such an offer themselves.

Environmental issues hidden in medical education: What are the effects on students' environmental awareness and knowledge?

INTRODUCTION

Global warming is one of the major challenges faced by society. To raise students' awareness related to these issues, we embedded environmental learning goals in mandatory courses. The aim of this initiative was to determine whether the integration of environmental topics into a seminar focussing on non-environmental issues facilitates changes in the environmental knowledge and awareness of students.

METHODS

Third-year molecular medicine students (intervention group, IG) were assigned short environment-related tasks in a not environment-related scientific writing seminar. Using standardized questionnaires before and after the seminar, students were assessed with a set of up to 48 questions relating to environmental affect, cognition, behavioral intention and knowledge as well as specific personal aspects. The comparison group (CG) consisted of third-year dentistry students who were assessed twice during an equivalent pre-post time period and who did not attend the seminar. The analysis was carried out with 15 students from the IG and 14 from the CG.

RESULTS

Integrating environmental topics into a scientific writing seminar focussing on non-environmental issues led to a significantly increased level of awareness of the threats from climate change in the IG (p<0.05). No further significant changes in other areas of environmental awareness were observed in either group. In addition, the environmental knowledge of the IG students (p≤0.01) but not of the CG students (p=0.285) was significantly enhanced.

DISCUSSION AND CONCLUSION

This study shows that factual environmental knowledge on the issues addressed can be increased by a cautious approach of environmental communication. However, more deep-seated personal attitudes and environmental awareness cannot be sustainably changed using this low intervention dose.

Effects of extreme precipitation on hospital visit risk and disease burden of depression in Suzhou, China

Background

The purpose of this study was to explore the impact of extreme precipitation on the risk of outpatient visits for depression and to further explore its associated disease burden and vulnerable population.

Methods

A quasi-Poisson generalized linear regression model combined with distributed lag non-linear model (DLNM) was used to investigate the exposure-lag-response relationship between extreme precipitation (≥95th percentile) and depression outpatient visits from 2017 to 2019 in Suzhou city, Anhui Province, China.

Results

Extreme precipitation was positively associated with the outpatient visits for depression. The effects of extreme precipitation on depression firstly appeared at lag4 [relative risk (RR): 1.047, 95% confidence interval (CI): 1.005–1.091] and lasted until lag7 (RR = 1.047, 95% CI: 1.009–1.087). Females, patients aged ≥65 years and patients with multiple outpatient visits appeared to be more sensitive to extreme precipitation. The attributable fraction (AF) and numbers (AN) of extreme precipitation on outpatient visits for depression were 5.00% (95% CI: 1.02–8.82%) and 1318.25, respectively.

Conclusions

Our findings suggested that extreme precipitation may increase the risk of outpatient visits for depression. Further studies on the burden of depression found that females, aged ≥65 years, and patients with multiple visits were priority targets for future warnings. Active intervention measures against extreme precipitation events should be taken to reduce the risk of depression outpatient visits.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14085-w.

[Climate change and child health: A nationwide survey among paediatricians in Germany]

BACKGROUND

Children are a vulnerable group affected by climate change. Paediatricians are important actors in protecting children from climate change-related health risks and in identifying and treating relevant health effects. The main objectives of this study were to determine how paediatricians assess the relevance of climate change-related health impacts, through which channels paediatricians can be reached most effectively, how often climate change-specific prevention measures are implemented and how they are assessed.

METHODS

Between February and July 2020, an online survey was conducted among paediatricians. The cross-sectional survey was designed to gather knowledge and attitudes about the relevance of climate change, sources of information and prevention measures. All participants who answered only one question or none at all were excluded. Differences between groups were determined using one-factorial analysis of variance. Correlations were determined using Pearson's bivariate correlation analysis and tested for two-sided significance.

RESULTS

A total of 408 questionnaires were analysed. Over 95% of the respondents were paediatricians, with just under half of them working in children's hospitals and a good third in paediatric practices. According to paediatricians, climate change has a relevant impact on children's health. The most significant effects on children's health were considered to be longer and stronger pollen seasons, neophytes and neozoa, Lyme disease and TBE (tick-borne encephalitis, summer meningoencephalitis), UV radiation and air pollutants. Certified training options in professional journals and participation in lectures or workshops at relevant congresses were identified as the two preferred types of training. Especially professional journals as the most frequently used source of information could function as a suitable tool to reach as many paediatricians as possible. 76% of the paediatricians have not yet carried out any corresponding prevention activities, although information activities for parents or children were seen as being effective by 80%. Whereas the possibilities of integrating climate change-oriented prevention activities into everyday practice, were perceived less positively. The most frequent reason given was lack of time.

DISCUSSION

To satisfy this future need for knowledge, but also for offerings from paediatricians for patients and their parents, concrete further continuous education and consultancy services must be prepared. In the future, further training offers, including the consultancy services, should be integrated into profession-specific training modules, presented at congresses, and then implemented into paediatricians' daily routine.

CONCLUSION

The results of the study illustrate that the topic "climate change and health" has a high relevance for paediatricians and that information measures for parents are considered to be effective. Although paediatricians are concerned with the topic, there is an implementation deficit. Support is needed in the form of intensifying awareness-raising projects and educational modules for paediatricians to move from knowledge to action.

A Changing Home: A Cross-Sectional Study on Environmental Degradation, Resettlement and Psychological Distress in a Western German Coal-Mining Region

Unwelcome environmental changes can lead to psychological distress, known as “solastalgia”. In Germany, the open-pit mining of brown coal results in environmental changes as well as in the resettlement of adjacent villages. In this study, we investigated the risk of open-pit mining for solastalgia and psychological disorders (e.g., depression, generalized anxiety and somatization) in local communities. The current residents and resettlers from two German open-pit mines were surveyed concerning environmental stressors, place attachment, impacts and mental health status. In total, 620 people responded, including 181 resettlers, 114 people from villages threatened by resettlement and 325 people from non-threatened villages near an open-pit mine. All groups self-reported high levels of psychological distress, approximately ranging between 2−7.5 times above the population average. Respondents from resettlement-threatened villages showed the worst mental health status, with 52.7% indicating at least moderate somatization levels (score sum > 9), compared to 28% among resettlers. We observed a mean PHQ depression score of 7.9 (SD 5.9) for people from resettlement-threatened villages, 7.4 (SD 6.0) for people from not-threatened villages, compared to 5.0 (SD 6.5) for already resettled people (p < 0.001). In conclusion, the degradation and loss of the home environment caused by open-pit mining was associated with an increased prevalence of depressive, anxious and somatoform symptoms in local communities. This reveals a need for further in-depth research, targeted psychosocial support and improved policy frameworks, in favor of residents’ and resettlers’ mental health.

Changes in the incidence and prevalence of ischemic stroke and associations with natural disasters: an ecological study in 193 countries

Epidemiological studies have indicated that natural disasters have important impacts on ischemic stroke. This study determined the associations between natural disasters and the incidence and prevalence of ischemic stroke at the global level. A 28-year ecological trend study was performed to estimate worldwide changes in the incidence and prevalence of ischemic stroke and their associations with natural disasters by analyzing data from 193 countries. Quantum geographic information system-based visualization and multivariable linear regression were used. Changes in the incidence and prevalence of ischemic stroke, as well as disaster occurrence, varied among the different regions over the past 28 years (p < 0.001). Multiple linear regression revealed an independent and positive association between disaster occurrence and the incidence of ischemic stroke in males, females and both sexes combined (standardized coefficients = 0.515, 0.470 and 0.483, p < 0.001); similar associations were found for the prevalence of ischemic stroke (standardized coefficients = 0.471, 0.417 and 0.438, p < 0.001). The incidence and prevalence of ischemic stroke changed significantly at the global level and were independently associated with natural disasters. Both males and females show common but different vulnerabilities to natural disasters. This evidence supports policy making and resource allocation for disaster response and disease burden reduction.

What do Final Year Medical Students in Germany know and think about Climate Change? - The ClimAttitude Study

Climate change (CC) is adversely affecting human health and will become far more dangerous in the future, if no substantial measures are taken. Young people in particular are taking an energetic stand for CC awareness. Some CC experts argue that medical doctors are especially well positioned to inform about the impact of CC on public health, as it is well established that they are among the most trusted members of society. However, medical doctors seem to be unsure of their role in addressing CC. This study aimed to investigate future doctors´, i.e., final year medical students´ (FYMS), attitudes towards CC and their personal role in CC education and health care. A questionnaire was developed to examine (1) the expected consequences of CC for FYMS, (2) their perceived individual responsibility, and their attitudes towards an additional (3) professional responsibility. To examine the climate-questionnaire's component correlations, we ran a factor analysis using oblique (promax) rotation and conducted a one-way ANOVA with repeated measures to compare the mean scores of the factors. Data are presented as mean ± SD or percentage, as appropriate. n = 65 FYMS (response rate: 87%) were participating and all of them completed the questionnaire. Items of the factor professional responsibility showed the lowest level of agreement (47.2 ± 21.2), while the 2 other factors showed higher levels of agreement (expected consequences (75.6 ± 18.4), individual responsibility (75.1 ± 20.6). Future doctors at Heidelberg University Hospital are well-informed about the expected health consequences of CC. They recognize human contributions to CC and make personal decisions to mitigate the impact. However, the opinion that they have a professional responsibility as physicians to patients or society in regard to CC is weaker. Specific teaching could help to change the way future doctors see their role and responsibility in tackling CC.

Heat Perception and Coping Strategies: A Structured Interview-Based Study of Elderly People in Cologne, Germany

The transdisciplinary project “Heat-Health Action Plan for Elderly People in Cologne” addresses the most heat-vulnerable risk group, people over 65 years of age. A quantitative study aimed to better understand heat perception and coping strategies of elderly people during heat waves to inform heat-health action plans. We conducted a representative quantitative survey via structured interviews with 258 randomly chosen people over 65 years old, living in their own homes in four areas of Cologne, Germany. These areas varied, both in terms of social status and heat strain. Data regarding demographics, health status, coping strategies, and heat perception were collected in personal interviews from August to October 2019. The majority of the participants perceived heat strain as moderate to very challenging. Women, people with a lower monthly income, and those with a lower health status found the heat more challenging. We found that participants adapted to heat with a number of body-related, home-protective, and activity-related coping strategies. The number of coping strategies was associated with perceived personal heat strain. There is a definite underuse of water-related heat adaption strategies among the elderly. This is of increasing relevance, as rising heat impact will lead to more heat-related geriatric morbidity. Our results are seminal to inform elderly-specific, socio-adapted local heat-health action plans.

Changes in ischemic heart disease mortality at the global level and their associations with natural disasters: A 28-year ecological trend study in 193 countries

BACKGROUND

Natural disasters are believed to be associated with cardiovascular disease. This study aimed to explore the changes in mortality due to ischemic heart disease (IHD) and their associations with natural disasters at the global level.

METHODS

Country-specific data on the impact of natural disasters, rates of mortality due to IHD and years of life lost (YLL) and socioeconomic variables were obtained for 193 countries for the period from 1990 to 2017. An ecological trend study was conducted to estimate the changes in the IHD mortality and YLL rates and their associations with natural disasters (occurrence, casualties and total damage). Correlation analyses and multivariate linear regression were used.

RESULTS

Significant changes were found in the IHD mortality and YLL rates and the occurrence of disasters between the two equal periods (1990 to 2003 and 2004 to 2017) (p<0.001). The bivariate Pearson correlation test revealed that the trend in the occurrence of natural disasters was positively correlated with trends in the IHD mortality and YLL rates among females and all individuals (p<0.05) and was marginally correlated among males. Multiple linear regression revealed an independent association between the occurrence of natural disasters and the IHD mortality rate among males, females and all individuals (standardized coefficients = 0.163, 0.357 and 0.241, p<0.05), and similar associations were found for the YLL rate (standardized coefficients = 0.194, 0.233 and 0.189, p<0.05).

CONCLUSIONS

Our study demonstrated significant changes in the IHD mortality and YLL rates at the global level and their independent associations with natural disasters. Both males and females were vulnerable to natural disasters. These results provide evidence that can be used to support policy making and resource allocation when responding to disasters and developing strategies to reduce the burden of IHD.

Disability-Adjusted Life Years (DALYs) Due to Ischemic Heart Disease (IHD) Associated with Natural Disasters: A Worldwide Population-Based Ecological Study

Background:

Recent studies have reported an association between natural disasters of various kinds and ischemic heart disease (IHD). We investigated the association between Disability-adjusted life years (DALYs) due to IHD and natural disasters and aimed to assess DALYs as a quantification of the burden of IHD related to natural disasters at the global level.

Methods:

Country-specific data of natural disaster impacts DALYs due to IHD and socioeconomic variables were obtained from open sources over the period of 1990–2013 and 2014–2017. A population-based trend ecological design was conducted to estimate the association between trends in DALYs and natural disasters (occurrence, casualties and total damage), adjusting for socioeconomic variables.

Results:

Most countries have experienced increases in natural disaster occurrences and decreases in DALYs during this study period. The unadjusted correlation analysis demonstrated a positive and significant correlation between DALYs and natural disasters for females and for both sexes (R = 0.163 and 0.146, p = 0.024 and 0.043), and a marginally significant correlation for males (R = 0.128, p = 0.076). After adjusting for socioeconomic variables, multiple linear regression demonstrated independent associations between the occurrence and DALYs due to IHD for males, females and both sexes (standardized coefficients = 0.192, 0.23 and 0.187, p = 0.016, 0.004 and 0.022).

Conclusions:

A weak but significantly positive association between natural disaster and IHD was confirmed and quantified at the global level by this DALY metric analysis. Adaptation strategies for natural disaster responses and IHD disease burden reduction need to be developed.

[Climate change: Causes, consequences, solutions and public health care implications]

BACKGROUND

Global warming is a fundamental threat to human civilization. Urgent and comprehensive actions are needed to achieve the Paris Climate Convention goals. This work aims to provide a systematic overview of global warming and its linkages to public healthcare.

METHODS

In a narrative review, we outline causes, consequences, and necessary measures regarding global warming and the implications for public healthcare.

RESULTS AND DISCUSSION

Closely linked to our resource behaviours and economic systems, greenhouse gas emissions play a central role in global warming. We are seeing an increase in temperature records and heat waves as well as droughts with crop losses, rising sea levels and, ultimately, effects on the human body and mind. Despite these threats, there is a gap between awareness and action. Measures are urgently needed at a political, innovative, economic and individual level. As a significant greenhouse gas emitter, the public health sector bears responsibility. Healthcare professionals are directly confronted with the impact of global warming through the treatment of people suffering from its effects; they can serve as role models in tackling it. Necessary changes in life (style) do not only involve a more conscious use of our resources, but also hold the chance of creating a new form of social solidarity.

CONCLUSIONS

Healthcare institutions and professionals play a significant role as emitters, practitioners, and role models in global warming.

Predictors Associated with Health-Related Heat Risk Perception of Urban Citizens in Germany

The rising probability of extremely high temperatures and an increasing number of consecutive hot days caused by climate change-combined with the impact of these high temperatures on human health-is widely discussed in the literature. There are calls for the development of heatwave adaptation measures by governmental and scientific institutions. In this research, the predictors of health-related heat risk perception of urban citizens in Augsburg, Germany, were investigated. An online survey was conducted with 468 citizens, asking about their heat risk perception, knowledge about heat risks, and demographic data and health information. Statistical methods (Spearman correlation, unpaired t-test, ANOVA and multiple regression) were used to determine which factors were significant and relevant. The results show that the knowledge of heat risks, heat risk sensitivity and an external locus of control are the most important factors for heat risk perception. The health implication score and chronic disease show significant effects in descriptive statistics. Furthermore, younger people showed the highest heat risk perception of all age groups. Surprisingly, income, education, living alone and gender did not play a role in heat risk perception. The findings imply a need for better and intensified heat risk communication in urban areas-especially among elderly people-and thus are important for creating acceptance towards heat wave risks, which is a prerequisite of willingness to adapt.

[Public perception of climate change and implications for risk communication]

Man-made climate change is associated with several weather and environmental changes that can influence the extent of certain health risks. The article gives an overview of the challenges of communicating these health risks. Theoretical considerations are linked with the results of a representative population survey, in which 1018 participants aged 14 years and above were polled about their perception of climate change and its associated health risks.According to the survey results, the majority of the population is convinced that climate change is actually taking place. However, the data suggest that respondents regard the topic with psychological distance. Health risks associated with climate change also play a relatively minor role in the participants' perception.The theoretical considerations in connection with the empirical results show that targeted communication measures are needed to enhance awareness of the health risks associated with climate change among the general public. This requires not only a comprehensive provision of information, but also instructions and action plans for the practical implementation of that knowledge. Communication measures should take into account factors that can influence risk perception and the willingness to act. They should also be embedded in a strategic communication concept that allows different target groups to be addressed.

[Extreme weather events and their impact on the mental health of children and adolescents]

As part of climate change, a rise in meteorological extreme weather events (EWE) like heavy precipitation and flooding can be observed in Germany. Severe extreme events can evoke great fear and pose a risk for traumatization. These traumas and the sustained stress caused by the event may result in adverse psychological health effects. Children and adolescents represent a vulnerable group due to the fact that they hold less coping strategies than adults and are strongly dependent on their environment.This narrative overview intends to summarise the prevalence of mental illness after an EWE and the related risk factors in order to draw meaningful conclusions about the mental health of children and adolescents in Germany. Therefore, existing literature from the WHO European region and from countries with a similar income level (e.g. Canada, Australia, USA) was taken into account. Since floods and heavy precipitation are the most frequent EWE in Germany, the focus was placed on them.An increase in anxiety disorders, depression symptoms, posttraumatic stress and behavioural disorders can be observed in children and adolescents after an EWE. The literature provides little information on the prevalence of such mental health effects as a result of EWEs and their effects, and which risk factors are of importance. There is thus still considerable need for research internationally and especially in Germany.