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.

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.

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 evidence‑based 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

OBJECTIVE

Aneurysmal degeneration of aortic dissection portends significant morbidity and mortality consequences in the subacute and chronic phases of aortic dissection. This paper describes the use of a multi-branched stent graft system for the treatment of thoracoabdominal aneurysmal degeneration of dissections with visceral segment involvement and reports upon the 30-day and one-year outcomes for the first 18 patients treated with this design configuration.

METHODS

The in-hospital, 30-day and one-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

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.

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.

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.

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.

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.

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.

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.

Australians report climate change as a bigger concern than COVID-19

Australia experienced two public health emergencies in 2020 - the catastrophic bushfires and the global coronavirus (COVID-19) pandemic. Whilst these were separate events, both have similar drivers arising from human pressures on the natural environment. Here we report on relative personal concerns of Australians in a survey implemented during the global COVID-19 pandemic. The study design was a cross sectional online survey administered between 11 August and 11 November 2020. The setting was an Australia-wide online population involving 5483 individuals aged ≥18 residing in Australia. Recruitment occurred in two stages: unrestricted self-selected community sample through mainstream and social media (N = 4089); and purposeful sampling using an online panel company (N = 1055). The sample was predominantly female (N = 3187); mean age of 52.7 years; and approximately representative of adults in Australia for age, location, state and area disadvantage (IRSD quintiles). Climate change was very much a problem for 66.3% of the sample, while COVID-19 was ranked at the same level by only 25.3%. Three times as many participants reported that climate change was very much a problem than COVID-19, despite responding at a time when Australians were experiencing Stage 2 through 4 lockdowns. Demographic differences relating to relative personal concerns are discussed. Even in the midst of the uncertainty of a public health pandemic, Australians report that climate change is their most significant personal problem. Australia needs to apply an evidence-based public health approach to climate change, like it did for the pandemic, which will address the climate change concerns of Australians.

Les inhibiteurs du système rénine-angiotensine et la mortalité par COVID-19 : une cohorte prospective de 1160 patients hypertendus, et revue de littérature

Introduction

L’influence d’un traitement chronique par inhibiteurs du système rénine-angiotensine (ISRA) chez les patients infectés par la COVID-19 a fait l’objet de nombreuses études en 2020 avec des résultats controversés, suggérant tantôt l’interruption du traitement au long cours, ou au contraire un effet protecteur du traitement. Nos objectifs étaient :

– d’étudier la mortalité associée à un traitement chronique par ISRA chez des patients hospitalisés pour une infection par le SARS-CoV-2 en France ;

– les raisons expliquant les résultats discordants dans la littérature.

Méthodes

Nous avons sélectionné les sujets hypertendus inclus dans l’étude nationale prospective de 3512 patients hospitalisés avec COVID-19 (cohorte French-COVID) jusqu’au 30 juin 2020. L’exposition était définie par la prescription d’inhibiteurs de l’enzyme de conversion ou antagonistes des récepteurs de l’angiotensine II avant hospitalisation. Des modèles de Cox avec pondérations basées sur le score de propension ont permis d’estimer des hazard ratios (HR) de mortalité à 30 jours du diagnostic de COVID-19 chez les sujets exposés aux ISRA par rapport aux non exposés. Notre revue de la littérature s’est intéressée aux méthodes (plan expérimental, population, exposition, critères de jugement, méthodes statistiques) et aux résultats des études observationnelles publiées étudiant le rôle pronostique des ISRA dans la COVID-19.

Résultats

Nous avons analysé 1160 patients hypertendus ; 719 (62 %) hommes, 777 (67 %) âgés de plus de 65 ans. Les principales comorbidités étaient le diabète (n = 416, 36 %), les maladies cardiaques (n = 401, 35 %) et l’obésité (n = 340, 29 %) ; 705 (61 %) patients étaient sous oxygène dans les deux jours suivant l’admission. Nous avons enregistré 135 (11,6 %) décès dans les 30 jours. Aucune association entre l’exposition chronique aux ISRA et la mortalité (HR non ajusté = 1,13, IC95 % [0,8–1,6] ; HR pondéré sur l’IPT = 1,09 [0,86–1,39] ; HR pondéré sur le SMR = 1,08 [0,79–1,47]) n’a été mise en évidence. Notre revue de littérature a retrouvé 51 études individuelles : 31 chez des patients hypertendus, et 39 chez des patients hospitalisés. Parmi ces dernières, 25/39 ont étudié l’effet du traitement chronique par ISRA avant l’hospitalisation, 11/39 ont étudié l’effet de l’exposition aux ISRA pendant le séjour, et pour 4/39 la temporalité de l’exposition était indéfinie. Un risque augmenté de mortalité associé à l’exposition aux ISRA était fréquemment rapporté dans les études menées dans des populations peu sélectionnées (non restreintes aux hypertendus) ou avec un ajustement inapproprié, généralement expliqué par un biais d’indication. A contrario, une diminution significative de la mortalité associée à l’exposition aux ISRA était le plus souvent rapportée dans des études où l’exposition était définie par le traitement ISRA au cours de l’hospitalisation, expliquée par un biais de causalité inverse et un biais d’immortalité.

Conclusion

Nos résultats ne montrent pas d’association significative entre la prise chronique d’ISRA et la mortalité chez des patients hypertendus hospitalisés pour COVID-19, en accord avec les recommandations des sociétés savantes qui recommandent la poursuite de ces traitements malgré la pandémie. La question d’introduire ces traitements en cours d’hospitalisation est en cours d’évaluation dans des essais randomisés.

Australia in 2030: what is our path to health for all?

CHAPTER 1: HOW AUSTRALIA IMPROVED HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH: Do not think that the social determinants of health equity are old hat. In reality, Australia is very far away from addressing the societal level drivers of health inequity. There is little progressive policy that touches on the conditions of daily life that matter for health, and action to redress inequities in power, money and resources is almost non-existent. In this chapter we ask you to pause this reality and come on a fantastic journey where we envisage how COVID-19 was a great disruptor and accelerator of positive progressive action. We offer glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity. It is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality. CHAPTER 2: ABORIGINAL AND TORRES STRAIT ISLANDER CONNECTION TO CULTURE: BUILDING STRONGER INDIVIDUAL AND COLLECTIVE WELLBEING: Aboriginal and Torres Strait Islander peoples have long maintained that culture (ie, practising, maintaining and reclaiming it) is vital to good health and wellbeing. However, this knowledge and understanding has been dismissed or described as anecdotal or intangible by Western research methods and science. As a result, Aboriginal and Torres Strait Islander culture is a poorly acknowledged determinant of health and wellbeing, despite its significant role in shaping individuals, communities and societies. By extension, the cultural determinants of health have been poorly defined until recently. However, an increasing amount of scientific evidence supports what Aboriginal and Torres Strait Islander people have always said - that strong culture plays a significant and positive role in improved health and wellbeing. Owing to known gaps in knowledge, we aim to define the cultural determinants of health and describe their relationship with the social determinants of health, to provide a full understanding of Aboriginal and Torres Strait Islander wellbeing. We provide examples of evidence on cultural determinants of health and links to improved Aboriginal and Torres Strait Islander health and wellbeing. We also discuss future research directions that will enable a deeper understanding of the cultural determinants of health for Aboriginal and Torres Strait Islander people. CHAPTER 3: PHYSICAL DETERMINANTS OF HEALTH: HEALTHY, LIVEABLE AND SUSTAINABLE COMMUNITIES: Good city planning is essential for protecting and improving human and planetary health. Until recently, however, collaboration between city planners and the public health sector has languished. We review the evidence on the health benefits of good city planning and propose an agenda for public health advocacy relating to health-promoting city planning for all by 2030. Over the next 10 years, there is an urgent need for public health leaders to collaborate with city planners - to advocate for evidence-informed policy, and to evaluate the health effects of city planning efforts. Importantly, we need integrated planning across and between all levels of government and sectors, to create healthy, liveable and sustainable cities for all. CHAPTER 4: HEALTH PROMOTION IN THE ANTHROPOCENE: THE ECOLOGICAL DETERMINANTS OF HEALTH: Human health is inextricably linked to the health of the natural environment. In this chapter, we focus on ecological determinants of health, including the urgent and critical threats to the natural environment, and opportunities for health promotion arising from the human health co-benefits of actions to protect the health of the planet. We characterise ecological determinants in the Anthropocene and provide a sobering snapshot of planetary health science, particularly the momentous climate change health impacts in Australia. We highlight Australia's position as a major fossil fuel producer and exporter, and a country lacking cohesive and timely emissions reduction policy. We offer a roadmap for action, with four priority directions, and point to a scaffold of guiding approaches - planetary health, Indigenous people's knowledge systems, ecological economics, health co-benefits and climate-resilient development. Our situation requires a paradigm shift, and this demands a recalibration of health promotion education, research and practice in Australia over the coming decade. CHAPTER 5: DISRUPTING THE COMMERCIAL DETERMINANTS OF HEALTH: Our vision for 2030 is an Australian economy that promotes optimal human and planetary health for current and future generations. To achieve this, current patterns of corporate practice and consumption of harmful commodities and services need to change. In this chapter, we suggest ways forward for Australia, focusing on pragmatic actions that can be taken now to redress the power imbalances between corporations and Australian governments and citizens. We begin by exploring how the terms of health policy making must change to protect it from conflicted commercial interests. We also examine how marketing unhealthy products and services can be more effectively regulated, and how healthier business practices can be incentivised. Finally, we make recommendations on how various public health stakeholders can hold corporations to account, to ensure that people come before profits in a healthy and prosperous future Australia. CHAPTER 6: DIGITAL DETERMINANTS OF HEALTH: THE DIGITAL TRANSFORMATION: We live in an age of rapid and exponential technological change. Extraordinary digital advancements and the fusion of technologies, such as artificial intelligence, robotics, the Internet of Things and quantum computing constitute what is often referred to as the digital revolution or the Fourth Industrial Revolution (Industry 4.0). Reflections on the future of public health and health promotion require thorough consideration of the role of digital technologies and the systems they influence. Just how the digital revolution will unfold is unknown, but it is clear that advancements and integrations of technologies will fundamentally influence our health and wellbeing in the future. The public health response must be proactive, involving many stakeholders, and thoughtfully considered to ensure equitable and ethical applications and use. CHAPTER 7: GOVERNANCE FOR HEALTH AND EQUITY: A VISION FOR OUR FUTURE: Coronavirus disease 2019 has caused many people and communities to take stock on Australia's direction in relation to health, community, jobs, environmental sustainability, income and wealth. A desire for change is in the air. This chapter imagines how changes in the way we govern our lives and what we value as a society could solve many of the issues Australia is facing - most pressingly, the climate crisis and growing economic and health inequities. We present an imagined future for 2030 where governance structures are designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples. We imagine that these changes were made by measuring social progress in new ways, ensuring taxation for public good, enshrining human rights (including to health) in legislation, and protecting and encouraging an independent media. Measures to overcome the climate crisis were adopted and democratic processes introduced in the provision of housing, education and community development.

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.

Addressing food insecurity in Australia through education for sustainability

Within Australia food insecurity affects an estimated 4 million people annually. Health promotion degrees traditionally prepare pre-service graduates to address food insecurity from a social determinants perspective, little consideration of integrating ecological determinants, however, has been noted. This is a significant problem considering unprecedented environmental challenges facing future food production. Education for sustainability (EfS) is purported to develop graduates who can respond to significant sustainability issues in the 21st century. This study examined the potential for health promotion degrees to utilize EfS to address food insecurity through an ecological lens. The study also illustrates why it might be valuable for academics to use such an approach. Semi-structured interviews with 15 Australian health and sustainability academics and document analysis of 26 associated teaching units was undertaken. Thematic analysis informed the data analysis process to provide meaning and insight into emerging themes. Academics were unaware of EfS or its potential for developing ecologically literate graduates. A lack of university commitment towards sustainability and knowledge and skills to implement EfS were identified as potential barriers. Academics, however, were ascribing to the central tenets used in EfS such as interdisciplinary thinking and reflective practice, demonstrating its potential use in health promotion. EfS, as a framework for incorporating an ecological perspective into health promotion degrees has not been fully realized. This study suggests capacity building of academics with regard to the use of EfS as an approach within health promotion degrees to address significant sustainability issues in the 21st century, such as food insecurity.

Applying the Mandala of Health in the Anthropocene

Issue addressed

The Anthropocene is a new era in which human activity has been the dominant influence on climate and the environment. The negative impact humans have on the earth's systems pose significant threats to human health. Health promotion is a discipline well placed to respond to planetary health challenges of the Anthropocene. The overarching aim of this paper is to describe the elements of 21st century socio‐ecological health and apply them in a revised socio‐ecological framework for health promotion.

Methods

A qualitative description study design was employed to explore the significance of ecological and cultural determinants of health and review models in contemporary health promotion to inform the development of a revised Mandala of Health. Purposeful sampling was used to recruit ten experts from across Australia including academics and practitioners working at the nexus of health promotion, environmental management and sustainability. Data were analysed thematically, using deductive and inductive methods.

Results

A revised Mandala of Health could address existing gaps in health promotion theory and practice. Ecological and cultural determinants of health were considered essential components of health promotion that is often lacking in socio‐ecological frameworks. Indigenous Knowledge Systems were considered immensely important when addressing ecological and cultural determinants of health.

Conclusions

A revised Mandala of Health could encourage development of contemporary health models, assisting health promotion to evolve with the health and environmental issues of the Anthropocene. This study highlights the need for more theoretical development and empirical research regarding ecological and cultural determinants of health in a health promotion context.

So what?

In the context of the Anthropocene, this study highlights the potential gaps in health promotion theory and practice in terms of the natural environment and health and emphasises the need of a paradigm shift to embed ecological and cultural determinants with other determinants of health.

Climate change glossary for public health practice: from vulnerability to climate justice

Climate change is an emerging and growing field of practice for the international public health community. As practitioners, researchers and policy-makers grapple with the local health impacts of climate change, there is an increasing need to clarify key terminology to support public health actors engage and respond in ways that promote intersectoral collaboration. This contribution introduces the public health discourse on climate change, with a particular focus on its implications for health equity. After defining key terms and existing adaptation practices, climate justice and assets-oriented inquiry into the intersectional determinants of health are discussed as future opportunities for addressing health equity in climate and health-related research and practice.

OS1.6 Peripheral blood immune profiles at first recurrence of IDH wild type glioblastoma after standard chemoradiotherapy predict overall survival: secondary analyses of the phase II DIRECTOR trial

BACKGROUND

Isocitrate dehydrogenase (IDH) wildtype glioblastoma is associated with distinctive peripheral blood immune cell profiles that evolve under first line chemoirradiation with temozolomide. Whether peripheral blood immune cell profiles at recurrence are associated with survival of IDH wildtype glioblastoma has not been studied in detail.

PATIENTS AND METHODS

Peripheral blood mononuclear cells (PBMC) of 21 healthy donors and of 52 clinically well-annotated patients with IDH wildtype glioblastoma were analyzed by 11-color flow cytometry at 1st recurrence after standard chemoirradiation with temozolomide and at 2nd recurrence after dose-intensified temozolomide re-challenge. Patients were treated within the randomized phase II trial DIRECTOR, which explored the efficacy of dose-intensified temozolomide at first recurrence of glioblastoma. Patients were classified based on unsupervised analyses of PBMC profiles at 1stand 2ndrecurrence. Associations with survival were explored in multivariate Cox models controlling for established prognostic and predictive factors.

RESULTS

At 1strecurrence, two patient clusters were identified which differed in CD4+ T-cell fractions, but not with respect to CD8+ T-cells, CD4+;CD25+;FoxP3+ regulatory T-cells, B-cells or monocytes. The composition of CD4+, CD8+ or regulatory T-cell fractions was similar in both clusters. All control samples clustered with the CD4high cluster. Patients in both clusters did not differ by established prognostic factors, including age, O6-methylguanine-DNA-methyl-transferase (MGMT) gene promoter methylation, tumor volume, Karfnosky performance score or steroid use. Progression-free survival was similar (CD4high vsCD4low 2.1 vs 2.4 months, p=0.19), whereas post-recurrence overall survival was longer among the CD4highcluster (12.7 vs 8.7 months, p= 0.004). At 2nd recurrence, monocyte fractions increased, whereas memory CD4+ T-cell fractions decreased. Unsupervised segregation of patients by CD4+ subpopulations yielded two clusters characterized by the abundance of memory T-cell fractions and higher memory CD4+ fractions were associated with longer overall survival at 2nd recurrence (p=0.004). The reported prognostic associations were retained in multivariate Cox models controlling for established prognostic factors.

CONCLUSION

We conclude that temozolomide-associated memory CD4+ T-cell depletion may have deteriorating effects on the survival of glioblastoma patients.

Health promotion and food insecurity: Exploring environmental sustainability principles to guide practice within Australia

ISSUE ADDRESSED

The Australian health promotion sector has made significant advances in food security over the years through recognition of social and economic factors. The incorporation of ecological determinants within health promotion practice to address food insecurity, however, is uncommon. This paper explores the potential of health promotion to use environmental sustainability principles to guide the development of health promotion food security programs in Australia.

METHODS

A mixed-methods approach guided by a pragmatic framework was adopted for this study. A national online survey (n = 61) and semi-structured interviews (n = 16) targeting Australian health promotion practitioners was utilised. Triangulation involved seven stages to develop points of convergence and corroboration of the data.

RESULTS

Practitioners were adopting principles of environmental sustainability such as ecological integrity and biodiversity protection to guide food security practice. The use of such principles demonstrates their compatibility within health promotion practice. This study, however, reveals that environmental sustainability principles were a relatively new area of practice for health promotion practitioners.

CONCLUSION

The possibilities for integrating health promotion and environmental sustainability principles are promising for addressing multifaceted issues inherent within food security practice. At present, a lack of principles exist for guiding the sector to address food security that is cognisant of both human health and the environment. SO WHAT?: This study indicates a lack of integration between environmental sustainability and health promotion principles to guide food security practice. It would be pertinent for the sector to consider the development of a set of principles that considers both health promotion and environmental sustainability to ensure future food security and planetary health. Capacity building of current practitioners and pre-service graduates around the use of such principles to guide practice could assist the sector in this process.

New frontiers in community initiatives to increase vegetable consumption

ISSUE ADDRESSED

Public health concerns about insufficient consumption of vegetables across all demographics in Australia have led to 20 years of behaviour change interventions ranging from social marketing to interactive small group programs, with modest results. To maximise health promotion intervention outcomes, practitioners need up-to-date information that helps them navigate the complexity of food systems and eating behaviours.

METHODS

This scoping review of Australian and international research, including peer-reviewed and grey literature, provides a picture of health promotion nutrition interventions, as well as other initiatives that may promote increased vegetable consumption. Search terms related to nutrition and vegetable consumption, type of intervention or initiative, for example, campaign; and consumer values and behaviour. A wide range of data sources were used including scholarly papers, market research reports and publicly available websites of community organisations (eg, OOOOBY). A broad food systems typology was developed to provide a framework for the review.

RESULTS

The review finds an emerging group of community-driven initiatives within local food systems that appear to have positive impacts on vegetable consumption. These initiatives sit within a multi-faceted approach to health and well-being that is consistent with the tenets of the Ottawa Charter for Health Promotion, including community engagement, social justice and sustainability goals.

CONCLUSIONS

More research into the impact of these new frontiers is needed, but our preliminary findings point to the potential for health promotion practitioners to collaborate on local/community food system initiatives that are not motivated primarily by health goals, but have the potential to deliver multiple health and environmental outcomes. SO WHAT?: This review demonstrated community-driven initiatives around local food systems show the most promise in promoting vegetable consumption and addressing the determinants of health. Health promotion efforts to encourage food security and healthy eating could be strengthened through collaborations within these new frontiers.

Public health guide to field developments linking ecosystems, environments and health in the Anthropocene

The impacts of global environmental change have precipitated numerous approaches that connect the health of ecosystems, non-human organisms and humans. However, the proliferation of approaches can lead to confusion due to overlaps in terminology, ideas and foci. Recognising the need for clarity, this paper provides a guide to seven field developments in environmental public health research and practice: occupational and environmental health; political ecology of health; environmental justice; ecohealth; One Health; ecological public health; and planetary health. Field developments are defined in terms of their uniqueness from one another, are historically situated, and core texts or journals are highlighted. The paper ends by discussing some of the intersecting features across field developments, and considers opportunities created through such convergence. This field guide will be useful for those seeking to build a next generation of integrative research, policy, education and action that is equipped to respond to current health and sustainability challenges.

Health promotion and sustainability programmes in Australia: barriers and enablers to evaluation

In an era characterised by the adverse impacts of climate change and environmental degradation, health promotion programmes are beginning to actively link human health with environmental sustainability imperatives. This paper draws on a study of health promotion and sustainability programmes in Australia, providing insights to evaluation approaches being used and barriers and enablers to these evaluations. The study was based on a multi-strategy research involving both quantitative and qualitative methods. Health promotion practitioners explained through surveys and semi-structured interviews that they focused on five overarching health and sustainability programme types (healthy and sustainable food, active transport, energy efficiency, contact with nature, and capacity building). Various evaluation methods and indicators (health, social, environmental, economic and demographic) were identified as being valuable for monitoring and evaluating health and sustainability programmes. Findings identified several evaluation enablers such as successful community engagement, knowledge of health and sustainability issues and programme champions, whereas barriers included resource constraints and competing interests. This paper highlights the need for ecological models and evaluation tools to support the design and monitoring of health promotion and sustainability programmes.

Exploring Australian health promotion and environmental sustainability initiatives

Issue addressed Health promotion practitioners have important roles in applying ecosystem approaches to health and actively promoting environmental sustainability within community-level practice. The present study identified the nature and scope of health promotion activities across Australia that tackle environmental sustainability. Methods A mixed-method approach was used, with 82 participants undertaking a quantitative survey and 11 undertaking a qualitative interview. Purposeful sampling strategies were used to recruit practitioners who were delivering community-level health promotion and sustainability programs in Australia. The data were analysed thematically and interpretation was guided by the principles of triangulation. Results Study participants were at various stages of linking health promotion and environmental sustainability. Initiatives focused on healthy and sustainable food, active transport, energy efficiency, contact with nature and capacity building. Conclusion Capacity building approaches were perceived as essential to strengthening this field of practice. Healthy and sustainable food and active transport were suitable platforms for simultaneously promoting community health and sustainability. There was potential for expansion of programs that emphasise contact with nature and energy issues, as well as interventions that emphasise systems thinking and interdisciplinary approaches. So what? It was promising that Australian health promotion programs have started to address complexity rather than single issues, as evidenced by explicit engagement with environmental sustainability. However, more effort is required to enable a shift towards ecosystem approaches to health.

Global Principles, Regional Action: Guiding Ecohealth Practice in Oceania

In Oceania, a region challenged by rapid urbanisation and climate change, integrative frameworks are required to enable effective actions on health and sustainability. The Ecohealth approach provides a framework for practice that acknowledges human health is intrinsically linked to ecosystem health. This research communication reports on a study involving interviews with twenty-seven leading health and sustainability thinkers from Oceania and across the globe. In examining their ideas for action, the report presents the study findings in relation to the guiding principles of Ecohealth: systems thinking, transdisciplinarity, participation, sustainability, equity and knowledge-to-action. Implications for Ecohealth practitioners working in Oceania are considered.

Healthy Cities and the Transition movement: converging towards ecological well-being?

This commentary identifies similarities, differences and opportunities for synergy and mutual learning between the Healthy Cities and the Transition movements. We outline what we consider to be the ‘pressing issues’ facing humanity and the planet in the early 21st century; consider the extent to which health promotion has engaged with and addressed these issues; compare Healthy Cities and the Transition movement; and conclude by suggesting possibilities for moving forward.

Exploring Ecosystems and Health by Shifting to a Regional Focus: Perspectives from the Oceania EcoHealth Chapter

This article highlights contributions that can be made to the public health field by incorporating "ecosystem approaches to health" to tackle future environmental and health challenges at a regional level. This qualitative research reviews attitudes and understandings of the relationship between public health and the environment and the priorities, aspirations and challenges of a newly established group (the Oceania EcoHealth Chapter) who are attempting to promote these principles. Ten semi-structured interviews with Oceania EcoHealth Chapter members highlighted the important role such groups can play in informing organisations working in the Oceania region to improve both public health and environmental outcomes simultaneously. Participants of this study emphasise the need to elevate Indigenous knowledge in Oceania and the role regional groups play in this regard. They also emphasis that regional advocacy and ecosystem approaches to health could bypass silos in knowledge and disciplinary divides, with groups like the Oceania EcoHealth Chapter acting as a mechanism for knowledge exchange, engagement, and action at a regional level with its ability to bridge the gap between environmental stewardship and public health.

It's here! Are we ready? Five case studies of health promotion practices that address climate change from within Victorian health care settings

ISSUE ADDRESSED

Climate changes and environmental degradation caused by anthropogenic activities are having an irrefutable impact on human health. The critical role played by health promotion in addressing environmental challenges has a history in seminal charters--such as the Ottawa Charter for Health Promotion--that explicitly link human well-being with the natural environment. The lack of documented practice in this field prompted an investigation of health promotion practice that addresses climate change issues within health care settings.

METHODS

This qualitative study involved five case studies of Victorian health care agencies that explicitly identified climate change as a priority. Individual and group interviews with ten health promotion funded practitioners as well as document analysis techniques were used to explore diverse practices across these rural, regional and urban health care agencies.

RESULTS

Health promotion practice in these agencies was oriented toward: active and sustainable transport; healthy and sustainable food supply; mental health and community resilience; engaging vulnerable population groups such as women; and organisational development.

CONCLUSION

Despite differences in approach, target population and context, the core finding was that health promotion strategies, competencies and frameworks were transferable to action on climate change in these health care settings.

Incorporating sustainability into community-based healthcare practice

There is now irrefutable evidence that climate change and increasing environmental degradation negatively affect population health. Healthcare plays an important role in addressing these emerging environmental challenges, considering its core aim is to protect and promote health. Preliminary research in Victoria, Australia, suggests that healthcare practitioners are endeavouring to factor in environmental concerns into their practice. Health promotion, an integral part of the healthcare system, is considered an area of practice that can support action on sustainability. Based on five qualitative case studies and key stakeholder interviews, this article explores key barriers and facilitators to incorporating sustainability into community-based healthcare practice. The findings demonstrate that despite multiple barriers, including funding and lack of policy direction, health promotion principles and practices can enable action on sustainability.

Acid lakes from natural and anthropogenic causes

Lakes may be acid because of natural ecological conditions or because of anthropogenic activities. Apparently there has been a recent increase in acidity of many lakes in the northeastern United States. Factors that may be contributing to this increase include the use by utilities of precipitators, sulfur scrubbers, and tall stacks; the use of petroleum; and methods of combustion of fossil fuels.

Temperature and manganese as determining factors in the presence of diatom or blue-green algal floras in streams

Diatoms are usually the major component of the algal flora in many streams, although green and blue-green algae may be present. These experiments were designed to determine if high temperature or a shift in the chemical composition of the water might bring about a dominance of blue-green algae and/or green algae rather than a dominance of diatoms in the algal flora.The results of these experiments indicate that an average temperature of 34 degrees to 38 degrees C results in a shift of dominance in the algal flora from diatoms to blue-green algae. Furthermore, a blue-green and green algal flora of species typically found in organically polluted water in favored if the manganese content is a few parts per billion. If the manganese content averaged 0.02-0.043 mg/liter in the natural stream to 0.04-0.28 mg/liter in the recycled water experiment, a diatom flora remained dominant.

Primary gynecological neoplasms and clinical outcomes in patients diagnosed with breast carcinoma

The purpose of this study was to quantify and describe nonmammary neoplasms (n-MN), particularly gynecological neoplasms, in a patient population previously diagnosed with breast cancer. Data were collected prospectively in our institutional review board-approved registry for patients diagnosed with infiltrating breast cancer or ductal carcinoma in situ. Patients who developed a second, n-MN were identified; neoplastic site, time to development after breast cancer, and clinical outcomes were recorded. FIGO stage was recorded for patients who developed a gynecological neoplasm. Synchronous bilateral breast cancer was defined as a second, contralateral diagnosis made within 12 months of the first and, similarly, synchronous n-MN were defined as those identified within 1 year of a breast cancer diagnosis. Outcome curves were generated using the method of Kaplan and Meier, and compared using the log-rank test. Of 4126 patients diagnosed with breast cancer, 3% developed a n-MN, the majority of which were nongynecological and asynchronous to the initial breast cancer diagnosis. Three percent of patients diagnosed with breast cancer were diagnosed with a second, n-MN. Among patients who developed a n-MN, most developed a nongynecological cancer more than 1 year after the initial breast cancer diagnosis, and their outcomes were significantly worse than those patients who did not develop a n-MN.

Primary gynecological neoplasms and clinical outcomes in patients diagnosed with breast carcinoma

The purpose of this study was to quantify and describe nonmammary neoplasms (n-MN), particularly gynecological neoplasms, in a patient population previously diagnosed with breast cancer. Data were collected prospectively in our institutional review board–approved registry for patients diagnosed with infiltrating breast cancer or ductal carcinoma in situ. Patients who developed a second, n-MN were identified; neoplastic site, time to development after breast cancer, and clinical outcomes were recorded. FIGO stage was recorded for patients who developed a gynecological neoplasm. Synchronous bilateral breast cancer was defined as a second, contralateral diagnosis made within 12 months of the first and, similarly, synchronous n-MN were defined as those identified within 1 year of a breast cancer diagnosis. Outcome curves were generated using the method of Kaplan and Meier, and compared using the log-rank test. Of 4126 patients diagnosed with breast cancer, 3% developed a n-MN, the majority of which were nongynecological and asynchronous to the initial breast cancer diagnosis. Three percent of patients diagnosed with breast cancer were diagnosed with a second, n-MN. Among patients who developed a n-MN, most developed a nongynecological cancer more than 1 year after the initial breast cancer diagnosis, and their outcomes were significantly worse than those patients who did not develop a n-MN.

Magnetic resonance imaging as a diagnostic tool for breast cancer in premenopausal women

BACKGROUND

Screening mammography has led to earlier diagnosis of breast cancer; however, the increased tissue density of young women can complicate mammographic interpretation. We hypothesized that magnetic resonance imaging (MRI) has value in detection of mammographically occult breast cancers, particularly in premenopausal women for whom the sensitivity of mammography is compromised.

METHODS

Data were available for 89 women with biopsy-proven breast cancer who had undergone both mammography and breast MRI. Variables evaluated included menopausal status and radiographic findings. Data were analyzed using Fisher's Exact test; P < .05 was considered significant.

RESULTS

Of the 89 women in our study, 69 were perimenopausal or postmenopausal and 20 were premenopausal at the time of diagnosis. The malignant lesion was identified on mammography and MRI for a majority of patients. One third of premenopausal women had negative mammography but positive MRI findings.

CONCLUSIONS

Our findings support a role for breast MRI in supplementing conventional mammography for early detection of breast cancer in premenopausal women.