Are we teaching the health impacts of climate change in a clinically relevant way? A systematic narrative review of biomechanism-focused climate change learning outcomes in medical curricula

PURPOSE

Introducing biomedical approaches to the health impacts of climate change can improve medical student engagement with relevant climate-related issues, improve the development of medical schemas, and minimise displacement into crowded medical curricula. This paper aims to systematically review the medical education curricula related to climate change, with a particular focus on systems-based biomechanisms for the health impacts of climate change. We do this to provide a clear agenda for further development of learning outcomes (LOs) in this area to maximize the clinical applicability of this knowledge.

MATERIAL AND METHODS

A systematic review was undertaken following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA; Liberati et al. 2009) guidelines for both the published and grey literature. Five databases (PubMed, SCOPUS, ERIC, Open Access Thesis and Dissertation, and Proquest Global Dissertation and Theses) were searched for works published between 2011 and June 2023. Full texts that contained LOs were the main inclusion criteria for the final review. Descriptive and content extraction guided the final narrative synthesis.

RESULTS

Analysis indicated that biomechanism-related LOs represented about 25% of each published LO set, on average. These outcomes were primarily at the "understand" level of Bloom's taxonomy and were spread across a range of body systems and climate-change aspects. Infectious diseases and extreme heat were strong focuses. Authorship analysis indicated that the majority of these sets of published LOs are from Western contexts and authored by researchers and educators with medical and population health qualifications.

CONCLUSIONS

Biomechanism-focused teaching about the health impacts of climate change is relatively rare in published curricula. Of the available sets of LOs, the majority are sourced from Western authors and are focused on a fairly circumscribed set of biomedical topics. There is scope to both broaden and deepen curriculum in this area, and we would recommend the field prioritise collaboration with medical educators from the Global South, where the effects of climate change are already the most acutely felt.

Achieving ultra-low and -uniform residual magnetic fields in a very large magnetically shielded room for fundamental physics experiments

High-precision searches for an electric dipole moment of the neutron (nEDM) require stable and uniform magnetic field environments. We present the recent achievements of degaussing and equilibrating the magnetically shielded room (MSR) for the n2EDM experiment at the Paul Scherrer Institute. We present the final degaussing configuration that will be used for n2EDM after numerous studies. The optimized procedure results in a residual magnetic field that has been reduced by a factor of two. The ultra-low field is achieved with the full magnetic-field-coil system, and a large vacuum vessel installed, both in the MSR. In the inner volume of ∼ 1.4 m 3 , the field is now more uniform and below 300 pT. In addition, the procedure is faster and dissipates less heat into the magnetic environment, which in turn, reduces its thermal relaxation time from 12 h down to 1.5 h .

Screening and Treatment for Co-occurring Gambling and Substance Use: A Scoping Review

There is a high prevalence of gambling harms co-occurring with substance use harms. Where harms are co-occurring, they may be experienced as more severe. However, there is little evidence that services are systematically screening for such co-occurring harms in treatment-seeking populations. Furthermore, treatment modalities remain relatively under-developed, with treatment usually addressing only one source of harm.This scoping review looks at the current literature on screening and therapeutic interventions for co-occurring gambling and substance use harms to understand how co-occurring harms may be managed in a treatment setting. It draws together available data on the intersections of substance use harms and gambling related harms, in a treatment context.This research identifies a range of potentially useful validated tools for clinicians in substance use treatment settings to screen for gambling harms. For workers in gambling treatment settings who are seeking validated tools to screen for co-occurring substance use harms, the literature provides less guidance.The validated toolbox of therapeutic interventions for those experiencing co-occurring substance use and gambling harms is relatively sparse. Psychosocial interventions appear to offer the best outcomes on gambling measures for those experiencing co-occurring substance use harms. Further research is needed to establish the benefits of different combinations of treatment and treatment types in achieving reductions across both substance use and gambling harms, when these harms are experienced concurrently.

Involvement of people who use alcohol and other drug services in the development of patient-reported measures of experience: A scoping review

INTRODUCTION

Patient-reported measures that assess satisfaction and experience are increasingly utilised in healthcare sectors, including the alcohol and other drug (AOD) sector. This scoping review identifies how and to what extent people accessing AOD services have been involved in the development of satisfaction and experience measures to date.

METHODS

PubMed, EMBASE, CINAHL, Scopus, ProQuest, Google and Google Scholar were searched. Included papers described the development and/or implementation of a multiple-item measure of patient-reported experience or satisfaction specifically for people accessing AOD treatment and/or harm reduction programmes. If there was more than one paper, key papers were chosen that described each measure. The method of development, including service user involvement, was assessed against a framework generated for this review. Two reviewers were involved at each stage.

RESULTS

Thirty measures-23 satisfaction and 7 experience-were identified. Sixteen measures reported some level of involvement by people accessing AOD services in their development, although, for most measures, at a relatively low level. This involvement increased over the time span of the review becoming more frequent in later years. Only four measures were developed for use in harm reduction-specific settings, and fewer than half reported undertaking analysis of underlying scale structure and constructs.

CONCLUSION

Several gaps could be addressed to enhance the measurement of patient-centred care in the AOD sector, including: developing experience measures for use in harm reduction settings and across various AOD settings in a service system; improved reporting of psychometric properties of these measures and increasing commitment to the meaningful involvement of AOD service users in measure development.

PATIENT OR PUBLIC CONTRIBUTION

This scoping review is part of a broader codesign project that involves a partnership between the peak organisation for AOD services and the peer-based AOD consumer organisation in the Australian Capital Territory, Australia. These organisations are working closely together to engage with AOD service users, service providers and policy makers in this codesign project. As such, the Executive Director of the peer-based AOD consumer organisation is involved as a co-author of this scoping review.

Efficacy of Communication Techniques and Health Outcomes of Bushfire Smoke Exposure: A Scoping Review

Public health officials communicate the relevant risks of bushfire smoke exposure and associated health protection measures to affected populations. Increasing global bushfire incidence in the context of climate change motivated this scoping review. English-language publications related to adverse health outcomes following bushfire smoke exposure and publications relating to communication during natural disasters were included. Bushfire smoke events potentially increase healthcare contact, especially presentations triggered by respiratory illness. At-risk populations include those with underlying cardiorespiratory disease, elderly, paediatric, pregnant persons, and First Nations people. We found that social media, television, and radio are among the most common information sources utilised in bushfire smoke events. Message style, content, and method of delivery can directly influence message uptake and behaviour modification. Age, rurality, and geographical location influence information source preferences. Culturally and linguistically diverse groups and those with hearing, vision, and mobility-related disabilities may benefit from targeted health recommendations. This review emphasises the health effects of bushfire smoke exposure and related communication recommendations during and after bushfire smoke events. Additional investigation may further clarify the health effects of bushfire smoke exposure and efficacy of related health messaging, particularly in at-risk populations. Quantitative comparison of communication methods may yield more specific recommendations for future bushfire smoke events.

The health impacts of waste incineration: a systematic review

INTRODUCTION

Waste incineration is increasingly used to reduce waste volume and produce electricity. Several incinerators have recently been proposed in Australia and community groups are concerned about health impacts. An overview of the evidence on health effects has been needed.

METHOD

A systematic review of English language literature for waste incinerators and health using PRISMA methodology.

RESULTS

A range of adverse health effects were identified, including significant associations with some neoplasia, congenital anomalies, infant deaths and miscarriage, but not for other diseases. Ingestion was the dominant exposure pathway for the public. Newer incinerator technologies may reduce exposure.

DISCUSSION

Despite these findings, diverse chemicals, poor study methodologies and inconsistent reporting of incinerator technology specifications precludes firmer conclusions about safety.

CONCLUSION

Older incinerator technology and infrequent maintenance schedules have been strongly linked with adverse health effects. More recent incinerators have fewer reported ill effects, perhaps because of inadequate time for adverse effects to emerge. A precautionary approach is required. Waste minimisation is essential. Implications for public health: Public health practitioners can offer clearer advice about adverse health effects from incinerators. We suggest improved research design and methods to make future studies more robust and comparable. We offer ideas for better policy and regulation.

[Calculation of standardised unit costs from a societal perspective for health economic evaluation]

PURPOSE

Due to demographic aging, economic evaluation of health care technologies for the elderly becomes more important. A standardised questionnaire to measure the health-related resource utilisation has been designed. The monetary valuation of the resource use documented by the questionnaire is a central step towards the determination of the corresponding costs. The aim of this paper is to provide unit costs for the resources in the questionnaire from a societal perspective.

METHODS

The unit costs are calculated pragmatically based on regularly published sources. Thus, an easy update is possible.

RESULTS

This paper presents the calculated unit costs for outpatient medical care, inpatient care, informal and formal nursing care and pharmaceuticals from a societal perspective.

CONCLUSION

The calculated unit costs can serve as a reference case in health economic evaluations and hence help to increase their comparability.

[FIMA--questionnaire for health-related resource use in an elderly population: development and pilot study]

AIM

Due to demographic trends towards an ageing population resource use of health care will increase. By collecting health-related costs via questionnaires, the impact of socio-economic variables and other medical factors can be examined. In addition, only patient reported resource use accounts for out-of-pocket payments. Thus, it is necessary to develop an appropriate tool to collect the health-related resource use in an elderly population.

METHODS

The development of the FIMA (questionnaire for the use of medical and non-medical services in old age) was carried out in 6 steps. These included the determination of necessary questionnaire contents based on a literature review and the wording and layout were defined. Finally the questionnaire was tested in a pilot study and was modified.

RESULTS

All direct medical and non-medical resource use excluding transportation and time costs were recorded. Productivity losses were not included. The recall time frames differed according to resource categories (7 days, 3 months, 12 months). For the pilot study, 63 questionnaires were analysed. The response rate was 69%. The questionnaire took an average of 21 min to complete. Three quarters of respondents completed the questionnaire without help and 90% rated the difficulty as easy or even very simple. There was good agreement between self-reported health-related quality of life and the resource use of nursing and domestic help (phi coefficient values between 0.52 and 0.58).

CONCLUSION

The FIMA is a generic questionnaire which collects the health-related resource use within the older population groups.

[Economic valuation of physician contacts in German outpatient care of COPD. Results from a survey of general practitioners and respiratory specialists]

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is associated with considerable morbidity and mortality and features a substantial economic burden.

METHODS

This article analyses the frequency of physician contacts and commonly provided services in the outpatient care of patients with COPD in Germany. Information on characteristic health care delivery in case of patients with COPD has been further used to construct basic scenarios of outpatient resource use.

RESULTS

Altogether, 34 out of 150 respiratory specialists and 55 out of 350 general practitioners participated in the survey (response rates of 22.7 and 15.7%, respectively). Results point out, that the number of commonly provided services (a) is limited to a very basic set, (b) does not differ substantially according to severity of COPD, and (c) does not substantially vary between the stable phase of the disease and the presence of exacerbations.

CONCLUSIONS

Despite its low level of evidence, the use of expert opinion can serve as a valuable and legitimate tool; especially when the literature does not provide any or only outdated information.

[Bullying, psychosocial health and risk behaviour in adolescence]

BACKGROUND

Bullying as a subform of aggressive behaviour has not received much attention as a specific risk behaviour in adolescence. Especially the adverse health effects in relation to bullying have been barely discussed in Germany. The objective of this study is to present age- and gender-specific prevalences in bullying and to analyse the association between the different bullying roles and subjective health as well as risk behaviour.

METHODS

Data were obtained from the German part of the international WHO collaborative study "Health Behaviour in School-aged Children (HBSC)" in 2002. Overall, 5,650 school children aged 11-15 years were interviewed with a standardised questionnaire. Multivariate logistic regression models were used to analyse the association between bullying, psychosocial health and risk behaviour separately for girls and boys.

RESULTS

About 17% of the boys and 10% of the girls aged 11-15 years were classified as repeated bullying perpetrators. About 10% of the school children are victims of being bullied several times a month. Another 3-5% of the adolescents belonged to the group of simultaneous victims and perpetrators (bully-victims). Perpetrators as well as victims showed strong associations with psychosocial health and risk behaviour. Independently of gender, victims were significantly more likely to report repeated psychosomatic complaints, adverse mental health and negative self-reported health (boys only), than uninvolved students. Especially for male perpetrators, strong associations with regular tobacco and alcohol use and repeated drunkenness were found, while these behaviour types were significantly less prevalent among victims. The bully-victim group is characterised by high rates of psychosomatic complaints and mental health problems (boys only).

CONCLUSIONS

Bullying also seems to be widespread in schools in Germany and is strongly associated with subjective health and substance-related risk behaviour. The results suggest that bullying is a critical issue that requires increasing attention in health research. The unique health problems of victims and perpetrators suggest different intervention strategies for both groups.

Animal welfare and developing countries: opportunities for trade in high-welfare products from developing countries

Discussion on the potential for developing countries to develop trade in niche markets such as higher welfare standards has been highlighted with moves by the World Organisation for Animal Health (OIE) to set internationally agreed standards for animal welfare. This paper examines the existing and potential trade in value-added higher welfare products using case studies in the beef and poultry sectors from three countries in Africa, Asia and Latin America. It shows that at present there is only a small trade in these products but that this can have a major effect at a national level. In the beef export trade from Namibia, the existence of the only assurance scheme in Africa setting standards in hygiene, veterinary care and animal welfare has created a trusted, safe and healthy product and ensured that Namibia has grown into Africa's largest exporter of beef to the European Union. In Thailand, the broiler industry, which has enjoyed annual growth in the past 15 years, is developing value-added products to develop markets to counter competition from other countries. The development and implementation of standards for organic products in both Thailand and Argentina over the past decade have also resulted in growth in the export markets of these products. The paper concludes that there is growth potential for the sectors in all three markets which can be assisted by the development of OIE baseline standards.

A multigene family of glycosyltransferases in a model plant, Arabidopsis thaliana

Glycosyltransferases transfer sugars from NDP-sugar donors to acceptors. The multigene family of transferases described in this paper typically transfer glucose from UDP-glucose to low-molecular-mass acceptors in the cytosol of plant cells. There are 107 sequences in the genome of Arabidopsis thaliana that contain a consensus, suggesting they belong to this Group 1 multigene family. The family has been analysed phylogenetically, and a functional genomics approach has been applied to explore the relatedness of sequence similarity to catalytic specificity and stereoselectivity. Enzymes belonging to this class of transferases glycosylate a vast array of acceptors, including natural products such as secondary metabolites and hormones, as well as xenobiotics absorbed by the plant, such as herbicides and pesticides. Conjugation to glucose potentially changes the activity of the acceptor molecule and invariably changes its location within the plant cell. Using the genomics approach described, a platform of knowledge has been constructed that will enable an understanding to be gained on the role of these enzymes in cellular homoeostasis, as well as their activity in biotransformations in vitro that require strict regioselectivity of glycosylation.

A carrot leucine-rich-repeat protein that inhibits ice recrystallization

Many organisms adapted to live at subzero temperatures express antifreeze proteins that improve their tolerance to freezing. Although structurally diverse, all antifreeze proteins interact with ice surfaces, depress the freezing temperature of aqueous solutions, and inhibit ice crystal growth. A protein purified from carrot shares these functional features with antifreeze proteins of fish. Expression of the carrot complementary DNA in tobacco resulted in the accumulation of antifreeze activity in the apoplast of plants grown at greenhouse temperatures. The sequence of carrot antifreeze protein is similar to that of polygalacturonase inhibitor proteins and contains leucine-rich repeats.

Signal transduction in the wound response of tomato plants

The wound response of tomato plants has been extensively studied, and provides a useful model to understand signal transduction events leading from injury to marker gene expression. The principal markers that have been used in these studies are genes encoding proteinase inhibitor (pin) proteins. Activation of pin genes occurs in the wounded leaf and in distant unwounded leaves of the plant. This paper reviews current understanding of signalling pathways in the wounded leaf, and in the systemically responding unwounded leaves. First, the nature of known elicitors and their potential roles in planta are discussed, in particular, oligogalacturonides, jasmonates and the peptide signal, systemin. Inhibitors of wound-induced proteinase inhibitor (pin) expression are also reviewed, with particular reference to phenolics, sulphydryl reagents and fusicoccin. In each section, results obtained from the bioassay are considered within the wider context of data from mutants and from transgenic plants with altered levels of putative signalling components. Following this introduction, current models for pin gene regulation are described and discussed, together with a summary for the involvement of phosphorylation-dephosphorylation in wound signalling. Finally, a new model for wound-induced pin gene expression is presented, arising from recent data from the author's laboratory.

Brain injury causes loss of cardiovascular response to hemorrhagic shock

The combined cardiovascular effects of hemorrhagic shock and mechanical brain injury were modeled in five groups of pigs. Standard and hypertonic saline resuscitation of hypotension were evaluated. Changes in mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), intracranial pressure (ICP), and brain water were measured. Brain injury (BI) was produced with a fluid percussion device that generated an extradural pressure of 3.5 x 10(5) N/m2 for 400 msec. Shock was caused by bleeding to a MAP of 60 mm Hg for 60 minutes and then resuscitated with shed blood only or shed blood plus 0.9% or 1.8% saline. Brain-injured only and shocked-only pigs served as controls. We found that brain injury alone caused refractory hypotension. Less shed blood was required to produce shock in brain injured animals (p < .05). Shock accompanied by brain injury was not reversed with crystalloid solutions. Volumes of saline required to restore blood pressure were large (> 6 L in 3 hours). 1.8% saline produced less rise in ICP than 0.9% saline but was less effective in restoring blood pressure. Brain edema was not decreased with 1.8% saline. Brain injury altered vascular compensation to hemorrhage and made accepted resuscitative measures ineffective.

Normal computed tomograms of the brain in osteosarcoma patients treated with high-dose methotrexate

Eighteen patients with osteosarcoma, most of whom were adolescents, were examined for abnormalities of the brain by use of computed axial tomography. These studies were performed at 15-60 months (median 47 months) after the completion of adjuvant chemotherapy, which included high-dose methotrexate, cyclophosphamide, and Adriamycin. No abnormalities were found. The results of this study, together with the absence of brain lesions in published reports in children receiving high-dose methotrexate but no cranial irradiation, indicate that delayed neurotoxicity is not a major complication of this form of therapy in older children.

Retroperitoneal rhabdomyosarcoma in children. Results of multimodality therapy

The clinical course of 18 consecutive children treated for primary retroperitoneal rhabdomyosarcoma was reviewed. At diagnosis, 8 patients had regional unresected tumor and 10 patients had disseminated tumor, including 3 patients with documented bone marrow infiltration by tumor. Following combined modality therapy, 14 of 18 patients achieved a greater than 50% tumor response (11 complete and 3 partial responses); 4 patients failed to respond and died of progressive disease within eight months of diagnosis. Among the 14 patients responding, 7 patients had subsequent reextension of active tumor three to 16 months (median, 9 months) following the onset of therapy. Three of the 7 remaining patients died of treatment complications, 2 of intestinal obstruction and 1 of disseminated histoplasmosis, within the first year of therapy and at post-mortem examination had no demonstrable tumor. Four patients are alive and free of active tumor for 10+, 10+, 32+ and 33+ months from diagnosis. Treatment complications have included hematopoietic depression, mucositis, enteritis, intestinal obstruction, excessive weight loss, malnutrition, and life-threatening infection. These results illustrate limitations in current combined modality therapy of retroperitoneal rhabdomyosarcoma and the necessity for future treatment modifications to both reduce morbidity and to improve survival.

High-dose methotrexate used alone and in combination for measurable primary or metastatic osteosarcoma

High-dose methotrexate with leucovorin rescue was used alone or in combination with Adriamycin and cyclophosphamide for the treatment of 27 osteosarcoma patients with measurable indicators of disease. Three patients developed complete responses of measurable lesions, two had partial responses, two had static disease, one had symptomatic improvement, and one had return to normal of physical findings following treatment of a flat bone primary osteosarcoma. While the doses and frequency of administration of high-dose methotrexate differed from those used by previous investigators, these results suggest that aggressive treatment with high-dose methotrexate must be attempted to further evaluate its efficacy as single-agent therapy for osteosarcoma patients not eligible for adjuvant chemotherapy trials.

Physical encounter and self-disclosure

This study investigated the hypothesis that physical and body contact exercises within an encounter group reduce barriers between people and increase their willingness to self-disclose. Ss participating in these exercises ( n = 18), in contrast to 9 controls, showed a significant increase in self-disclosure following the group session.