Effects of temperature and nutrients on microscopic stages of the bull kelp (Nereocystis luetkeana, Phaeophyceae).

Warming ocean temperatures have been linked to kelp forest declines worldwide, and elevated temperatures can act synergistically with other local stressors to exacerbate kelp loss. The bull kelp Nereocystis luetkeana is the primary canopy-forming kelp species in the Salish Sea, where it is declining in areas with elevated summer water temperatures and low nutrient concentrations. To determine the interactive effects of these two stressors on microscopic stages of N. luetkeana, we cultured gametophytes and microscopic sporophytes from seven different Salish Sea populations across seven different temperatures (10-22°C) and two nitrogen concentrations. The thermal tolerance of microscopic gametophytes and sporophytes was similar across populations, and high temperatures were more stressful than low nitrogen levels. Additional nitrogen did not improve gametophyte or sporophyte survival at high temperatures. Gametophyte densities were highest between 10 and 16°C and declined sharply at 18°C, and temperatures of 20 and 22°C were lethal. The window for successful sporophyte production was narrower, peaking at 10-14°C. Across all populations, the warmest temperature at which sporophytes were produced was 16 or 18°C, but sporophyte densities were 78% lower at 16°C and 95% lower at 18°C compared to cooler temperatures. In the field, bottom temperatures revealed that the thermal limits of gametophyte growth (18°C) and sporophyte production (16-18°C) were reached during the summer at multiple sites. Prolonged exposure of bull kelp gametophytes to temperatures of 16°C and above could limit reproduction, and therefore recruitment, of adult kelp sporophytes.

The 2021 report of the MJA-Lancet Countdown on health and climate change: Australia increasingly out on a limb.

The MJA-Lancet Countdown on health and climate change in Australia was established in 2017, and produced its first national assessment in 2018, its first annual update in 2019, and its second annual update in 2020. It examines indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. Our special report in 2020 focused on the unprecedented and catastrophic 2019-20 Australian bushfire season, highlighting indicators that explore the relationships between health, climate change and bushfires. For 2021, we return to reporting on the full suite of indicators across each of the five domains and have added some new indicators. We find that Australians are increasingly exposed to and vulnerable to excess heat and that this is already limiting our way of life, increasing the risk of heat stress during outdoor sports, and decreasing work productivity across a range of sectors. Other weather extremes are also on the rise, resulting in escalating social, economic and health impacts. Climate change disproportionately threatens Indigenous Australians' wellbeing in multiple and complex ways. In response to these threats, we find positive action at the individual, local, state and territory levels, with growing uptake of rooftop solar and electric vehicles, and the beginnings of appropriate adaptation planning. However, this is severely undermined by national policies and actions that are contrary and increasingly place Australia out on a limb. Australia has responded well to the COVID-19 public health crisis (while still emerging from the bushfire crisis that preceded it) and it now needs to respond to and prepare for the health crises resulting from climate change.

The 2020 special report of the MJA-Lancet Countdown on health and climate change: lessons learnt from Australia's "Black Summer".

The MJA-Lancet Countdown on health and climate change was established in 2017, and produced its first Australian national assessment in 2018 and its first annual update in 2019. It examines indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. In the wake of the unprecedented and catastrophic 2019-20 Australian bushfire season, in this special report we present the 2020 update, with a focus on the relationship between health, climate change and bushfires, highlighting indicators that explore these linkages. In an environment of continuing increases in summer maximum temperatures and heatwave intensity, substantial increases in both fire risk and population exposure to bushfires are having an impact on Australia's health and economy. As a result of the "Black Summer" bushfires, the monthly airborne particulate matter less than 2.5 µm in diameter (PM2.5 ) concentrations in New South Wales and the Australian Capital Territory in December 2019 were the highest of any month in any state or territory over the period 2000-2019 at 26.0 µg/m3 and 71.6 µg/m3 respectively, and insured economic losses were $2.2 billion. We also found growing awareness of and engagement with the links between health and climate change, with a 50% increase in scientific publications and a doubling of newspaper articles on the topic in Australia in 2019 compared with 2018. However, despite clear and present need, Australia still lacks a nationwide adaptation plan for health. As Australia recovers from the compounded effects of the bushfires and the coronavirus disease 2019 (COVID-19) pandemic, the health profession has a pivotal role to play. It is uniquely suited to integrate the response to these short term threats with the longer term public health implications of climate change, and to argue for the economic recovery from COVID-19 to align with and strengthen Australia's commitments under the Paris Agreement.

Applying the triple bottom line of sustainability to healthcare research-a feasibility study.

OBJECTIVE: The triple bottom line (TBL) of sustainability is an important emerging conceptual framework which considers the combined economic, environmental and social impacts of an activity. Despite its clear relevance to the healthcare context, it has not yet been applied to the evaluation of a healthcare intervention. The aim of this study was to demonstrate whether doing so is feasible and useful. DESIGN: Secondary data analysis of a 12-month randomized controlled trial. SETTING: Community based mental health care. PARTICIPANTS: Patients with chronic psychotic illnesses (n = 333). INTERVENTION(S): Community treatment orders. MAIN OUTCOME MEASURE(S): Financial and environmental (CO2 equivalent) costs of care, obtained from healthcare service use data, were calculated using publicly available standard costs; social sustainability was assessed using standardized social outcome measures included in the trial data. RESULTS: Standardized costing and CO2e emissions figures were successfully obtained from publicly available data, and social outcomes were available directly from the trial data. CONCLUSIONS: This study demonstrates that TBL assessment can be retrospectively calculated for a healthcare intervention to provide a more complete assessment of the true costs of an intervention. A basic methodology was advanced to demonstrate the feasibility of the approach, although considerable further conceptual and methodological work is needed to develop a generalizable methodology that enables prospective inclusion of a TBL assessment in healthcare evaluations. If achieved, this would represent a significant milestone in the development of more sustainable healthcare services. If increasing the sustainability of healthcare is a priority, then the TBL approach may be a promising way forward.

The 2019 report of the MJA-Lancet Countdown on health and climate change: a turbulent year with mixed progress.

The MJA-Lancet Countdown on health and climate change was established in 2017 and produced its first Australian national assessment in 2018. It examined 41 indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. It found that, overall, Australia is vulnerable to the impacts of climate change on health, and that policy inaction in this regard threatens Australian lives. In this report we present the 2019 update. We track progress on health and climate change in Australia across the same five broad domains and many of the same indicators as in 2018. A number of new indicators are introduced this year, including one focused on wildfire exposure, and another on engagement in health and climate change in the corporate sector. Several of the previously reported indicators are not included this year, either due to their discontinuation by the parent project, the Lancet Countdown, or because insufficient new data were available for us to meaningfully provide an update to the indicator. In a year marked by an Australian federal election in which climate change featured prominently, we find mixed progress on health and climate change in this country. There has been progress in renewable energy generation, including substantial employment increases in this sector. There has also been some progress at state and local government level. However, there continues to be no engagement on health and climate change in the Australian federal Parliament, and Australia performs poorly across many of the indicators in comparison to other developed countries; for example, it is one of the world's largest net exporters of coal and its electricity generation from low carbon sources is low. We also find significantly increasing exposure of Australians to heatwaves and, in most states and territories, continuing elevated suicide rates at higher temperatures. We conclude that Australia remains at significant risk of declines in health due to climate change, and that substantial and sustained national action is urgently required in order to prevent this.

The MJA-Lancet Countdown on health and climate change: Australian policy inaction threatens lives.

Climate plays an important role in human health and it is well established that climate change can have very significant impacts in this regard. In partnership with The Lancet and the MJA, we present the inaugural Australian Countdown assessment of progress on climate change and health. This comprehensive assessment examines 41 indicators across five broad sections: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. These indicators and the methods used for each are largely consistent with those of the Lancet Countdown global assessment published in October 2017, but with an Australian focus. Significant developments include the addition of a new indicator on mental health. Overall, we find that Australia is vulnerable to the impacts of climate change on health, and that policy inaction in this regard threatens Australian lives. In a number of respects, Australia has gone backwards and now lags behind other high income countries such as Germany and the United Kingdom. Examples include the persistence of a very high carbon-intensive energy system in Australia, and its slow transition to renewables and low carbon electricity generation. However, we also find some examples of good progress, such as heatwave response planning. Given the overall poor state of progress on climate change and health in Australia, this country now has an enormous opportunity to take action and protect human health and lives. Australia has the technical knowhow and intellect to do this, and our annual updates of this assessment will track Australia's engagement with and progress on this vitally important issue.

From the predictable to the unexpected: kelp forest and benthic invertebrate community dynamics following decades of sea otter expansion.

The recovery of predators has the potential to restore ecosystems and fundamentally alter the services they provide. One iconic example of this is keystone predation by sea otters in the Northeast Pacific. Here, we combine spatial time series of sea otter abundance, canopy kelp area, and benthic invertebrate abundance from Washington State, USA, to examine the shifting consequences of sea otter reintroduction for kelp and kelp forest communities. We leverage the spatial variation in sea otter recovery to understand connections between sea otters and the kelp forest community. Sea otter increases created a pronounced decline in sea otter prey-particularly kelp-grazing sea urchins-and led to an expansion of canopy kelps from the late 1980s until roughly 2000. However, while sea otter and kelp population growth rates were positively correlated prior to 2002, this association disappeared over the last two decades. This disconnect occurred despite surveys showing that sea otter prey have continued to decline. Kelp area trends are decoupled from both sea otter and benthic invertebrate abundance at current densities. Variability in kelp abundance has declined in the most recent 15 years, as it has the synchrony in kelp abundance among sites. Together, these findings suggest that initial nearshore community responses to sea otter population expansion follow predictably from trophic cascade theory, but now, other factors may be as or more important in influencing community dynamics. Thus, the utility of sea otter predation in ecosystem restoration must be considered within the context of complex and shifting environmental conditions.

Climate change, food, water and population health in China.

Anthropogenic climate change appears to be increasing the frequency, duration and intensity of extreme weather events. Such events have already had substantial impacts on socioeconomic development and population health. Climate change's most profound impacts are likely to be on food, health systems and water. This paper explores how climate change will affect food, human health and water in China. Projections indicate that the overall effects of climate change, land conversion and reduced water availability could reduce Chinese food production substantially - although uncertainty is inevitable in such projections. Climate change will probably have substantial impacts on water resources - e.g. changes in rainfall patterns and increases in the frequencies of droughts and floods in some areas of China. Such impacts would undoubtedly threaten population health and well-being in many communities. In the short-term, population health in China is likely to be adversely affected by increases in air temperatures and pollution. In the medium to long term, however, the indirect impacts of climate change - e.g. changes in the availability of food, shelter and water, decreased mental health and well-being and changes in the distribution and seasonality of infectious diseases - are likely to grow in importance. The potentially catastrophic consequences of climate change can only be avoided if all countries work together towards a substantial reduction in the emission of so-called greenhouse gases and a substantial increase in the global population's resilience to the risks of climate variability and change.

Le changement climatique anthropique est à l'origine d'une augmentation de la fréquence, de la durée et de l'intensité de phénomènes météorologiques extrêmes. Ces phénomènes ont déjà eu des conséquences notables sur le développement socioéconomique et la santé des populations. Les effets les plus marqués du changement climatique se manifesteront certainement au niveau de l'alimentation, des systèmes sanitaires et de l'eau. Cet article examine la manière dont le changement climatique affectera l'alimentation, la santé humaine et l'eau en Chine. Selon les prévisions, les effets globaux du changement climatique, la conversion des terres et la diminution de l'eau disponible pourraient considérablement réduire la production alimentaire chinoise, bien que de telles prévisions comportent inévitablement un certain degré d'incertitude. Le changement climatique aura probablement des conséquences importantes sur les ressources en eau, avec par exemple des modifications des régimes de précipitations ou encore des sécheresses et des inondations plus fréquentes dans certaines régions de Chine. Ces effets mettront indubitablement en péril la santé et le bien-être de nombreuses communautés. À court terme, la santé des populations en Chine devrait se trouver affectée par l'augmentation des températures de l'air et de la pollution. Sur le moyen et le long terme, cependant, ce sont les effets indirects du changement climatique (par ex., changements au niveau de la disponibilité des denrées alimentaires, de l'eau et des lieux de résidence, dégradation de la santé mentale et du bien-être des personnes, changements dans la répartition et la saisonnalité des maladies infectieuses) qui devraient prendre de l'importance. Les conséquences potentiellement catastrophiques du changement climatique ne peuvent être évitées que si tous les pays œuvrent ensemble en vue de réduire sensiblement les émissions de gaz à effet de serre et d'augmenter la résilience de la population mondiale face aux risques de variabilité et de changement climatiques.

Parece que el cambio climático antropogénico está aumentando la frecuencia, duración e intensidad de fenómenos meteorológicos extremos. Tales fenómenos ya han afectado enormemente el desarrollo socioeconómico y la salud pública. Los efectos más profundos del cambio climático tienen posibilidades de afectar a la alimentación, los sistemas sanitarios y el agua. En este artículo se explora cómo influirá el cambio climático en la alimentación, la salud pública y el agua en China. Las previsiones indican que los efectos generales del cambio climático, la conversión del suelo y la menor disponibilidad de agua podrían reducir la producción de alimentación en China de forma sustancial, a pesar de que la incertidumbre es inevitable en dichas previsiones. Es probable que el cambio climático afecte de manera importante a los recursos de agua, por ejemplo, cambios en los patrones de las precipitaciones y aumentos de la frecuencia de las sequías y las inundaciones en algunas zonas de China. Sin duda, tales impactos amenazarán la salud pública y el bienestar de muchas comunidades. A corto plazo, la salud pública china se verá perjudicada por los aumentos de la temperatura del aire y la contaminación. Sin embargo, de medio a largo plazo, es probable que aumente la importancia de los efectos indirectos del cambio climático, como los cambios de la disponibilidad de alimentos, refugio y agua, una reducción del bienestar y la salud mental y cambios en la propagación y estacionalidad de enfermedades infecciosas. Las posibles consecuencias catastróficas del cambio climático pueden evitarse únicamente si todos los países trabajan juntos para reducir en gran medida la emisión de los conocidos gases de efecto invernadero y para aumentar la resistencia de la población mundial ante los riesgos de la variabilidad y el cambio climáticos.

A qualitative exploration of the unmet psychosocial rehabilitation needs of cancer survivors in China.

OBJECTIVE: This study explores the unmet psychosocial rehabilitation needs of cancer survivors. METHODS: Sixty-eight cancer survivors from the Shanghai Cancer Rehabilitation Club in China participated in one of the eight focus groups. These were transcribed verbatim, coded using thematic analysis and analysed using NVivo 10. RESULTS: Five main themes were identified: the need for (1) better information: Chinese cancer survivors find it difficult to sort and evaluate the overwhelming mass of information with which they are confronted; (2) psychological support: survivors fear cancer relapse and neighbours' discrimination against them; support from other cancer survivors can relieve the stress; (3) support for survivors' families: like the survivors, family members are under great but usually unacknowledged pressure; (4) improved health and medical services: community health service centres provide little medical, informational or psychological support for cancer survivors, who seek and expect more communication with doctors; and (5) assistance with the financial burden: costs of treatment and lack of adequate medical insurance cause substantial financial pressure for survivors. CONCLUSIONS: This study shows that, in addition to their illness, Chinese cancer survivors experience a range of stresses related to their financial circumstances, lack of reliable and summarised information, poor access to support and services (including for their families) and discrimination. Support from families seems to improve survivors' ability to cope. Cancer survivors (and their families) need an integrated package of support from their families, doctors and other service providers, hospitals and communities. These findings can inform approaches to continuing care for cancer survivors. Copyright © 2015 John Wiley & Sons, Ltd.

Social capital, health, and elderly driver status.

Driving a car enables many people to engage in meaningful activities that, in turn, help develop and maintain personal social capital. Social capital, a combination of community participation and social cohesion, is important in maintaining well-being. This paper argues that social capital can provide a framework for investigating the general role of transportation and driving a car specifically to access activities that contribute to connectedness and well-being among older people. This paper proposes theoretically plausible and empirically testable hypotheses about the relationship between driver status, social capital, and well-being. A longitudinal study may provide a new way of understanding, and thus of addressing, the well-being challenges that occur when older people experience restrictions to, or loss of, their driver's license.

The cost of hospital-acquired complications for older people with and without dementia; a retrospective cohort study.

BACKGROUND: Increased length of stay and high rates of adverse clinical events in hospitalised patients with dementia is stimulating interest and debate about which costs may be associated and potentially avoided within this population. METHODS: A retrospective cohort study was designed to identify and compare estimated costs for older people in relation to hospital-acquired complications and dementia. Australia's most populous state provided a census sample of 426,276 discharged overnight public hospital episodes for patients aged 50+ in the 2006-07 financial year. Four common hospital-acquired complications (urinary tract infections, pressure areas, pneumonia, and delirium) were risk-adjusted at the episode level. Extra costs were attributed to patient length of stay above the average for each patient's Diagnosis Related Group, with separate identification of fixed and variable costs (all in Australian dollars). RESULTS: These four complications were found to be associated with 6.4% of the total estimated cost of hospital episodes for people over 50 (A$226million/A$3.5billion), and 24.7% of the estimated extra cost of above-average length of stay spent in hospital for older patients (A$226million/A$914million). Dementia patients were more likely than non-dementia patients to have complications (RR 2.5, p <0.001) and these complications comprised 22.0% of the extra costs (A$49million/A$226million), despite only accounting for 10.4% of the hospital episodes (44,488/426,276). For both dementia and non-dementia patients, the complications were associated with an eightfold increase in length of stay (813%, or 3.6 days/0.4 days) and doubled the increased estimated mean episode cost (199%, or A$16,403/A$8,240). CONCLUSION: Urinary tract infections, pressure areas, pneumonia and delirium are potentially preventable hospital-acquired complications. This study shows that they produce a burdensome financial cost and reveals that they are very important in understanding length of stay and costs in older and complex patients. Once a complication occurs, the cost is similar for people with and without dementia. However, they occur more often among dementia patients. Advances in models of care, nurse skill-mix and healthy work environments show promise in prevention of these complications for dementia and non-dementia patients.

Perceived profitability and well-being in Australian dryland farmers and irrigators.

OBJECTIVE: To describe the relationship between self-reported farm profitability and farmer well-being, and to explore potential implications for farmer assistance policy. DESIGN: Cross-sectional analysis of farmers from Regional Wellbeing Survey data (wave 1, 2013) and comparison between groups. PARTICIPANTS: Participants were 1172 dryland farmers (35% women) and 707 irrigators (24% women). MAIN OUTCOME MEASURE: The Personal Wellbeing Index and the Kessler 10-item measure of general psychological distress. RESULTS: There is a consistent and significant relationship between higher profitability, greater well-being and less distress among dryland farmers and irrigators. CONCLUSIONS: The relationship between farm profitability and the well-being of Australian dryland farmers and irrigators has the potential to inform farmer assistance policy. Assistance programs can be more effective if they explicitly incorporate a profitability assessment into their targeting and eligibility requirements and a well-being component into program design and delivery. SETTING: Rural Australia. INTERVENTION: Not applicable.

The impact of drought on the association between food security and mental health in a nationally representative Australian sample.

BACKGROUND: The association between food insecurity and mental health is established. Increasingly, associations between drought and mental health and drought and food insecurity have been observed in a number of countries. The impact of drought on the association between food insecurity and mental health has received little attention. METHODS: Population-based study using data from a nationally representative panel survey of Australian adults in which participants report behaviour, health, social, economic and demographic information annually. Exposure to drought was modelled using annual rainfall data during Australia's 'Big Dry'. Regression modelling examined associations between drought and three indicative measures of food insecurity and mental health, controlling for confounding factors. RESULTS: People who reported missing meals due to financial stress reported borderline moderate/high distress levels. People who consumed below-average levels of core foods reported more distress than those who consumed above the average level, while people consuming discretionary foods above the average level reported greater distress than those consuming below the threshold. In all drought exposure categories, people missing meals due to cost reported higher psychological distress than those not missing meals. Compared to drought-unadjusted psychological distress levels, in most drought categories, people consuming higher-than-average discretionary food levels reported higher levels of distress. CONCLUSIONS: Exposure to drought moderates the association between measures of food insecurity and psychological distress, generally increasing the distress level. Climate adaptation strategies that consider social, nutrition and health impacts are needed.

A qualitative study of smoking behavior among the floating population in Shanghai, China.

BACKGROUND: China has become the world's largest producer and consumer of tobacco and lung cancer is China's leading cause of cancer deaths. The large majority of Chinese smokers are men. Tobacco consumption is of particular concern among China's internal floating (or migrant) population, which has become a permanent feature of Chinese society, because this population is very large (over 100 million persons) and it has a high prevalence of smoking. Considering additionally that like the general population of China, the smoking prevalence rate of women from this group is quite low, we therefore aimed to explore smoking-related knowledge, attitudes and behaviours among male smokers in the floating population to help inform the development of effective smoking cessation interventions in this important target group in China. METHODS: We interviewed 39 floating population male smokers in six focus groups and performed a qualitative content analysis of the interviews. RESULTS: Most participants knew that smoking is risky to health but they knew little about why. Habit and social participation were key drivers of smoking. Smoking was regarded as a core component of their identity by the urban residents. Some participants had tried to stop smoking but none reported having ever been educated about smoking. CONCLUSIONS: Smoking cessation interventions for China's male floating population would need to incorporate comprehensive education and information about why smoking is dangerous and the benefits of stopping.

Correlates of persisting posttraumatic symptoms in children and adolescents 18 months after a cyclone disaster.

OBJECTIVE: To describe PTSD symptom persistence and resolution, including the potential phenomenon of late-onset PTSD, in children and adolescents 18 months after a cyclone disaster; and to investigate factors that predict longer-term symptom outcome. METHOD: 71 children and 191 adolescents who were screened three months after a Category 5 Cyclone were re-screened 18 months post-disaster. Child-report measures included the PTSD Reaction Index, measures of event exposure and social connectedness. RESULTS: Approximately 1-in-5 children and 1-in-12 adolescents endorsed cyclone-related PTSD symptoms at the moderate to severe level 18 months post-disaster. Of these approximately one-half (44.8%) of children were in the 'high-persister' group at 18-month follow-up. Persistence of low symptoms was very common (97.6%) and late-onset PTSD was a rare phenomenon. This pattern was similar in adolescents: 25.0% were in the 'high-persister' group and few students experienced late-onset PTSD. In multivariate analysis, only initial severe to very severe PTSD category made a significant independent contribution to explaining persisting moderate to severe PTSD symptoms in primary school students (ORadj=8.33, 95% CI=1.45-47.84). There was a trend for a similar result in secondary students. CONCLUSION: A child or adolescent with few PTSD symptoms three months post-disaster is likely to remain so unless a further traumatic event occurs. However, if symptomatic at three months, there is approximately a 30-45% chance that the child or adolescent will still be symptomatic 18 months after the disaster. Given the high rate of students in the 'resolver' group, initial posttraumatic symptoms are a necessary but not sufficient condition for predicting chronic symptomatology. Other targets for predictive modelling include initial threat perception and high and low social connectedness.

Summer of sorrow: measuring exposure to and impacts of trauma after Queensland's natural disasters of 2010-2011.

OBJECTIVES: To assess the population prevalence of property, income and emotional impacts of the 2010-2011 Queensland floods and cyclones. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional telephone-based survey using a brief trauma exposure and impact screening instrument, conducted between 11 March and 6 June 2011, of 6104 adults who answered natural disaster and mental health questions. MAIN OUTCOME MEASURES: Natural disaster property damage exposure and emotional wellbeing impacts. RESULTS: Two-thirds of respondents (62%) reported being affected by the disasters, with property damage exposure ranging from 37.2% (suburb or local area) to 9.2% (own home, with 2.1% living elsewhere at least temporarily). Income was reduced for 17.0% of respondents and 11.7% of income-producing property owners reported damage to those properties. Trauma impacts ranged from 14.3% of respondents feeling "terrified, helpless or hopeless" to 3.9% thinking they might be "badly injured or die". Up to 5 months after the disasters, 7.1% of respondents were "still distressed" and 8.6% were "worried about how they would manage". Adults of working age and residents of regional and remote areas and of socioeconomically disadvantaged areas were disproportionately likely to report exposure to damage and emotional impacts. CONCLUSIONS: Weather-related disasters exact a large toll on the population through property damage and resultant emotional effects. Vulnerable subpopulations are more severely affected. There is a need for realistic, cost-effective and rapid-deployment mass interventions in the event of weather disasters.

How interprofessional learning improves care.

Students from different health disciplines often have little idea of what each other's roles entail. Interprofessional learning increase this knowledge, as well as giving students an understanding of the interpersonal skills needed for liaison and communication. IPL has been shown to create teams that work together better and improve patient experience. It has been introduced successfully at the University of East Anglia and at other higher education institutions.

Climate Change and Substance-Use Behaviors: A Risk-Pathways Framework.

Climate change is undermining the mental and physical health of global populations, but the question of how it is affecting substance-use behaviors has not been systematically examined. In this narrative synthesis, we find that climate change could increase harmful substance use worldwide through at least five pathways: psychosocial stress arising from the destabilization of social, environmental, economic, and geopolitical support systems; increased rates of mental disorders; increased physical-health burden; incremental harmful changes to established behavior patterns; and worry about the dangers of unchecked climate change. These pathways could operate independently, additively, interactively, and cumulatively to increase substance-use vulnerability. Young people face disproportionate risks because of their high vulnerability to mental-health problems and substance-use disorders and greater number of life years ahead in which to be exposed to current and worsening climate change. We suggest that systems thinking and developmental life-course approaches provide practical frameworks for conceptualizing this relationship. Further conceptual, methodological, and empirical work is urgently needed to evaluate the nature and scope of this burden so that effective adaptive and preventive action can be taken.