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

Climate change, climate disasters and oncology care: a descriptive global survey of oncology healthcare professionals

PURPOSE

Climate disasters and climate change have implications for healthcare globally. As the number and intensity of climate disasters increase, it is important to understand the effects on healthcare. We conducted a global survey of oncology healthcare providers to identify awareness, experiences, and educational needs related to climate change.

METHODS

An existing climate and health survey was adapted to oncology. This IRB- approved, 30-item survey measured demographics, climate disaster awareness, effects on cancer care and educational needs. Healthcare professionals employed in oncology settings (practice, research, or academic) were eligible. The survey was disseminated via social media and professional organizations. Descriptive statistics were computed using SPSS.

RESULTS

154 responses from 26 countries were received from nurses (56%), physicians (19%), and other healthcare professionals (25%). Common climate change-related events impacting oncology care were extreme heat (63.8%) and heavy rains (52.2%). Respondents reported their workplace has a disaster plan for climate-related weather events (50.4%) or has taken steps to prepare for a climate-related weather event (48.5%). Respondents were aware that the planet has warmed significantly (98.7%), that healthcare contributes to greenhouse gas emissions (98.6%) and reported wanting to learn more about how climate change affects cancer care (88.3%). Preferred educational modalities include webinars (69%), e-learning (55%), journal articles (48.3%), conferences (46.3%) and podcasts (38.9%).

CONCLUSIONS

This global survey is the first to identify the awareness, experiences, and educational needs of oncology healthcare professionals related to climate change and climate disasters. Healthcare providers are positioned to take leadership roles related to climate and health.

Measurement of the reaction enthalpy of CO2 in aqueous solutions with thermographic and gravimetric methods

In this work, a new concept for the approximate determination of the reaction enthalpy of the reaction between CO2 and monoethanolamine (MEA) in aqueous solution was developed. For this purpose, a CO2 gas stream was flowed into aqueous MEA solutions with different concentrations of 1 wt%, 2.5 wt% and 7.5 wt%. The weight difference ∆T, which is based on the increase in CO2 bound by the MEA over time, was documented using a thermographic camera. The mass difference ∆m, which is also based on the increase in CO2 bound by the MEA over time, was determined using a balance. By determining ∆T and ∆m, an approximate calculation of the reaction enthalpy is possible. The deviation from the values from the data known from the literature was less than 5% in all experiments.

The trends of disease burden due to high temperature in Mainland China from 1990 to 2019 and its prediction to 2030

The risk of high-temperature-related diseases is increasing owing to global warming. This study aimed to assess the trend of disease burden caused by high temperatures in Mainland China from 1990 to 2019 and to predict the trend of disease burden over the next 10 years. The latest data were downloaded from the Global Burden of Disease Database (GBD) for analysis, and the disease burden related to high temperature was described by mortality and disability-adjusted life-years (DALYs) and stratified by etiology, sex, and age. Statistical analyses were performed using the R software. In 2019, there were 13,907 deaths attributed to high temperatures in Mainland China, and this was 29.55% higher than the 10,735 deaths in 1990. Overall, the age-standardized mortality and DALYs attributed to high temperatures showed a downward trend from 1990 to 2019. We observed an etiological shift in high-temperature-related diseases. The age-standardized DALYs contribution attributed to high temperatures in 1990 was mainly from communicable, maternal, neonatal, and nutritional diseases (CMNND) (21.81/100,000), followed by injury (18.30/100,000) and non-communicable diseases (10.40/100,000). In 2019, the largest contribution shifted to non-communicable diseases (10.07/100,000), followed by injuries (5.21/100,000), and CMNND (2.30/100,000). The disease burden attributed to high temperatures was higher in males than in females and increased with age. In 2030, the mortality rate and DALYs due to high temperatures are predicted to decrease further, and the largest contribution will come from chronic non-communicable diseases, the occurrence of which will remain at a high level over the next 10 years. The burden of disease due to high temperatures in Mainland China is still heavy, mainly due to population aging and an increase in non-communicable diseases.

Initiative for the implementation of planetary health in postgraduate medical training and continuing medical education in Switzerland

The Swiss Medical Association FMH drew up the strategy "Planetary health - Strategy on the courses of action on climate change for the medical profession in Switzerland" in collaboration with the Swiss Institute for Medical Education SIME, the umbrella organisations and students. On 7 October 2021, the strategy was approved by the Swiss Medical Chamber with a budget of over CHF 380,000 (approx € 365,000). The first step in implementation involved setting up an advisory group which will tackle the concrete implementation of the strategy. This article provides an insight into the current state of work on the project with a focus on the measures in the areas of postgraduate medical training and continuing medical education. It is a work in progress.

A hidden curriculum for environmental topics in medical education: Impact on environmental knowledge and awareness of the students

Objective

Climate change constitutes a major challenge. The higher education sector plays an important role in regard to climate change and the adaptation to its consequences. Various approaches toward the integration of environmental subject areas to higher education teaching have already been described in other studies, but there is a lack of data supporting the effectiveness of these approaches in changing not only the environmental knowledge of students, but also their awareness. To address this, the present study tracked whether student attitudes about the environment could be changed by implicitly addressing medically relevant environmental topics as part of an online seminar.

Methods

Second semester students of molecular medicine attending a mandatory 14-hour online seminar, which was required to obtain additive key qualifications and which consisted of independent study phases as well as online class meetings, were divided into two groups: the intervention group (IG, n=27, thereof 20 in the pretest and 21 in the posttest) was exposed to medically relevant environmental topics, while the comparison group (CG, n=26, thereof 22 in the pretest and 21 in the posttest) was exposed to general, non-environmental medical topics. Surveys were conducted with standardized questionnaires before and after the seminar in order to study the influence on the students' environmental knowledge, awareness and other personal attitudes.

Results

While the seminar did not significantly change the environmental awareness in either group, the environmental knowledge of the IG was significantly increased by the group's exposure to environmental topics. In addition, the IG assessed its own environmental awareness regarding sustainable working methods in a laboratory as significantly higher after the seminar than the CG did, and some students of the IG had become more interested in issues relating to sustainability.

Conclusion

The approach used to communicate environmental content mainly increased the environmental knowledge of students and piqued the interest of some students in climate-related and environmental topics. However, it was not possible to change deeper personal attitudes about environmental awareness, especially everyday behavior.

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.

Epithelial barrier hypothesis: Effect of the external exposome on the microbiome and epithelial barriers in allergic disease

Environmental exposure plays a major role in the development of allergic diseases. The exposome can be classified into internal (e.g., aging, hormones, and metabolic processes), specific external (e.g., chemical pollutants or lifestyle factors), and general external (e.g., broader socioeconomic and psychological contexts) domains, all of which are interrelated. All the factors we are exposed to, from the moment of conception to death, are part of the external exposome. Several hundreds of thousands of new chemicals have been introduced in modern life without our having a full understanding of their toxic health effects and ways to mitigate these effects. Climate change, air pollution, microplastics, tobacco smoke, changes and loss of biodiversity, alterations in dietary habits, and the microbiome due to modernization, urbanization, and globalization constitute our surrounding environment and external exposome. Some of these factors disrupt the epithelial barriers of the skin and mucosal surfaces, and these disruptions have been linked in the last few decades to the increasing prevalence and severity of allergic and inflammatory diseases such as atopic dermatitis, food allergy, allergic rhinitis, chronic rhinosinusitis, eosinophilic esophagitis, and asthma. The epithelial barrier hypothesis provides a mechanistic explanation of how these factors can explain the rapid increase in allergic and autoimmune diseases. In this review, we discuss factors affecting the planet's health in the context of the 'epithelial barrier hypothesis,' including climate change, pollution, changes and loss of biodiversity, and emphasize the changes in the external exposome in the last few decades and their effects on allergic diseases. In addition, the roles of increased dietary fatty acid consumption and environmental substances (detergents, airborne pollen, ozone, microplastics, nanoparticles, and tobacco) affecting epithelial barriers are discussed. Considering the emerging data from recent studies, we suggest stringent governmental regulations, global policy adjustments, patient education, and the establishment of individualized control measures to mitigate environmental threats and decrease allergic disease.

[Psychosocial Medicine in Times of Change: Climate Change and Mental Health]

Der diesjährige Kongress der Deutschen Gesellschaft für Medizinische Psychologie und der Deutschen Gesellschaft für Medizinische Soziologie in Hamburg war betitelt „Psychosoziale Medizin in Zeiten des Umbruchs“ (https://dgmp-dgms-2021.de/) und fand online vom 15. bis 17. September 2021 statt. Thematisch fokussierte der Kongress auf die Umbrüche und umfassenden Veränderungen, die sowohl die Welt, unsere Gesellschaft als auch unsere Fächer in Zukunft vor Herausforderungen stellen werden. Dies gilt für die Folgen des globalen Klimawandels, für die aktuelle COVID-19-Pandemie und auch sehr konkret für die bevorstehende Reform des Medizinstudiums und der Approbationsordnung. Einer der Hauptvorträge widmete sich dem Klimawandel als globale Herausforderung und der Frage, was die genannten Umbruchsituationen für die psychische Gesundheit bedeuten.

Medical education and the COVID-19 pandemic - a dress rehearsal for the "climate pandemic"?

In the present commentary, we raise the question whether the COVID-19 pandemic should be seen as just the dress rehearsal for what awaits us in the impending climate crisis. Many factors have helped us navigate the challenge of this coronavirus pandemic and continue to do so. These include: recognizing scientific expertise, medical education, and digitalization as important driving forces, providing us with key information about the SARS-CoV-2 virus, as well as integrating it into our curricula and promoting action-oriented research. However, the "premiere of the climate pandemic" will, in all likelihood, confront us with even greater challenges, difficulties, and threats. Adhering to scientific findings, promoting medical education about the effects of global warming and using the power of digitalization, as well as consciously engaging in our role as medical caregivers and leaders will make a decisive contribution to providing impetus for climate action.