The perils of poly- and perfluorinated chemicals on the reproductive health of humans, livestock, and wildlife.

Poly- and perfluoroalkyl substances (PFAS) are a prominent class of persistent synthetic compound. The widespread use of these substances in various industrial applications has resulted in their pervasive contamination on a global scale. It is therefore concerning that PFAS have a propensity to accumulate in bodily tissues whereupon they have been linked with a range of adverse health outcomes. Despite this, the true extent of the risk posed by PFAS to humans, domestic animals, and wildlife remains unclear. Addressing these questions requires a multidisciplinary approach, combining the fields of chemistry, biology, and policy to enable meaningful investigation and develop innovative remediation strategies. This article combines the perspectives of chemists, soil scientists, reproductive biologists, and health policy researchers, to contextualise the issue of PFAS contamination and its specific impact on reproductive health. The purpose of this article is to describe the challenges associated with remediating PFAS-contaminated soils and waters and explore the consequences of PFAS contamination on health and reproduction. Furthermore, current actions to promote planetary health and protect ecosystems are presented to instigate positive social change among the scientific community.

A case of extracapsular silicone gel implant rupture with contralateral gel migration.

Symmastia is a rare complication of augmentation mammaplasty that occurs when a breast implant crosses the midline and connects with the contralateral implant pocket. We present a case of implant rupture, migration to the contralateral breast, and ultimate symmastia following a traumatic fall in a patient with prior breast augmentation.

Mechanical upcycling of single-use face mask waste into high-performance composites: An ecofriendly approach with cost-benefit analysis.

The COVID-19 pandemic created an unprecedented demand for PPE, with single-use face masks emerging as a critical tool in containing virus transmission. However, the extensive use and improper disposal of these single-use face masks, predominantly composed of non-biodegradable plastics, has exacerbated environmental challenges. This research presents an innovative method for mechanically upcycling PPEs used in medical sectors i.e. single use face masks. The study investigates a facile approach for reclamation of infection-free and pure polypropylene (PP) plastic from discarded single use face masks (W-PP) and blends it with various vegetable oil percentages (5, 10 and 20 %), resulting in a versatile material suitable for various applications. Melt flow index, rheological behaviour, DSC and FTIR were employed to investigate the effect of vegetable oil/radical initiator through chemical grafting on W-PP properties. The results demonstrate significant enhancements in the tensile strength and modulus of W-PP when blended with vegetable oil and a radical initiator. There was a marked increase in tensile strength (33 %) and strain (55 %) compared to untreated W-PP, rendering W-PP both robust and flexible. Furthermore, we employed this upcycled W-PP in the fabrication of glass fibre-reinforced composites, resulting in notable enhancements in both tensile strength and impact resistance. The upcycled W-PP demonstrates excellent potential for various applications, such as sheet forming and 3D printing, where the non-brittleness of plastics plays a pivotal role in manufacturing high-quality products. The cost-benefit analysis of this approach underscores the potential of upcycling PPE waste as a sustainable solution to mitigate plastic pollution and conserve valuable resources. The applications of this upcycled material span a wide range of industries, including automotive composites, packaging, and 3D printing.

Minding our futures: Understanding climate-related mental wellbeing using systems science.

INTRODUCTION: Climate change impacts mental wellbeing through complex pathways and young people are among the most vulnerable to climate-related anxiety. Minding our Futures used methods from systems science to explore this issue and identify actions to promote mental wellbeing for young Australians (18-24 years). METHODS: This qualitative study used Group Model Building via three online facilitated workshops recruiting health, youth and climate practitioners and researchers engaged with young people around climate change and/or mental wellbeing (N = 14). Analysis created a systems map and rich description of the relationships between causal factors and their impact on young people. RESULTS: Three themes emerged; "Government, Services and Structures" highlighted underlying structural issues including capitalism and political powerlessness; "Social Norms, Communication and Taking Action" reflected social media and misinformation; and "Personal Experience of Environmental Disasters" described the impact of climate-related disasters and importance of nature and place connection. Participants specified connections between the themes and mental health outcomes. CONCLUSION: This novel applied translational research process supported key informants to design structural responses to a complex and critical public health issue. Their vision was a multi-faceted approach, co-led with young people, drawing on Indigenous knowledges and change-focused policy, community empowerment and nature-based interventions.

The co-benefits of biodiversity citizen science for well-being and nature relatedness.

Human well-being is dependent on the health of our planet. Biodiversity-related citizen science supports conservation research, and there is increasing interest in its potential as a health co-benefits intervention. This randomized controlled study investigates the health co-benefits of biodiversity citizen science participation. Seventy participants were randomly assigned to a citizen science project or control group for an 8-month period. Both groups completed pre- and post-intervention surveys, evaluating nature relatedness, self-efficacy related to biodiversity loss, subjective well-being, and climate change anxiety. A subset (N = 13) of participants engaged in the citizen science project also took part in focus group discussions. The intervention group reported a significant increase in nature relatedness and self-efficacy to help address issues of biodiversity loss. Although no significant changes were observed for other well-being or anxiety scales, most participants reported positive outcomes related to mental or physical well-being in focus groups. There were stronger positive effects for participants without previous environmental volunteering experience. These results suggest that citizen science participation has the potential to contribute to Planetary Health goals, with sustained co-benefits for well-being and nature relatedness. Future interventions evaluating co-benefits should consider previous environmental volunteering experience and focus on participants with little experience to maximize health outcomes.

Three Reasons Why Expecting 'Recovery' in the Context of the Mental Health Impacts of Climate Change Is Problematic.

Global warming is bringing with it continued long-term changes in the climate system. Extreme weather-related events, which are already becoming a daily reality around the world, are predicted to be more intense and frequent in the future. The widespread occurrence of these events and climate change more broadly are being experienced collectively and at scale and do not affect populations evenly. These climate changes have profound impacts on mental health and wellbeing. Existing reactive responses include frequent implied and direct references to the concept of 'recovery'. This is problematic in three ways: it conceives of extreme weather events as single, one-off occurrences; implies their unexpected nature; and contains an integral assumption of an end point where individuals/communities are 'recovered'. Models of mental health and wellbeing support (including funding) need to change, shifting away from 'recovery' towards a focus on adaptation. We argue that this presents a more constructive approach that may be used to collectively support communities.

Understanding and managing psychological distress due to climate change.

BACKGROUND: Australia has warmed by 1.4°C since pre-industrial times. This is greater than the global average and is predicted to exceed 1.5°C by 2030. This will have significant environmental effects that can threaten human wellbeing. Most Australians have direct experience of climate change-related events, with health, social, cultural and economic impacts already evident and wide-ranging implications for mental health. OBJECTIVE: This article provides an overview of climate distress, which encompasses both 'climate anxiety' and other forms of distress related to climate change. It outlines the features and prevalence of climate distress, as well as approaches for assessment and management based on current evidence and theory. DISCUSSION: Climate distress is common and can take many forms. These concerns may not be readily disclosed, but can be sensitively elicited, and patients may benefit from the opportunity for empathic, non-judgemental exploration of their experiences. Care must be taken not to pathologise rational distress while identifying maladaptive coping strategies and serious mental illness. Management should focus on adaptive coping strategies, use evidence­based psychological interventions and draw upon emerging evidence about behavioural engagement, nature connection and group processes.

Treatment of Thoracoabdominal Aortic Aneurysmal Degeneration Following Aortic Dissections at a Single Surgical Center Using a Physician-Assembled Branched Endovascular Stent Graft.

BACKGROUND: Aneurysmal degeneration of aortic dissection portends significant morbidity and mortality consequences in the subacute and chronic phases of aortic dissection. This article describes the use of a multibranched stent graft system for the treatment of thoracoabdominal aneurysmal degeneration of dissections with visceral segment involvement and reports upon the 30-day and 1-year outcomes for the first 18 patients treated with this design configuration. METHODS: The in-hospital, 30-day and 1-year morbidity and mortality outcomes of 18 consecutive patients treated with the physician-assembled visceral manifold or unitary manifold stent graft systems between 2013 and 2022 were evaluated. RESULTS: A total of 18 patients were treated for aneurysmal changes after aortic dissection. A total of 71 visceral vessels were successfully stented. There were no acute procedural failures. There were no episodes of paraplegia, reinterventions for type I or III endoleaks, patency-related events or mortalities reported in the first 30 days following treatment. One-year, all-cause mortality demonstrated 2/11 (18.2%). CONCLUSIONS: The aneurysmal degeneration of aortic dissection poses significant risks to patients with medically managed aortic dissections and those under surveillance. When these aneurysms develop in the thoracoabdominal region, treatment becomes even more challenging given the problem of visceral vessel patency, as these vessels can originate off the true or false lumens. The physician-designed endovascular stent graft system reported upon here has been successfully deployed in 18 patients with no acute procedural failures and promising clinical results. This treatment modality may offer utility to vascular surgeons whose patients with thoracoabdominal aneurysmal degeneration following aortic dissection have historically had limited endovascular repair prospects.

Prevalence and determinants of mental health related to climate change in Australia.

AIMS: The climate emergency will likely prove this century's greatest threat to public health within which mental health effects need consideration. While studies consistently show the majority of Australians are very concerned about the impacts of climate change, there is limited evidence from nation-wide research linking climate change with mental health burden in sub-populations. This study aimed to understand the impact of climate change on mental health in the Australian population and identify populations who are most at risk of climate-related mental health burden. METHODS: A nation-wide Australian survey conducted between August and November 2020 of adults was approximately representative across sex, age, location, state and area disadvantage. Two-stage recruitment involved unrestricted self-selected community sample through mainstream and social media (N = 4428) and purposeful sampling using an online panel (N = 1055). RESULTS: Most Australians report having a direct experience of a climate change-related event. Young people are experiencing significant rates of eco-anxiety. One in four people with direct experience of a climate change-related event met post-traumatic stress disorder screening criteria. People who have not had a direct experience are showing symptoms of pre-trauma, particularly in younger age groups and women. There were 9.37% (503/5370) of respondents with responses indicating significant eco-anxiety, 15.68% (370/2359) with pre-traumatic stress and 25.60% (727/2840) with post-traumatic stress disorder. Multivariable regressions confirmed that younger people are more affected by eco-anxiety and post-traumatic stress disorder (pre- or post-trauma); women are more affected by post-traumatic stress disorder (pre- or post-trauma) and those from more disadvantaged regions are more affected by eco-anxiety. CONCLUSION: Australia is facing a potential mental health crisis. Individuals with and without direct experience of climate change are reporting significant mental health impacts, with younger age groups being disproportionately affected. There are key roles for clinicians and other health professionals in responding to and preventing climate-related mental health burden.

Telemedicine in the Wake of COVID-19: A Statewide Demographic Study on Provider Utilization and Perspective In South Dakota.

INTRODUCTION: The COVID-19 pandemic has ushered in a rapid evolution of regulations surrounding telemedicine and the public's need for affordable, accessible, high-quality care at a distance. This necessity led to a rise in telemedicine demand that forced health systems to adapt, and for providers to witness the potential benefits and limitations of such services. METHODS: In this analysis, Sanford Health EMR data was evaluated from Q2 of 2019 to Q2 of 2020 to compare specialty utilization of telemedicine and quantify percentage change within the midst of the COVID-19 pandemic. A survey was conducted to evaluate provider opinion within the Sanford Health system regarding demographics, usage, perceived benefits, and perceived barriers to this rapid adoption. RESULTS: Results suggest that Sanford Health experienced a significant, 1,600 percent increase of telemedicine usage. Additionally, with this increased usage of telemedicine, provider opinion of telemedicine and its potential has improved. During the pandemic, a greater percentage of providers believe telemedicine is highly beneficial to their practice and a majority believe telemedicine will continue to play a vital role in their practice in the future. However, the barriers found within the survey included limited patient access, technical difficulties, reimbursement, and insurance coverage. CONCLUSIONS: With the rapid increase in provider usage and the subsequent approval of providers, telemedicine has the potential to facilitate higher quality healthcare going forward. The COVID-19 pandemic has necessitated evolution and adoption of virtual media in medicine and has provided a unique glimpse into telemedicine's limitations and exceptional potential.

Planetary health pedagogy: Preparing health promoters for 21st-century environmental challenges.

ISSUE ADDRESSED: Multiple interconnected drivers threaten the health and wellbeing of humans and the environment, including biodiversity loss, climate change, pollution, rapid urbanisation and displacement. This requires enhanced literacy on health of the environment and innovation in problem conceptualisation and cross-sectoral solutions. Contemporary mandates (eg, Ottawa Charter) task health promoters to tackle the human and environmental health crisis. To address the complex determinants across multiple settings, health promotion graduates require competencies in interdisciplinary collaboration grounded in systems thinking. They also require knowledge and agility to leverage multiple gains from health promotion action that benefits people and planet. Similarly, health promotion practitioners are currently aware of the need for skills to deliver co-benefits to people and planet. Planetary health, as theory and framework, provides a socio-ecological focus, systems thinking approach, co-benefits framework for action and foundational basis to enhance health promotion graduates' skills and competencies to address multiple health and planetary challenges. To date, there have been limited practical attempts to address these challenges. METHOD: A desktop review and synthesis of teaching and learning scholarship in planetary health were coupled with iterative critical reflections of teaching practice, and the use of two case studies, to illuminate innovations in health promotion competencies. RESULTS: Two examples of how planetary health promotion challenges are addressed through teaching and learning scholarship are presented to illustrate the use of a tailored sustainability tool and a deliberative interdisciplinary approach to collaboration, delivered within a course that constructively aligns curriculum content and assessment. CONCLUSION: A bespoke model, the Sustainability Wheel of Fortune, combined with constructive interactive teaching approaches, adds interdisciplinary collaboration and systems thinking approaches to the knowledge and practice of planetary health. A postgraduate microcredential fast-tracks knowledge and skills acquisition for recent graduates and established practitioners interested in upskilling for planning planet and population health co-benefits. SO WHAT?: The Sustainability Wheel of Fortune provides health promotion students with a model for understanding, and addressing, complex global and local challenges. The microcredential builds on health promotion competencies to develop interdisciplinary and systems-based approaches to planetary health challenges.

Bushfires, COVID-19 and Young People's Climate Action in Australia.

Australia's summer bushfires of 2020-2021 were catastrophic, negatively impacting people, and the natural environment. This climate change-related event exacerbated the influence of the COVID-19 pandemic on public health. Young people are a priority population whose health and livelihoods are significantly impacted by these events. At the same time, young people are active agents for climate action. This exploratory mixed-method study draws on descriptive analyses of survey data (n = 46) and thematic analyses of interview data (n = 6) which demonstrated that some young people, whilst concerned about existential and real impacts of climate change, use contact with nature to cope and as motivation for taking climate actions.

Hope, Coping and Eco-Anxiety: Young People's Mental Health in a Climate-Impacted Australia.

(1) Background: In Australia, young people are one of the most vulnerable populations to the mental health impacts of climate change. The aim of this article was to explore mental health promotion issues related to climate change for young people in Australia. (2) Methods: An exploratory mixed-method approach, co-led by young people, was used to engage young people living in Australia aged 18-24 years in semi-structured interviews (N = 14) and an online survey (N = 46). Data were analysed thematically and with descriptive statistics. (3) Results: Findings indicated that negative impacts included worry, eco-anxiety, stress, hopelessness/powerlessness and feelings of not having a voice. Several mediating factors, in particular social media engagement, highlighted the duality of mental health impacts for young people's mental health. Positive impacts of climate action included feeling optimistic and in control. (4) Conclusions: This exploratory study contributes to an emerging field of public health research on young people's mental health in a climate-impacted Australia. Climate change is a significant concern for young people, and it can negatively affect their mental health. The findings can inform the design of public health interventions that raise awareness of climate change-related mental health issues among young people and promote their participation in nature-based interventions, climate action and empowering social media engagement.

Minding environment, minding workers: environmental workers' mental health and wellbeing.

Climate change and environmental degradation caused by human activities are having an irrefutable impact on human health, particularly mental health. People working in the environment sector are confronted with these impacts daily. This exploratory study was conducted as a response to concern in the sector about rising levels of worry and distress, and a need for organizational knowledge about effective workplace mental health strategies. Using evidenced-based frameworks for workplace mental health and wellbeing, the study focused on the relationship between climate change, environmental degradation and mental health issues for this sector. This Australian-based exploratory qualitative study was guided by participatory research approaches. Maximum variation and criterion sampling strategies were applied to engage environmental sector senior managers (n = 8) in individual/paired interviews, followed by online focus group sessions with frontline employees (n = 9). Qualitative thematic analysis techniques were used in an iterative process, combining inductive and deductive strategies. Data was triangulated and interpretation was finalized with reference to literature and a workplace mental health promotion framework. Interview data provided new perspectives on the interconnectivity between risk and protective factors for mental health. Workers were motivated by commitment and values to continue their work despite experiencing increasing levels of trauma, ecological grief, and stress due to overwork and ecological and climate change crises. The findings highlight the need for integrated health promotion approaches that acknowledge the complex interactions between risk and supportive factors that influence mental health in this sector.

Exploring the co-benefits of environmental volunteering for human and planetary health promotion.

ISSUE ADDRESSED: Health promotion has adopted the planetary health perspective to address the threats posed by climate change, environmental degradation and environmental deprivation. Nature is a setting for health promotion that can produce co-benefits for human health and the protection of the environment. This paper presents the findings of a New South Wales (NSW) study of peoples' motivations for, and co-benefits of, environmental volunteering. METHODS: This paper combines the findings of a literature review and qualitative data from a larger mixed-methods study of environmental volunteering (eg administration and co-ordination, bush regeneration, advocacy, tour guiding) in NSW. A review of international literature from 2005 yielded 100 documents for analysis. Maximum variation and stratified purposeful sampling strategies were applied to engage 12 environmental volunteers and 30 employees of environmental organisations in a series of focus groups (n = 2) and interviews (n = 22). Qualitative thematic analysis techniques were applied and data triangulated. RESULTS: Motivations for environmental volunteering include the following: personal, for example, new skills or knowledge, environmental, for example, improve the environment and social/community, for example, forming connections. Environmental volunteering offers a range of benefits for individuals, environmental organisations and the natural environment. These include enhanced mental and social health, and connection to place and learning about the environment. CONCLUSIONS: Environmental volunteering has the potential to address key determinants of health - social inclusion, employment and education. From a planetary health perspective, there are multiple co-benefits of human-environmental interaction arising from environmental volunteering. Environmental volunteering is a planetary health strategy that could be incorporated into community-based health promotion. SO WHAT?: Health promotion has a mandate to act on ecological determinants of health. Environmental volunteering is an untapped resource for community-based health promotion and for achieving planetary health goals.

Planetary health indicators for the local level: opportunities and challenges in applying the happy planet index in Victoria, Australia.

The United Nations Sustainable Development Goals, New Urban Agenda and Paris Agreement on Climate Change are blueprints for health promotion action that mandate human health is linked inextricably to the health of the environment. In the Anthropocene, new indicators are required to promote community engagement with, and measurement of, healthy and sustainable wellbeing for people and planet. This study explored the need for a metric such as the Happy Planet Index that explicitly links human health to health of the environment for a local level scale in Australia. The project arose from an international coalition of health promoters advocating for 'planetary health' approaches. Qualitative description methods guided the study design involving key informant interviews (n = 17) and four focus groups (n = 27 participants) with health and/or sustainability academics, practitioners and policy-makers. Document analysis of health and environment indices and policy mandates augmented the analysis. Qualitative content analysis techniques were used to analyse the findings. There was strong interest for a local level composite indicator, such as a rescaled Happy Planet Index (life expectancy × life satisfaction × equity adjustment/ecological footprint) for use at a local level. The value of a composite index was: its ability to promote community engagement with planetary health thinking; an advocacy tool for joint health and sustainability policy; to justify programs on health and environmental co-benefits; and to provide a mechanism for correlative comparisons between local governments and national comparisons. However, disciplinary silos currently limit partnerships for health promotion and planetary health and a local composite index could help bridge these divides.

Integrating Standardized Multimedia to Supplement Physical Examination Curriculum: An Assessment of Medical Student and Evaluator Perspective.

INTRODUCTION: As a new generation enters the realm of medical education, so do their preferences for technology integration into didactic curricula. An analysis of 106 LCME-accredited medical schools found that 97 percent of programs utilize supplemental e-learning to enhance traditional, face-to-face education in their physical examination curricula. Of these programs, 71 percent produced their multimedia internally. Existing literature indicates medical students benefit from the utilization of multimedia tools and the standardization of the instruction process in the learning of physical examination techniques. However, no studies were found that outline a detailed, reproducible integration model for other institutions to follow. Current literature also fails to assess the effect of multimedia tools on student well-being and largely ignores the educator perspective. This study aims to demonstrate a practical approach to integrating supplemental videos into an existing curriculum and to assess first year medical student and evaluator perspectives at strategic points throughout the process. METHODS: A video curriculum tailored to the Sanford School of Medicine's Objective Structured Clinical Examination (OSCE) requirements was created. The curriculum contained four videos, each designed for a specific examination component - musculoskeletal, head and neck, thorax/abdominal, and neurology examinations. First-year medical students participated in a pre-video integration survey as well as a post-video-integration and OSCE survey assessing student confidence, anxiety reduction, education standardization, and video quality. The OSCE evaluators completed a survey assessing the ability of the video curriculum to standardize the education and evaluation process. All surveys administered were based on a 5-point Likert scale format. RESULTS: Of survey respondents, 63.5 percent (n = 52) utilized at least one of the videos in the series. Prior to implementation of the video series, 30.2 percent of students agreed with the statement, "I am confident in my ability to demonstrate the skills needed to complete the following exam." After implementation, 100 percent of video-users agreed with this statement compared to 94.2 percent of non-video-users. A reported 81.8 percent of video-users agreed that the video series decreased anxiety when performing the neurologic, abdomen/thorax, and head and neck exams, whereas 83.8 percent agreed in the use of the musculoskeletal video series. A reported 84.2 percent of video users agreed the video curriculum standardized the instruction process. OSCE evaluator participation in the survey was 68.8 percent (n=11), and 90.9 percent of these evaluators agreed the videos standardized the education and evaluation process. CONCLUSIONS: Overall, this study outlines the process of augmenting traditional didactic physical examination curricula with multimedia and the support of this process from medical student and OSCE evaluators. Video users report decreased anxiety and increased confidence in performing physical examination skills for the OSCE after integration of the video series. Students and OSCE evaluators found the video series to be a useful tool in the educational process and evaluation standardization.

A Practical Guide to Trauma Resuscitation - Recommendations for Managing Hemorrhagic Shock in the Rural Healthcare Setting.

Traumatic injury is the leading cause of death in individuals under the age of 45 and hemorrhage is the leading cause of preventable death within hours of presentation. This review article on adult trauma resuscitation is intended to be a practical guide for critical access centers. This is accomplished by discussing the pathophysiology and management of hemorrhagic shock.