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The idealisation of rural work, people, and communities is remarkably persistent in Western countries. With the diminishing role of agriculture in national economies and changing values, this agrarian sentiment could be expected to lose currency. Yet, agrarian tropes and narratives remain evident in popular culture, political discourse, and public policy. Flinn and Johnson, in the 1970s, pioneered empirical studies of agrarianism based on a regionally specific and relatively small sample from which they identified five tenets of agrarianism. We sought to develop a survey instrument to explore whether changes in societal values, and in the structures and practices of agriculture, mean these tenets no longer hold. We find that, overall, many of the key elements identified by Flinn and Johnson are still evident. In addition, we have identified three domains of agrarianism: foundationalism, ruralism, and stewardship, that represent some of the historical diversity of agrarian themes and some accommodation with environmentalism.

Climate change is a major global public-health challenge that will have wide-ranging impacts on human psychological health and well-being. Children and adolescents are at particular risk because of their rapidly developing brain, vulnerability to disease, and limited capacity to avoid or adapt to threats and impacts. They are also more likely to worry about climate change than any other age group. Drawing on a developmental life-course perspective, we show that climate-change-related threats can additively, interactively, and cumulatively increase psychopathology risk from conception onward; that these effects are already occurring; and that they constitute an important threat to healthy human development worldwide. We then argue that monitoring, measuring, and mitigating these risks is a matter of social justice and a crucial long-term investment in developmental and mental health sciences. We conclude with a discussion of conceptual and measurement challenges and outline research priorities going forward.

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

Background Climate change is associated with greater frequency, duration, intensity and unpredictability of certain weather-related events, including floods. Floods harm mental health. There is limited understanding of the mental health and well-being effects from river flooding, particularly over the longer term and in rural contexts. This paper describes the rationale, aims, objectives, study design and socio-demographic characteristics of the sample for a study measuring associations between flood experience and mental health and wellbeing of residents (particularly those most likely to be negatively impacted and hard to reach) in rural NSW Australia 6 months following a devastating flood in 2017. To our knowledge, the study is the first of its kind within Australia in a rural community and is an important initiative given the likelihood of an increasing frequency of severe flooding in Australia given climate change. Methods A conceptual framework (The Flood Impact Framework) drawing on social ecological approaches was developed by the research team. It was based on the literature and feedback from the community. The Framework describes putative relationships between flood exposure and mental health and wellbeing outcomes. Within a community-academic partnership approach, a cross-sectional survey was then undertaken to quantify and further explore these relationships. Results The cross-sectional survey was conducted online (including on mobile phone) and on paper between September and November 2017 and recruited 2530 respondents. Of those, 2180 provided complete demographic data, among whom 69% were women, 91% were aged 25–74, 4% identified as Aboriginal and/or Torres Strait Islander, 9% were farmers and 33% were business owners. Conclusions The study recruited a wide range of respondents and the partnership facilitated the community’s engagement with the design and implementation of the study. The study will provide a basis for a follow-up study, that will aim to improve the understanding of mental health and wellbeing effects over the longer term. It will provide an important and original contribution to understanding river flooding and mental health in rural Australia, a topic that will grow in importance in the context of human-induced climate change, and identify critical opportunities to strengthen services, emergency planning and resilience to future flooding.

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

In many developed countries, the number of farmers working in commercial agriculture continues to decline with more likely to leave in the future. The act of farming and autonomy of farming...

The Lancet Countdown: tracking progress on health and climate change was established to provide an independent, global monitoring system dedicated to tracking the health dimensions of the impacts of, and the response to, climate change. The Lancet Countdown tracks 41 indicators across five domains: climate change impacts, exposures, and vulnerability; adaptation, planning, and resilience for health; mitigation actions and health co-benefits; finance and economics; and public and political engagement. This report is the product of a collaboration of 27 leading academic institutions, the UN, and intergovernmental agencies from every continent. The report draws on world-class expertise from climate scientists, ecologists, mathematicians, geographers, engineers, energy, food, livestock, and transport experts, economists, social and political scientists, public health professionals, and. doctors. The Lancet Countdown’s work builds on decades of research in this field, and was first proposed in the 2015 Lancet Commission on health and climate change,1 which documented the human impacts of climate change and provided ten global recommendations to respond to this public health emergency and secure the public health benefits available (panel 1).

It is increasingly necessary to quantify the impacts of climate change on populations, and to quantify the effectiveness of mitigation and adaptation strategies. Despite growing interest in the health effects of climate change, the relationship between mental health and climate change has received little attention in research or policy. Here, we outline current thinking about climate change and mental health, and discuss crucial limitations in modern epidemiology for examining this issue. A systems approach, complemented by a new style of research thinking and leadership, can help align the needs of this emerging field with existing and research policy agendas.

Background: Northern New South Wales in Australia is a "hotspot" for natural disaster declarations with recent extensive flooding in early 2017. With limited knowledge about how climate change affects mental health and resilience, robust local assessments are required to better understand long-term impact, particularly in communities prone to extreme weather events. Methods: Six months post-flood, a cross-sectional survey of adults living in the region during the flood was conducted to quantify associations between flood impact and psychological morbidity (post-traumatic stress (PTSD), anxiety, depression, suicidal ideation) for different exposure scenarios, and respondent groups. We adopted a community-academic partnership approach and purposive recruitment to increase participation from marginalized groups. Results: Of 2,180 respondents, almost all (91%) were affected by some degree of flood-related exposure at an individual and community level (ranging from suburb damage to home or business inundated). Socio-economically marginalized respondents were more likely to have their homes inundated and to be displaced. Mental health risk was significantly elevated for respondents: whose home/business/farm was inundated [e.g., home inundation: PTSD adjusted odds ratio (AOR) 13.72 (99% CI 4.53-41.56)]; who reported multiple exposures [e.g., three exposures: PTSD AOR 6.43 (99% CI 2.11-19.60)]; and who were still displaced after 6 months [e.g., PTSD AOR 24.43 (99% CI 7.05-84.69)]. Conclusion: The 2017 flood had profound impact, particularly for respondents still displaced and for socio-economically marginalized groups. Our community-academic partnership approach builds community cohesion, informs targeted mental health disaster preparedness and response policies for different sectors of the community and longer-term interventions aimed at improving community adaptability to climate change.

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

Funding for this study was provided by the Faculty of Health and the Murray Darling Basin Futures Collaborative Research Network at the University of Canberra. We acknowledge the funders of MDBfutures, in particular the Australian federal government Department of Education.

Anthropogenic climate change appears to be increasing the frequency, duration and intensity of extreme weather events. Such events have already had substantial impacts on socioeconomic development and population health. Climate change's most profound impacts are likely to be on food, health systems and water. This paper explores how climate change will affect food, human health and water in China. Projections indicate that the overall effects of climate change, land conversion and reduced water availability could reduce Chinese food production substantially - although uncertainty is inevitable in such projections. Climate change will probably have substantial impacts on water resources - e.g. changes in rainfall patterns and increases in the frequencies of droughts and floods in some areas of China. Such impacts would undoubtedly threaten population health and well-being in many communities. In the short-term, population health in China is likely to be adversely affected by increases in air temperatures and pollution. In the medium to long term, however, the indirect impacts of climate change - e.g. changes in the availability of food, shelter and water, decreased mental health and well-being and changes in the distribution and seasonality of infectious diseases - are likely to grow in importance. The potentially catastrophic consequences of climate change can only be avoided if all countries work together towards a substantial reduction in the emission of so-called greenhouse gases and a substantial increase in the global population's resilience to the risks of climate variability and change.Le changement climatique anthropique est à l'origine d'une augmentation de la fréquence, de la durée et de l'intensité de phénomènes météorologiques extrêmes. Ces phénomènes ont déjà eu des conséquences notables sur le développement socioéconomique et la santé des populations. Les effets les plus marqués du changement climatique se manifesteront certainement au niveau de l'alimentation, des systèmes sanitaires et de l'eau. Cet article examine la manière dont le changement climatique affectera l'alimentation, la santé humaine et l'eau en Chine. Selon les prévisions, les effets globaux du changement climatique, la conversion des terres et la diminution de l'eau disponible pourraient considérablement réduire la production alimentaire chinoise, bien que de telles prévisions comportent inévitablement un certain degré d'incertitude. Le changement climatique aura probablement des conséquences importantes sur les ressources en eau, avec par exemple des modifications des régimes de précipitations ou encore des sécheresses et des inondations plus fréquentes dans certaines régions de Chine. Ces effets mettront indubitablement en péril la santé et le bien-être de nombreuses communautés. À court terme, la santé des populations en Chine devrait se trouver affectée par l'augmentation des températures de l'air et de la pollution. Sur le moyen et le long terme, cependant, ce sont les effets indirects du changement climatique (par ex., changements au niveau de la disponibilité des denrées alimentaires, de l'eau et des lieux de résidence, dégradation de la santé mentale et du bien-être des personnes, changements dans la répartition et la saisonnalité des maladies infectieuses) qui devraient prendre de l'importance. Les conséquences potentiellement catastrophiques du changement climatique ne peuvent être évitées que si tous les pays œuvrent ensemble en vue de réduire sensiblement les émissions de gaz à effet de serre et d'augmenter la résilience de la population mondiale face aux risques de variabilité et de changement climatiques.Parece que el cambio climático antropogénico está aumentando la frecuencia, duración e intensidad de fenómenos meteorológicos extremos. Tales fenómenos ya han afectado enormemente el desarrollo socioeconómico y la salud pública. Los efectos más profundos del cambio climático tienen posibilidades de afectar a la alimentación, los sistemas sanitarios y el agua. En este artículo se explora cómo influirá el cambio climático en la alimentación, la salud pública y el agua en China. Las previsiones indican que los efectos generales del cambio climático, la conversión del suelo y la menor disponibilidad de agua podrían reducir la producción de alimentación en China de forma sustancial, a pesar de que la incertidumbre es inevitable en dichas previsiones. Es probable que el cambio climático afecte de manera importante a los recursos de agua, por ejemplo, cambios en los patrones de las precipitaciones y aumentos de la frecuencia de las sequías y las inundaciones en algunas zonas de China. Sin duda, tales impactos amenazarán la salud pública y el bienestar de muchas comunidades. A corto plazo, la salud pública china se verá perjudicada por los aumentos de la temperatura del aire y la contaminación. Sin embargo, de medio a largo plazo, es probable que aumente la importancia de los efectos indirectos del cambio climático, como los cambios de la disponibilidad de alimentos, refugio y agua, una reducción del bienestar y la salud mental y cambios en la propagación y estacionalidad de enfermedades infecciosas. Las posibles consecuencias catastróficas del cambio climático pueden evitarse únicamente si todos los países trabajan juntos para reducir en gran medida la emisión de los conocidos gases de efecto invernadero y para aumentar la resistencia de la población mundial ante los riesgos de la variabilidad y el cambio climáticos.يبدو أن التغير المناخي الناجم عن تأثيرات بشرية يؤدي إلى زيادة وتيرة حدوث الظواهر الجوية الشديدة ومدة سريانها وشدتها. وكان لمثل هذه الظواهر تأثيرات كبيرة بالفعل على التنمية الاجتماعية والاقتصادية وعلى صحة السكان. من المرجح أن تقع التأثيرات الأشد خطورة لتغير المناخ على الطعام والأنظمة الصحية والمياه. تساهم هذه المقالة البحثية في استكشاف تأثير تغير المناخ على الطعام وصحة الإنسان والمياه في الصين. تشير التوقعات إلى أن التأثيرات الإجمالية لتغير المناخ، وتبوير الأراضي الزراعية، ونقص توفير المياه يمكن أن تقلل من إنتاج الصين للغذاء بشكل كبير – بالرغم من أن مثل هذه التوقعات تحتمل قدرًا من عدم التيقن وهو أمر حتمي. من المحتمل أن يكون لتغير المناخ تأثيرات كبيرة على الموارد المائية - فعلى سبيل المثال التغيرات في أنماط هطول الأمطار وزيادة حدوث موجات الجفاف والفيضانات في بعض مناطق الصين. ومما لا شك فيه أن مثل هذه التأثيرات سوف تؤدي إلى تهديد صحة السكان وعافيتهم في العديد من المجتمعات. من المرجح أن تتأثر صحة السكان في الصين بشدة على المدى القصير بسبب الزيادة في درجات الحرارة ومعدلات التلوث. إلا أن التأثيرات غير المباشرة لتغير المناخ على المدى المتوسط إلى البعيد – على سبيل المثال التغيرات في معدل توفير الطعام والمأوى والمياه، وانخفاض مستوى الصحة العقلية والعافية، وتغير معدلات انتشار الأمراض المعدية وحدوثها بحسب الفصول – من المرجح أن تزيد أهميتها. لا يمكن تفادي العواقب الكارثية المحتملة لتغير المناخ إلا إذا تعاونت جميع البلدان وعملت معًا بهدف خفض معدلات انبعاث ما يسمى الغازات المسببة للاحتباس الحراري بنسبة كبيرة وزيادة قدرة سكان العالم على مواجهة مخاطر تقلب المناخ وتغيره.由人类活动引起的气候变化导致极端天气事件的频率、持续时间和严重程度正逐渐增加。 这类事件已经对社会经济发展和人口健康产生了重大影响。 气候变化最具冲击力的影响可能是在食物、卫生系统和水源方面。 本文探究气候变化将如何影响中国的食物、人类健康和水源。 据预测，气候变化、土地流失和可用水资源减少的总体影响可能会导致中国食物产量大幅度下降——虽然此类预测中存在一定不可避免的不确定性。 气候变化可能会对水资源产生重大影响——例如，中国部分地区降水方式发生变化以及干旱与洪涝频率增加。 毫无疑问，此类影响将威胁许多社区的人口健康和幸福感。 短期来看，气温上升和污染加剧可能会对中国人口健康产生不利影响。 但从中长期来看，气候变化间接影响因素——例如可用食物、住所和水资源的变化、心理健康和幸福感的下降、传染疾病的分布和季节性的变化——可能会越来越重要。 只有各国协力合作，从本质上降低温室气体的排放，并提高全球人口对气候多样性和气候变化的适用能力，才能避免气候变化带来的潜在灾难性后果。.Антропогенные климатические изменения, по-видимому, способствуют увеличению частоты возникновения, продолжительности и интенсивности экстремальных погодных явлений. Такие явления уже оказали значительное влияние на социально-экономическое развитие и здоровье населения. Наиболее серьезные последствия климатических изменений, вероятно, затронут продукты питания, системы здравоохранения и воду. В данной статье изучается влияние изменения климата на продукты питания, здоровье человека и воду в Китае. Согласно результатам прогнозирования, общие последствия изменения климата, освоения земель и уменьшения доступности воды могут привести к значительному сокращению производства продуктов питания в Китае, хотя прогнозы всегда несут в себе долю неопределенности. Изменение климата, вероятно, значительно повлияет на водные ресурсы, например на режим выпадения осадков и на увеличение частоты засух и наводнений в некоторых областях Китая. Такие последствия, несомненно, поставят под угрозу здоровье и благосостояние населения во многих сообществах. В краткосрочной перспективе здоровье населения в Китае, скорее всего, подвергнется негативному воздействию повышенных температур и загрязнения воздуха. При этом в средне- и долгосрочной перспективе вероятен рост значимости косвенных последствий климатических изменений, т. е. изменения доступности продуктов питания, жилья и воды, ухудшение психического здоровья и благосостояния и изменения распределения и сезонности инфекционных заболеваний. Чтобы избежать потенциально катастрофических последствий изменения климата, все страны должны объединить свои усилия по значительному уменьшению выброса так называемых парниковых газов и значительному увеличению устойчивости мирового населения к рискам, связанным с нестабильностью и изменением климата.

•Addressing global environmental change needs science and governance to work together.•Global R&D investment and governance measures indicate the strength of that capacity.•Governance and R&D investment are directly associated over and above income levels.•Relationships between governance and R&D are more complex in lower-income countries.

In 2017, marginalised groups were disproportionately impacted by extensive flooding in a rural community in Northern New South Wales, Australia, with greater risk of home inundation, displacement and poor mental health. While social capital has been linked with good health and wellbeing, there has been limited investigation into its potential benefits in post-disaster contexts, particularly for marginalised groups. Six months post-flood, a cross-sectional survey was conducted to quantify associations between flood impact, individual social capital and psychological distress (including probable post-traumatic stress disorder). We adopted a community-academic partnership approach and purposive recruitment to increase participation from socio-economically marginalised groups (Aboriginal people and people in financial hardship). These groups reported lower levels of social capital (informal social connectedness, feelings of belonging, trust and optimism) compared to general community participants. Despite this, informal social connectedness and belonging were important factors for all participant groups, associated with reduced risk of psychological distress. In this flood-prone, rural community, there is a pressing need to build social capital collectively through co-designed strategies that simultaneously address the social, cultural and economic needs of marginalised groups. Multiple benefits will ensue for the whole community: reduced inequities, strengthened resilience, improved preparedness and lessened risk of long-term distress from disaster events.

Background Hospital-acquired complications increase length of stay and contribute to poorer patient outcomes. Older adults are known to be at risk for four key hospital-acquired complications (pressure injuries, pneumonia, urinary tract infections and delirium). These complications have been identified as sensitive to nursing characteristics such as staffing levels and level of education. The cost of these complications compared to the cost of admission severity, dementia, other comorbidities or age has not been established. Method To investigate costs associated with nurse-sensitive hospital-acquired complications in an older patient population 157,178 overnight public hospital episodes for all patients over age 50 from one Australian state, 2006/07 were examined. A retrospective cohort study design with linear regression analysis provided modelling of length-of-stay costs. Explanatory variables included patient age, sex, comorbidities, admission severity, dementia status, surgical status and four complications. Extra costs were based on above-average length-of-stay for each patient’s Diagnosis Related Group from hospital discharge data. Results For adults over 50 who have length of stay longer than average for their diagnostic condition, comorbid dementia predicts an extra cost of A$874, (US$1,247); any one of four key complications predicts A$812 (US$1,159); each increase in admission severity score predicts A$295 ($US421); each additional comorbidity predicts A$259 (US$370), and for each year of age above 50 predicts A$20 (US$29) (all estimates significant at p

In common with much of the Western world, agrarianism—valuing farmers and agricultural activity as intrinsically worthwhile, noble, and contributing to the strength of the national character—runs through Australian culture and politics. Agrarian sentiments and attitudes have been identified through empirical research and by inference from analysis of political debate, policy content, and studies of media and popular culture. Empirical studies have, however, been largely confined to the US, with little in the way of recent re-evaluations of, or developments from, early work. This paper reports on research that seeks quantitative empirical evidence for the existence of agrarianism in the Australian community and seeks to identify its core characteristics. Using a purpose-designed sub-set of items within a large, omnibus-style survey of regional and rural Australia, we demonstrate that agrarianism exists as a scientifically quantifiable concept identifiable through responses to four key propositions: that Australians should support policies aimed at improving the position of the agricultural industries; that working in agriculture and associated industries brings out the best in people; that agricultural producers make a major contribution to environmental protection and biodiversity conservation; and that the development of agriculture in Australia contributed to the development of the national character. We found very little variation in the degree to which different demographic groupings agree with agrarianism. Older people, farmers, and non-Indigenous Australian-born respondents were among those who were statistically significantly more likely to agree with the defining propositions of agrarianism, but their scores were only very slightly higher than those of other sub-populations in the sample.

Objective: To evaluate the impact of drought on the mental health of rural Australian women and those in vulnerable sub‐populations: women who were more isolated, poorer and less educated; and women who had histories of chronic disease or poor mental health. Methods: Surveys were mailed in 1996, 1998, 2001, 2004 and 2008 to 6,664 women born between 1946 and1951 who were participating in the Australian Longitudinal Study on Women's Health. The surveys included the Mental Health Index of the Medical Outcomes Study Short‐Form 36 (MHI). Drought was assessed by linking the latitude and longitude of women's place of residence at each survey to the Hutchinson Drought Index. Associations between MHI and drought were assessed using linear mixed‐models. Results: While 31% of the women experienced drought in 1998 and 50% experienced drought in 2007; experience of droughts was less common in the other years. Although drought varied from survey year to survey year, mental health did not vary with drought conditions for rural women or vulnerable sub‐populations. Conclusions: These findings are contrary to the long‐held assumption that droughts increase mental health problems in Australia. Implications: While similar results may not be true for men, empirical evidence (rather than assumptions) is required on associations between drought and mental health.

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

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

The links between social capital and mental wellbeing are established but the direction of the social capital-wellbeing relationship is rarely systematically examined. This omission undermines the validity of social capital as a basis for health interventions. The aim of this paper was to explore the short-term (one-year) reciprocal relationship between community participation – an important component of social capital – and mental wellbeing. We used nationally representative Household, Income and Labour Dynamics in Australia (HILDA) Survey data, 2005–11. The HILDA Survey is an annual cohort study from which was extracted a sub-sample of panel data (the same people participating across multiple waves) enabling us to use fixed effects regression methods to model the longitudinal association of mental health and participation controlling for individual heterogeneity. The results showed that better mental wellbeing in one year was generally related to more community participation the next year, while greater past community participation was linked to better mental wellbeing the next year independent of (i) initial mental wellbeing, (ii) multiple potentially confounding factors and (iii) unobserved and time-constant heterogeneity. Political participation was marginally related to worse mental health in both directions. The results also showed that the association between community participation and mental wellbeing the next year is weaker for those with poor initial wellbeing than for initially healthier respondents. Our findings may inform the trial and scientific evaluation of programs aimed at increasing informal social connectedness and civic engagement to promote mental wellbeing.

It is widely believed that cortical changes are a consequence of long standing neuropathic pain (NP). In this paper we demonstrate that NP in people with subacute spinal cord injury (SCI) has characteristic electroencephalographic (EEG) markers which precede the onset of pain. EEG was recorded in a relaxed state and during motor imagination tasks in 10 able bodied participants and 31 subacute SCI participants (11 with NP, 10 without NP and 10 who developed pain within 6 months of EEG recording). All 20 SCI participants initially without NP were tested for mechanically induced allodynia but only one person, who later developed pain, reported an unpleasant sensation. The EEG reactivity to opening eyes was reduced in the alpha band and absent in the theta and beta bands in participants who later developed pain, and it was reduced in participants who already had pain. Alpha band power was reduced at BA7 in both the relaxed state and during motor imagination in participants who either had or later developed pain compared to participants without pain. All SCI groups had reduced dominant alpha frequency and beta band power at BA7.\ud \ud Electroencephalographic reactivity to eyes opening, and reduced spontaneous and induced alpha activity over the parietal cortex were predictors of future NP as well as markers of existing NP.\ud \ud Clinical Trial Registration Number: NCT02178917\ud \ud Perspectives: We demonstrate that brain activity in subacute SCI contains both early markers and predictors of NP, which may manifest before sensory discomfort. These markers and predictors may complement known sensory phenotypes of NP. They may exist in other patient groups suffering from NP of central origin.

Background: Falls are of great concern to older adults and costly to the health system. In addition the relationship between falls risk and falls risk predictor characteristics is complex. Objective: This study aimed to explore the relationship between two objective fall-risk measures tools, the Physiological Profile Assessment and the Berg Balance Scale and to determine how an individual’s sex, level of physical function, health-related and body composition characteristics impact these objective falls risk measures. Design: A cross-sectional, observational study. Participants: 245 community-dwelling older adults (M age=68.12 years, SD=6.21; 69.8% female). Measurements: Participants were assessed for falls-risk (Physiological Profile Assessment and the Berg Balance Scale), physical activity, physical functional and body composition characteristics. Pearson product-moment correlation coefficients were calculated to examine bivariate relationships and hierarchical multiple linear regression modelling was used to estimate the contribution of each predictor in explaining variance in falls-risk. Results: In females, there was a weak association between the two objective falls-risk measures (r =-0.17 p

‘Photovoice’, a community-based participatory research methodology, uses images as a tool to deconstruct problems by posing meaningful questions in a community to find actionable solutions. This community-enhancing technique was used to elicit experiences of climate change among women in rural Nepal. The current analysis employs mixed methods to explore the subjective mental health experience of participating in a 4- to 5-day photovoice process focused on climate change. A secondary objective of this work was to explore whether or not photovoice training, as a one-time 4-to 5-day intensive intervention, can mobilise people to be more aware of environmental changes related to climate change and to be more resilient to these changes, while providing positive mental health outcomes.

Aims: The aim of this research was to investigate whether a simple balance-specific exercise simultaneously improves physical functionality and falls. Methods: Thirty-two community-dwelling individuals aged 65–92 years were assigned to either the control or wobble-board group. Participants were assessed pre- and postintervention using the Physiological Profile Assessment (a measure of falls risk) and the Continuous-Scale Physical Functional Performance-10 (a measure of physical functionality). Results: Participants in the intervention group, wobble-board training, had a decrease in their risk of falling by 36% (p = 0.009, ηρ2 = 0.396), while the control group recorded a slight but nonsignificant increase (6%). No change was seen in their total Continuous-Scale Physical Functional Performance-10 score. Conclusion: A balance-specific intervention decreased falls-risk and improved balance but not sufficiently to affect total physical functionality.

The mental health impact of drought is poorly quantified and no previous research has demonstrated a relationship between distress and explicit environmentally based measures of drought. With continuing climate change, it is important to understand what drought is and how it may affect the mental health. We quantified drought in terms of duration and intensity of relative dryness and identified drought characteristics associated with poor mental health to evaluate any vulnerability in rural and urban communities. Our methods involved analysis of 100-year longitudinal records of monthly rainfall linked to one wave (2007–2008) of the Household, Income and Labour Dynamics in Australia Survey. Cluster analysis was used to characterise different patterns of dryness and linear regression analysis was used to examine associations with participant distress, as well as the moderating role of rural locality. The results showed that, during a seven-year period of major and widespread drought, one pattern of relative dryness (extreme cumulative number of months in drought culminating in a recent period of dryness lasting a year or more) was associated with increased distress for rural but not urban dwellers. The increase in distress was estimated to be 6.22%, based on 95% confidence intervals. Thus, we show that it is possible to quantitatively identify an association between patterns of drought and distress.

The 2013 report from the Intergovernmental Panel on Climate Change has caused renewed concern among both clinicians and health policy makers. Climate change is continuing at an increasing rate. This guest editorial describes how climate change might affect global mental health and proposes three things that psychiatrists from every country could implement to respond appropriately to this urgent and severe global threat. These responses are mitigation and adaptation strategies for mental health services, and the integration of sustainability into training.

BackgroundAortic stenosis is the most common age-related valvular pathology. Patients with aortic stenosis and myocardial fibrosis have worse outcome but the underlying mechanism is unclear. Lipoprotein(a) is associated with adverse cardiovascular risk and is elevated in patients with aortic stenosis. Although mechanistic pathways could link Lipoprotein(a) with myocardial fibrosis, whether the two are related has not been previously explored. In this study, we investigated whether elevated Lipoprotein(a) was associated with the presence of myocardial replacement fibrosis.MethodsA total of 110 patients with mild, moderate and severe aortic stenosis were assessed by late gadolinium enhancement (LGE) cardiovascular magnetic resonance to identify fibrosis. Mann Whitney U tests were used to assess for evidence of an association between Lp(a) and the presence or absence of myocardial fibrosis and aortic stenosis severity and compared to controls. Univariable and multivariable linear regression analysis were undertaken to identify possible predictors of Lp(a).ResultsThirty-six patients (32.7%) had no LGE enhancement, 38 (34.6%) had midwall enhancement suggestive of midwall fibrosis and 36 (32.7%) patients had subendocardial myocardial fibrosis, typical of infarction. The aortic stenosis patients had higher Lp(a) values than controls, however, there was no significant difference between the Lp(a) level in mild, moderate or severe aortic stenosis. No association was observed between midwall or infarction pattern fibrosis and Lipoprotein(a), in the mild/moderate stenosis (p = 0.91) or severe stenosis patients (p = 0.42).ConclusionThere is no evidence to suggest that higher Lipoprotein(a) leads to increased myocardial midwall or infarction pattern fibrosis in patients with aortic stenosis.

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

Objective: The aim of this study was to investigate a new social connectedness factor and Posttraumatic Stress Disorder (PTSD) in children who experienced a cyclone disaster. Method: Three months post-disaster school-based screening for PTSD was conducted. 804 children (mean age=10.22 years, SD=1.24) participated. 12.0% of children reported severe or very severe PTSD symptoms. Results: Low connected children, adjusted for age, gender and independent of cyclone exposure and threat perception, were 3.96 times more likely to experience severe to very severe PTSD. A structural model of child PTSD indicated that connectedness was the most important factor explaining variance in children’s symptomatology. The final model accounted for 60% of the variance of child PTSD scores. Conclusions: We conclude that child connectedness is a new, significant, independent factor in a model of post-disaster child PTSD. Connectedness may represent a vulnerability factor that can be targeted preventatively in children in disaster-prone regions. Conversely, a pre-disaster intervention that helps children develop high connectedness may have the potential to confer resilience.

This paper examines the role farmers’ health plays as an element of adaptive capacity. The study examines which of twenty aspects of adaptation may be related to overall health outcomes, controlling for demographic and on-farm-factors in health problems. The analysis is based on 3,993 farmers’ responses to a national survey of climate risk and adaptation. Hierarchical linear regression modelling was used examine the extent to which, in a multivariate analysis, the use of adaptive practices was predictively associated with self-assessed health, taking into account the farmer’s rating of whether their health was a barrier to undertaking farm work. We present two models, one excluding pre-existing health (model 1) and one including pre-existing health (model 2). The first model accounted for 21% of the variance. In this model better health was most strongly predicted by an absence of on-farm risk, greater financial viability, greater debt pressures, younger age and a desire to continue farming. Social capital (trust and reciprocity) was moderately associated with health as was the intention to adopt more sustainable practices. The second model (including the farmers’ health as a barrier to undertaking farm work) accounted for 43% of the variance. Better health outcomes were most strongly explained, in order of magnitude, by the absence of pre-existing health problems, greater access to social support, greater financial viability, greater debt pressures, a desire to continue farming and the condition of on-farm resources. Model 2 was a more parsimonious model (only nine predictors, compared with 15 in model 1), and explained twice as much variance in health outcomes. These results suggest that (i) pre-existing health problems are a very important factor to consider when designing adaptation programs and policies and (ii) these problems may mediate or modify the relationship between adaptation and health.

Objective: To report Aboriginal communities' views of how prolonged drought in rural NSW has affected their social and emotional well‐being, and of possible adaptive strategies. Design: Content analysis of issues, priorities and adaptive strategies raised in semistructured community forums. Setting: Rural centres across NSW. Participants: Aboriginal people, service providers and other stakeholders. Voluntary participation by invitation with consent to record discussions. Results: Three themes (containing six issues) emerged: (i) impacts on culture (harm to traditional family structure, culture and place; bringing shame to culture); (ii) sociodemographic and economic impacts (skewing of the population profile; loss of livelihood and participation; aggravation of existing socioeconomic disadvantage); and (iii) loss. In addition to continuing well‐being programs that were already successful, proposed adaptive strategies were: capturing the spirit of Aboriginal knowledge and traditions; knowing your land; and Aboriginal arts. Conclusion: Prolonged drought presented substantial and unique adversity for rural NSW Aboriginal communities, compounding existing, underlying disadvantage. Drought‐induced degradation of and, sometimes, the necessity to leave traditional land drove people apart and disrupted Caring for Country activities. Some people reported despair at not being able to discharge cultural obligations. At the same time, the drought prompted increased love of and concern for land and a renewed enthusiasm for expressing connectedness to land through all forms of art. Modern Aboriginal and wider community well‐being programs helped frame a response to drought alongside traditional Aboriginal dreaming and cultural approaches to emotional health and well‐being.

Objective: To describe the experiences of older farmers in the face of prolonged drought and rapid change. Design: Content analysis of issues and priorities raised in semi‐structured community forums. Setting: Rural centres in NSW. Participants: One hundred and fifty older farmers, their families, Industry and Investment NSW, rural financial and mental health services, the Country Women's Association and other non‐government agencies. Intervention: Five public forums organised under the Rural Adversity Mental Health Program. Results: Prolonged drought caused pressures on farmers that compounded the usual stresses of farming and of ageing. These were experienced in the context of rapid social and industry change, fuel price volatility and the insidious threat of climate change. Three main themes were articulated: loss, government compliance pressures and difficulties accessing and/or inappropriate services. Conclusion: Older farmers felt an overwhelming sense of loss: of profitability and professional success, community status, physical well‐being and comfort, the ability to participate in the modern world and, above all, of relationships (partners, children and friends moving away). They interpreted government compliance requirements as evidence of community and government loss of trust in famers. They resisted using the few mental health services that might be available, fearing being labelled as 'crazy' and discouraged by the culturally inappropriate way in which services were offered. Older farmers would benefit from joint services related to health and well‐being simultaneously with modern business management offered in trusted, comfortable settings.

Objective: To record the drought‐related experiences of young people and to contrast these with their teachers' and other adults' observations. Design: Content analysis of issues and priorities raised in semistructured school‐based forums. Setting: Rural schools in NSW centres. Participants: Young people, their teachers and service providers. Intervention: Six youth and community forums organised under the Rural Adversity Mental Health Program. Results: Participants welcomed increased community connectedness in response to prolonged drought but reported that drought's mental health impact was mainly negative. Adults observed children's distress, wondering if anyone else noticed it. They witnessed young people worrying about their families, increasingly isolated, at risk of harm, unable to obtain help and facing educational and employment limitations. Young people disclosed many mental health and relationship difficulties at school and at home. They worried about their families, communities and futures and about money and being isolated. Conclusion: Adults and young people reported similar effects of prolonged drought on young people's mental health. But, while adults were more concerned with risks to young people (of harm, abuse, homelessness, problems with the law and constrained opportunities), young people were simply overwhelmed, wanting help for their immediate worries. They sought coordinated support within schools, schools working together, more information about mental health and where to seek help for them and their friends, and support people who understood drought and rural circumstances and on whose discretion they could rely. Mental health programs that are developed in and for metropolitan contexts need to be adapted before being deployed in rural settings.

Objective: NSW has just experienced its worst drought in a century. As years passed with insufficient rain, drought‐related mental health problems became evident on farms. Our objective is to describe how, in response, the Rural Adversity Mental Health Program was introduced in 2007 to raise awareness of drought‐related mental health needs and help address these needs in rural and remote NSW. The program has since expanded to include other forms of rural adversity, including recent floods. Setting: Rural NSW. Design, participants, interventions: Designed around community development principles, health, local service networks and partner agencies collaborated to promote mental health, education and early intervention. Strategies included raising mental health literacy, organising community social events and disseminating drought‐related information. Priority areas were Aboriginal communities, older farmers, young people, women, primary health care and substance use. Results: Over 3000 people received mental health literacy training in the four years of operation from 2007 to 2010. Stakeholders collaborated to conduct hundreds of mental health‐related events attended by thousands of people. A free rural mental health support telephone line provided crisis help and referral to rural mental health‐related services. Conclusion: Drought affected mental health in rural NSW. A community development model was accepted and considered effective in helping communities build capacity and resilience in the face of chronic drought‐related hardship. Given the scale, complexity and significance of drought impacts and rural adjustment, and the threats posed by climate change, a long‐term approach to funding such programs would be appropriate.

This paper, presented at the 2010 rural health researchers' National Scientific Symposium on Rural and Remote Health, provides an overview of large Australian population mental health cohort studies which have a focus on climate-related and environmental adversity, social factors and mental health. These studies highlight the value of exploiting multiple exceptional datasets to better understand the drivers of rural health, including how to use population-level research to improve health resources in non-metropolitan areas. We show how the key characteristics of rural and remote mental health might be explored by exploiting the following cohort studies: Household, Income and Labour Dynamics in Australia Survey; Australian Rural Mental Health Study; Hunter Community Study; and Extending Treatments, Education and Networks in Depression study. Existing cohort studies that focus on significant rural and regional characteristics can be creatively analysed to better understand geographic variation in mental health. They have the potential to move understanding beyond simple prevalence to building knowledge about the trajectories of psychological distress and determinants of mental disorders and outcomes over time.

Although the implications of climate change for public health continue to be elucidated, we still require much work to guide the development of a comprehensive strategy to underpin the adaptation of the health system. Adaptation will be an evolving process as impacts emerge. The authors aim is to focus on the responses of the Australian health system to health risks from climate change, and in particular how best to prepare health services for predicted health risks from heat waves, bushfires, infectious diseases, diminished air quality, and the mental health impacts of climate change. In addition, the authors aim to provide some general principles for health system adaptation to climate change that may be applicable beyond the Australian setting. They present some guiding principles for preparing health systems and also overview some specific preparatory activities in relation to personnel, infrastructure, and coordination. Increases in extreme weather—related events superimposed on health effects arising from a gradually changing climate will place additional burdens on the health system and challenge existing capacity. Key characteristics of a climate change—prepared health system are that it should be flexible, strategically allocated, and robust. Long-term planning will also require close collaboration with the nonhealth sectors as part of a nationwide adaptive response.

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

This paper examines the relationship between disability and poverty at a health- demographic surveillance site in Viet Nam using alternative measures of disability severity. Analysis of the site population (n ¼65400) is combined with interviews of 27 households containing members with disabilities. Results show that disability severity is positively associated with poverty. Results support recent efforts of the Vietnamese government to extend programmes of social protection for households containing members with severe disabilities. However, a higher level of disability targeting is required, both in terms of eligibility and of benefit levels. Copyright # 2010 John Wiley & Sons, Ltd.

Australian mental health policy emphasises the central importance of social inclusion for promoting mental health and treating illness. Social capital is a commonly used concept for describing and evaluating social inclusion, but its relationship to mental health has not been investigated among groups of differing cultural backgrounds in rural and remote Australia, where need is greatest. The aims of this study were to compare levels of social capital and associations with mental health among Aboriginal Australians, New Australians and Other Australians living in a disadvantaged coastal community and to draw implications for policy and service development. Participants were 963 community members, aged 19-97, randomly selected from a socio-economically disadvantaged coastal Australian region, voluntarily completing an anonymous postal survey. Measures of components of social capital were analysed in terms of general psychological distress and happy feelings using multiple hierarchical linear regression modelling. For all groups, higher levels of participation, more positive perceptions about participation, and greater cohesion were associated with less distress and more happy feelings. In multivariate analyses, greater social capital overall was strongly associated with less distress and more happy feelings, the former particularly for Aboriginal Australians. Different aspects of social capital were related to mental health and wellbeing for different groups. Social capital is essential for good mental health and wellbeing but it is neither evenly shared among different groups nor do the same components of social capital matter, or matter to the same degree, among different groups. Social capital may be particularly important (and sensitive) for protecting Aboriginal people against mental health problems. In that these findings suggest approaches to designing policy and services, these must be tested via careful intervention research.

To accurately characterise cardiopulmonary baseline performance in aerobically untrained paraplegic subjects by means of an incremental exercise test (IET) and to derive possible training recommendations based on these measurements.Twelve motor complete paraplegic subjects with no previous experience in stimulated leg-cycling participated in the study. Exercise testing was performed on a recumbent FES-tricycle by means of a work rate and cadence controlled IET until maximal work rate was reached. Heart rate (HR) and respiratory parameters were recorded continuously.Peak oxygen uptake was 671 +/- 192 mL min(-1) (mean + standard deviation), peak HR 90 +/- 12 beats min(-1), net peak power 8.4 +/- 3.3 W and peak minute ventilation 23.6 +/- 7.5 L min(-1). Aerobic gas exchange threshold (GET) was found to be 51% +/- 10% of peak oxygen uptake and corresponded to 41% +/- 13% of peak power.A cadence and work rate controlled exercise test allows the determination of cardiopulmonary parameters during stimulated cycle ergometry even in aerobically untrained paraplegic subjects. The precise determination of GET allows an appropriate exercise intensity to be prescribed and thus provides a suitable method for exercise intensity calculation in the spinal cord injured population in the future.

With the prevalence and costs of mental health problems increasing, safe, effective and economically viable prevention and treatment strategies are urgently needed. Community participation is protectively linked to mental health and is considered a valid mental health promotion strategy. However, little consideration has been given to socio-demographically driven patterns of participation that would differentially affect the success of such a strategy. The aims of this study were to group and describe members of a socio-economically disadvantaged rural region according to patterns of community participation, report on their levels of social cohesion and psychological distress and reflect on policy implications. Participants were 963 community members, aged 19-97, randomly selected from a socio-economically disadvantaged coastal Australian region, who voluntarily completed an anonymous postal survey. Measures included (1) frequency of fourteen types of participation, (2) thoughts and feelings about each type, and (3) five aspects of social cohesion. Two-step cluster analysis was undertaken to derive groupings of respondents based on their socio-demographic characteristics and levels of and perceptions about their participation. Psychological distress was assessed for each group. Four distinct groupings of participants were identified: social capital elite; busy working parents; aging, participating less; and excluded participators. The last of these reported particularly poor participation, cohesion and psychological distress. For mental health promotion strategies to be effective, they must be tailored to the circumstances of intended recipients. This requires a sophisticated analysis of target groups. This study has shown that members of a socio-economically disadvantaged rural region may be described according to systematically varying patterns of socio-demographic characteristics, participation, social cohesion and distress. Policy-makers might consider (1) how and whether different groups might respond to the use of increased community participation as a mental health promotion strategy and (2) barriers that might have to be overcome in different groups.