Sea-level rise and mental health among coastal communities: A quantitative survey and conditional process analysis.

This is the first large-scale empirical study examining the impact of sea-level rise induced by climate change on mental health outcomes among coastal communities. The study focuses on Bangladesh, a country severely affected by salinity ingress, flood risks, and agricultural damage due to sea-level changes. Participants (n = 1,200) randomly selected from three coastal regions each having high, moderate, or low vulnerability to sea-level rise were surveyed during the pre-monsoon season in 2021. The cross-sectional survey included validated measures of psychological distress, depression, anxiety, stress, environmental stressors, resource loss, and demographics. The results indicated significantly higher levels of psychological distress, depression, anxiety, and stress in residents of high-vulnerability areas compared to moderate or low-vulnerability regions. Resource loss served as a mediating variable between environmental stressors and mental health outcomes. Furthermore, demographic analyses showed that older adults and women reported higher levels of psychological distress. These findings align with the Sendai Framework for Disaster Risk Reduction, highlighting urgent need for targeted mental health interventions and sustainable models of care in coastal areas increasingly threatened by sea-level rise.

Climate hazards and psychological health among coastal communities in the Asia-Pacific region: a systematic review of quantitative and qualitative evidence.

This systematic review assesses the relationship between climate induced coastal hazards and psychological well-being of communities in the Asia-Pacific region. The review synthesises findings from 13 peer-reviewed articles published between 2007 and 2020, encompassing data from seven countries: Bangladesh, India, Indonesia, Philippines, Solomon Islands, Tuvalu, and Vietnam. Results reveals a robust negative association between exposure to coastal hazards and psychological outcomes, notably stress, depression, anxiety, and distress. Most of the studies (77%) corroborate negative impacts of coastal hazards on psychological health. Additionally, 69% of the reviewed articles suggest a correlation between coastal hazards and negative outcomes for community livelihoods and essential resources. The review highlights increased psychological vulnerability among marginalised subpopulations, such as economically disadvantaged communities, a trend supported by 92% of the examined articles. The findings indicates that factors such as environmental vulnerability, resource availability, community traits, and coping methods are important in determining whether a community can effectively handle coastal hazards or face increased psychological health risks. This research aligns with international health frameworks, including the World Health Organization's Health Emergency and Disaster Risk Management guidelines. However, a notable research gap emerges - the absence of studies that specifically explore psychological responses of communities to ongoing climate-related coastal hazards, such as sea-level rise. These findings emphasise an urgent need for targeted research to guide comprehensive, multidisciplinary policy interventions aimed at mitigating the psychological and socio-economic repercussions of climate-related coastal hazards.

Evaluating the Effectiveness of Intravesical Instillation of BCG by Modified Maintenance Method in Patients With High-Risk Ta and T1 Bladder Cancer: A Randomized Clinical Trial.

Background: It is estimated that 75% of urothelial bladder cancers are non-muscle-invasive cancers (NMIBCs). The development of more effective methods for optimizing the management of this subset of patients is of paramount importance. This study aimed to evaluate the effectiveness and side effects of modified maintenance Bacillus Calmette-Guérin (BCG) therapy in patients with high-risk NMIBC. Methods: A total of 84 patients with NMIBC who met the inclusion criteria were randomly divided into 2 groups of 42 patients after receiving intravesical BCG weekly, 1 month after transurethral resection of the bladder tumor (TURT) for 6 weeks as the induction. In group I, patients continued monthly intravesical instillation of BCG for 6 months as maintenance, whereas group II patients did not. All patients were followed up for recurrence and progression for 2 years. Results: Although the recurrence rate was lower in group I (16.7% vs 31%), there was no significant difference among groups (P = .124). Pathology progression was also lower in group I (7.1% vs 11.9%) with no significant difference among groups (P = .713). Complications were not statistically different among groups (P = .651). A statistically significant difference was not observed between the groups in the acceptance rate of patients (97.6% in group I vs 100% in group II). Conclusions: The recurrence rate and progression rate in NMIBC patients with maintenance-free induction therapy after TURT were almost twice as high as those with 6-month maintenance therapy; however, it was not statistically significant. Modified BCG maintenance protocol made favorable compliance for patients. Trial registration: This study was retrospectively registered at Iranian Registery of Clinical Trials with the code IRCT20220302054165N1.

Partial nephrectomy and positive surgical margin, oncologic outcomes and predictors: a 15-year single institution experience.

INTRODUCTION: The aim of this article was to compare oncological outcomes after partial nephrectomy between patients with positive (PSM) and negative (NSM) surgical margins. MATERIAL AND METHODS: In this retrospective study, the data of 733 patients who underwent partial nephrectomy with diagnosis of renal cell carcinoma (RCC) were analyzed. A total of 80 patients from the NSM group were matched to 42 PSM patients. The Kaplan-Meier method was used to estimate freedom from local disease recurrence and metastatic progression and overall survival. Cox proportional hazards models were used to assess the predictors for recurrence/metastasis. RESULTS: The mean age was 58.4 ±11.4 years (range: 29 to 82). Median follow-up was 24 months (IQ25-75: 15-36.2). A total of 5 patients from the PSM group (6.2%) developed local recurrence and metastasis was detected in 2 (2.5%) of them while no metastasis or recurrence was observed in the NSM group. In the multivariate analysis, positive surgical margin was the only independent predictor for recurrence/metastasis (HR[CI] = 0.19[0.04-0.75], p = 0.019). Recurrence-free survival was higher in the NSM group (100% for the NSM group vs 88.1%, p = 0.002) and recurrence/metastasis-free survival was also higher in the NSM group (100% for the NSM group vs 85.7%, p = 0.001), but there were no differences in overall survival between the two groups (96.3% for the NSM group vs 97.6% for the PSM group, p = 0.68). CONCLUSIONS: Although tumor recurrence was more prevalent in positive surgical margin patients who underwent partial nephrectomy, there were no differences in overall survival between the two groups. Therefore, active surveillance against further surgery would be a proper option after finding the tumor-involved margins.