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Children and young people (henceforth referred to as young people) are one of the groups most affected by climate change and are at the forefront of climate action. Yet, there is scarce evidence on how young people navigate the challenges presented by climate change using their personal strengths and the resources accessible to them. This study aimed to address this gap by drawing on qualitative data from workshops with 31 young people between 12 and 22 years of age from metropolitan Melbourne and a bushfire-risk region in Victoria, Australia. An inductive thematic analysis of workshop transcripts showed that participants had progressively become aware of climate change in an increasingly uncertain world and sought to gain a sense of connection, agency, and hope. Participants aimed to achieve the latter by becoming aware of opportunities for climate actions in everyday life and developing themselves as agents of change. We discussed our findings from a developmental perspective to gain a better understanding of how supporting young people in learning about and acting on climate change can benefit their mental health and sense of agency.

Background Although much is known about psychopathology such as post-traumatic stress disorder (PTSD) and depression following bushfire (also known as wildfire), little is known about prevalence, trajectory and impacts for those experiencing general adjustment difficulties following exposure to these now-common events. Aims This was an exploratory analysis of a large cohort study that examined the prevalence, trajectory and risk factors of probable adjustment disorder over a 10-year period following bushfire exposure. Method The Beyond Bushfires study assessed individuals exposed to a large and deadly bushfire across three time points spanning 10 years. Self-report survey data from participants from areas with moderate and high levels of fire-affectedness were analysed: n = 802 participants at Wave 1 (3–4 years post-fires), n = 596 at Wave 2 (5 years post-fires) and n = 436 at Wave 3 (10 years post-fires). Surveys indexed fire-related experiences and post-fire stressors, and comprised the six-item Kessler Psychological Distress Scale (probable adjustment disorder index), four-item Posttraumatic Stress Disorder Checklist (probable fire-related PTSD) and nine-item Patient Health Questionnaire (probable major depressive episode). Results Prevalence of probable adjustment disorder was 16% (Wave 1), 15% (Wave 2) and 19% (Wave 3). Probable adjustment disorder at 3–4 years post-fires predicted a five-fold increase in risk for escalating to severe psychiatric disorder (i.e. probable fire-related PTSD/major depressive episode) at 10 years post-fires, and was associated with post-fire income and relationship stressors. Conclusions Adjustment difficulties are prevalent post-disaster, many of which are maintained and exacerbated over time, resulting in increased risk for later disorder and adaptation difficulties. Psychosocial interventions supporting survivors with adjustment difficulties may prevent progression to more severe disorder.

Adolescent boys (age 9-19) are impacted differently by humanitarian emergencies. However, academic research on adolescent health and child protection has tended to focus on the direct impacts of an emergency rather than indirect impacts that may arise after a crisis. We sought to identify child protection concerns affecting adolescent boys in emergency settings and boys who are more vulnerable to harm through a case study of the humanitarian response to the 2017 Rohingya refugee crisis. We collected data in the Rohingya refugee crisis in Cox's Bazar, Bangladesh between 2018-2019. This included six months of participant observation, 23 semi-structured interviews and 12 informal ethnographic interviews with humanitarian staff working in the crisis, and 10 focus group discussions with a total of 52 child protection caseworkers from four child protection organisations. Our results showed that adolescent Rohingya boys were exposed to numerous protection concerns, including child labour, drug trafficking, substance abuse, family violence, and neglect. We classified these into three main typologies: community-related violence, income-related violence, and life-stage vulnerabilities. We found that adolescent boys who were unaccompanied or separated from their caregivers, adolescent boys who were members of vulnerable households, and adolescent boys with a disability were at more risk of harm. Our findings indicate that adolescent boys are exposed to an array of impactful child protection concerns in humanitarian emergencies and that this has implications for the delivery of public health and child protection interventions. We believe that humanitarian actors should improve recognition of the complexity of adolescent boys' lives and their exposure to gender and age-based harm as a critical matter for addressing adolescent health equity.

Introduction Longitudinal studies can provide timely and accurate information to evaluate and inform COVID-19 control and mitigation strategies and future pandemic preparedness. The Optimise Study is a multidisciplinary research platform established in the Australian state of Victoria in September 2020 to collect epidemiological, social, psychological and behavioural data from priority populations. It aims to understand changing public attitudes, behaviours and experiences of COVID-19 and inform epidemic modelling and support responsive government policy.Methods and analysis This protocol paper describes the data collection procedures for the Optimise Study, an ongoing longitudinal cohort of ~1000 Victorian adults and their social networks. Participants are recruited using snowball sampling with a set of seeds and two waves of snowball recruitment. Seeds are purposively selected from priority groups, including recent COVID-19 cases and close contacts and people at heightened risk of infection and/or adverse outcomes of COVID-19 infection and/or public health measures. Participants complete a schedule of monthly quantitative surveys and daily diaries for up to 24 months, plus additional surveys annually for up to 48 months. Cohort participants are recruited for qualitative interviews at key time points to enable in-depth exploration of people’s lived experiences. Separately, community representatives are invited to participate in community engagement groups, which review and interpret research findings to inform policy and practice recommendations.Ethics and dissemination The Optimise longitudinal cohort and qualitative interviews are approved by the Alfred Hospital Human Research Ethics Committee (# 333/20). The Optimise Study CEG is approved by the La Trobe University Human Ethics Committee (# HEC20532). All participants provide informed verbal consent to enter the cohort, with additional consent provided prior to any of the sub studies. Study findings will be disseminated through public website (https://optimisecovid.com.au/study-findings/) and through peer-reviewed publications.Trial registration number NCT05323799.

Participatory Health Research (PHR) has the potential to result in more equitable health interventions and impactful research outcomes, and is an increasingly used paradigm in migrant health research. In the context of intersecting systems of social disadvantage imposed on migrant and refugee women, PHR could offer an opportunity for researchers to challenge unequal power dynamics in academic research by co-creating knowledge to improve these women’s healthcare access and use. However, there is limited information about how PHR has been conducted with migrant women, including the extent of their involvement throughout the research process. This scoping review aimed to describe and summarize current evidence on the research approaches and methods that have been used in PHR with women of migrant and refugee backgrounds living in high-income countries, and the extent of community engagement in PHR with this population. We searched MEDLINE Ovid, CINHAL, Scopus, and Web of Science databases from 1 January 2012 to 31 December 2021 to identify qualitative, quantitative, and mixed method studies adopting a PHR approach with migrant women as participants. We included 91 studies from 12 countries. Health topics of included studies included: knowledge, screening and prevention of HPV, cervical and breast cancer, mental health, nutrition and physical activity, gender-based violence, and health promotion and education. The most common PHR approaches were Community-Based Participatory Research and participatory action research. Overall, community engagement was commonly reported in most stages of research; however, participatory engagement with migrant women was more often done by proxy through community organisations or agents, rather than women themselves. We argue that more rigorous reporting of community engagement is necessary to demonstrate PHR conducted with migrant women is following the principles of equity and inclusion in community-academic partnerships.

Abstract Forced migrant women experience high levels of violence across their journeys and violence can be characterised as having three overarching forms: structural, symbolic, and interpersonal. It is important to understand the intersecting nature of gendered forms of symbolic, structural and interpersonal violence, and their impact on the mental health of forced migrant women in order to develop holistic IPV and resettlement programs and interventions. This article adopts an ecological framework of violence and qualitative methods with mental health service providers and survivors of IPV to understand the intersections of different forms of violence and their impact on mental health as they relate to the lived experiences of Arabic-speaking forced migrant survivors currently residing in Melbourne, Australia. Our research has three key findings: (1) that forced migrant women living in Melbourne, Australia experience intersecting forms of violence during resettlement (2) Structural and symbolic violence against forced migrant women persists regardless of marital status (3) Autonomy and independence plays a vital role in the mental health and wellbeing of forced migrant women. Our findings reveal that structural and symbolic violence increase the risk of IPV for forced migrant women during resettlement and that even when forced migrant women leave IPV situations, structural and symbolic violence persist and exacerbate mental ill-health. This article also reveals the importance autonomy and independence in both the perpetration of violence and in healing and recovery.

IntroductionThis paper examines the relationship between gender-based violence (GBV) and religion in a range of forced displacement contexts. While it has been acknowledged that religion frequently shapes experiences of GBV survivors, little is known about the influences of religion on GBV experiences in forced displacement and its potential role in strengthening interventions.MethodsUtilizing empirical evidence from 58 interviews from the SEREDA project with forced migrants in Sweden, UK, Turkey and Australia, we outline the interactions between religious resources and GBV in migrants' forced displacement experiences. We conceptualise religious resources as comprising religious ideas, religious practices, religious experience and religious organization.ResultsSurvivors talked about religion spontaneously when responding to questions relating to resilience, coping mechanisms, and risk factors. Religion acted as both a “protective” and “risk” factor for GBV experiences. Religious beliefs were assets in coping with GBV experiences, but also contributed to creating an environment in which violence was normalized, exposing women to further harm. Religious practices supported survivors emotionally to cope with GBV but also some practices posed risks. Religious organizations in many cases served as a lifeline for many displaced women, offering practical and emotional support, however religious leaders at times encouraged survivors to stay in abusive relationships. Religious experiences “empowered” and “disempowered” survivors across the processes of forced migration.DiscussionWe demonstrate the relevance and importance of acknowledging the role of religion in the experiences of GBV in forced displacement. Our analysis advances the understanding of religious resources as both protective and risk factors that affect forced migrants' experiences of GBV over time and place. We suggest a way forward for practitioners and researchers to account for the roles of religion in experiences of GBV and forced displacement, as opportunities and barriers to GBV prevention and response, and to work with religious leaders and local faith communities to strengthen protection of survivors.

Abstract Background Stigma is a social process that impedes access to support for mental health conditions and alcohol and other drug (AOD) use, particularly for people from migrant and ethnic minority backgrounds. There is limited understanding, however, of people’s experiences of stigma, the underlying drivers, intersections with ethnicity, gender, and citizenship status, and how powerful discourses and social institutions create and perpetuate systems of stigma. This review aims to synthesise and critically analyse qualitative evidence to understand how stigma associated with mental health conditions and AOD use operates among people from migrant and ethnic minority groups. Methods Qualitative evidence will be identified using MEDLINE, Embase, PsycINFO, CINAHL, Applied Social Sciences Index and Sociological Abstracts. Two reviewers will screen the titles, abstracts and full-text articles. Eligible studies will include original, empirical, peer-reviewed qualitative evidence, published in English since 1990. Studies must examine stigma in relation to mental health conditions, illicit drug use or alcohol consumption among participants who are from migrant and ethnic minority backgrounds. Studies will be critically appraised using the Joanna Briggs Institute Critical Appraisal Checklist for qualitative studies and the level of confidence in the findings will be assessed using Confidence in the Evidence from Reviews of Qualitative research. Data will be analysed using the ‘best fit’ framework synthesis approach, drawing on the Health Stigma and Discrimination Framework. Discussion This review will provide an in-depth understanding of the stigma associated with mental health conditions and AOD use among people from migrant and ethnic minority backgrounds. The findings will inform culturally responsive interventions that aim to reduce the negative impact of stigma on individuals, families and communities. Systematic review registration PROSPERO CRD42021204057

Burnout is commonly associated with professions that entail a high rate of close relationships with other individuals or groups. This paper explores the association between burnout and interpersonal relationships using a relational, social network framework. We collected data on advice-seeking relationships among 102 teachers and administrative staff from a secondary school in Melbourne, Australia. Burnout was measured using the Burnout Assessment Tool and we focused on four core subscales: (1) exhaustion; (2) mental distance; (3) emotional impairment; and (4) cognitive impairment. We applied a particular class of statistical model for social networks called Exponential Random Graph Models (ERGMs) to shed new light on how level of burnout relates to formation of advice relations among school staff. Results indicated that high levels of overall burnout were linked to a higher number of advice-seeking ties among school staff. Additionally, teachers who scored high in cognitive impairment (i.e., difficulties in thinking clearly and learn new things at work) tended to seek and to provide advice to a greater number of others. Finally, school staff who scored high in exhaustion (i.e., a severe loss of energy that results in feelings of both physical and mental exhaustion) tended to be sought out less as advisors to others, while those high in mental distance (i.e., psychologically distancing oneself from others) were generally less likely to seek advice from other school staff. We discuss these findings drawing on Conservation of Resource theory. Notably, our results show that burnout is not only an individual-level problem, but that burnout is associated with reduced social connectivity in specific ways that may impact on how other school staff collaborate, culminating in a staff-wide overall impact that affects how schools function.

Summary: Disasters are an important public health issue; however, there is scarce evidence to date on what happens when communities and populations experience more than one disaster. This scoping review identifies literature on the effects of multiple disasters published until Aug 2, 2021, 1425 articles were identified, of which 150 articles were included. We analysed direct and indirect public health implications of multiple disasters. Our analysis suggests that exposure to multiple disasters can affect mental health, physical health, and wellbeing, with some evidence that the potential risks of multiple disaster exposure exceed those of single disaster exposure. We also identified indirect public health implications of multiple disaster exposure, related to changes in health-care facilities, changes in public risk perception, and governmental responses to multiple disasters. We present findings on community recovery and methodological challenges to the study of multiple disasters, and directions for future research.

Reproductive coercion (RC), generally considered a form of intimate partner violence (IPV), refers to perpetrator behaviours and actions that are intended to interfere with and control the autonomous decision-making of a person regarding their reproductive health. To date there are few studies that document RC as experienced by immigrant and refugee women. In this article, we explore cases of RC as described by women who were part of a larger qualitative study investigating violence against immigrant and refugee women in southern Australia. The study aimed to identify the types of RC detailed in immigrant and refugee women's narratives, and to illustrate the contexts in which these experiences occurred. Analysis followed Baxter and Jack's (2008) case study methodology; whereby particular "cases" are used to describe a phenomenon in context. Thirteen women from seven countries described experiences that fit definitions of RC. The cases describe various types of RC including violence during pregnancy with the intent of causing miscarriage, forced abortion, contraception sabotage and forced pregnancy. As well as intimate partners, some women described multiple perpetrators being complicit in their experience of RC, especially in regard to controlling women's access to, and interactions with health services. More information is needed about immigrant and refugee women's experiences of RC, and how vulnerability to multi-perpetrator violence affects health service access. In particular knowledge about how multi-perpetrator RC can affect consent processes for women who already face barriers to health care requires attention. Further research is required to address knowledge gaps about appropriate prevention and advocacy work about RC in refugee and migrant communities, and what training is needed for professionals in the family violence sector, women's health services, women's organisations, multicultural and ethno-specific services.

While much attention is focused on rape as a weapon of war, evidence shows that forced migrant women and girls face increased risks of Sexual and Gender-Based Violence (SGBV) both during and following forced displacement. In this paper, we argue that gendered forms of structural and symbolic violence enable and compound the harms caused by interpersonal SGBV against forced migrant women and girls. These forms of violence are encountered in multiple contexts, including conflict and post-conflict settings, countries of refuge, and following resettlement. This paper illustrates the consequences of resultant cumulative harms for individuals and communities, and highlights the importance of considering these multiple, intersecting harms for policy and practice.

Abstract Background Violence against women is a major human rights and public health issue globally. The experience of violence affects women across Australia, including the large number of migrant and refugee women who permanently or temporarily resettle in the country. Many women who experience violence find it difficult to access support, and evidence suggests women who have resettled in Australia face additional barriers to violence-specific services. Previous research, however, indicates many migrant and refugee women experiencing violence have contact with, and may disclose violence to, settlement and multicultural services. There has been limited research documenting current knowledge of, and practices by, settlement and multicultural services in relation to violence. The MuSeS project will address this knowledge gap and identify strategies settlement and multicultural services can use to better support women experiencing violence. Methods This mixed methods research project will be conducted in six geographic communities across three Australian states: South Australia, Tasmania and Victoria. The different migration and resettlement patterns seen in these jurisdictions will enable generation of data relevant to settings across the country. The project has been designed in consultation with partner organisations from the settlement and multicultural service sector to ensure the research addresses their concerns and priorities. A mix of quantitative and qualitative methods will be used to generate rich data to inform strategies for settlement and multicultural services to better support women experiencing violence. These methods include an anonymous online survey of settlement and multicultural service providers to assess current knowledge, practices and professional development needs; in-depth interviews with settlement, multicultural and specialist (refugee) mental health service providers; in-depth interviews with refugee women; and focus group discussions with frontline workers and volunteers working with settlement and multicultural services. Discussion Findings from this two-year research project will generate an in-depth understanding of the current and potential role of Australian settlement and multicultural services in supporting migrant and refugee women experiencing violence, and inform strategies to strengthen services’ capacity to appropriately respond. Given the prevalence of violence against women globally, findings will be useful for services engaging with migrant and refugee populations around the world.

BackgroundDisasters pose a documented risk to mental health, with a range of peri- and post-disaster factors (both pre-existing and disaster-precipitated) linked to adverse outcomes. Among these, increasing empirical attention is being paid to the relation between disasters and violence.AimsThis study examined self-reported experiences of assault or violence victimisation among communities affected by high, medium, and low disaster severity following the 2009 bushfires in Victoria, Australia. The association between violence, mental health outcomes and alcohol misuse was also investigated.MethodParticipants were 1016 adults from high-, medium- and low-affected communities, 3–4 years after an Australian bushfire disaster. Rates of reported violence were compared by areas of bushfire-affectedness. Logistic regression models were applied separately to men and women to assess the experience of violence in predicting general and fire-related post-traumatic stress disorder, depression and alcohol misuse.ResultsReports of experiencing violence were significantly higher among high bushfire-affected compared with low bushfire-affected regions. Analyses indicated the significant relationship between disaster-affectedness and violence was observed for women only, with rates of 1.0, 0 and 7.4% in low, medium and high bushfire-affected areas, respectively. Among women living in high bushfire-affected areas, negative change to income was associated with an increased likelihood of experiencing violence (odds ratio, 4.68). For women, post-disaster violence was associated with more severe post-traumatic stress disorder and depression symptoms.ConclusionsWomen residing within high bushfire-affected communities experienced the highest levels of violence. These post-disaster experiences of violence are associated with post-disaster changes to income and with post-traumatic stress disorder and depression symptoms among women. These findings have critical implications for the assessment of, and interventions for, women experiencing or at risk of violence post-disaster.

NADPH oxidase NOX4 has been linked to poor cancer survival. Here the authors show that NOX4 regulates drug resistance in renal cancer carcinoma by regulating PKM2 and that NOX4 activity is allosterically activated by reduced mitochondrial ATP levels thus coupling energy metabolism to drug resistance.

Sports participation can confer a range of physical and psychosocial benefits and, for refugee and migrant youth, may even act as a critical mediator for achieving positive settlement and engaging meaningfully in Australian society. This group has low participation rates however, with identified barriers including costs; discrimination and a lack of cultural sensitivity in sporting environments; lack of knowledge of mainstream sports services on the part of refugee-background settlers; inadequate access to transport; culturally determined gender norms; and family attitudes. Organisations in various sectors have devised programs and strategies for addressing these participation barriers. In many cases however, these responses appear to be ad hoc and under-theorised. This article reports findings from a qualitative exploratory study conducted in a range of settings to examine the benefits, challenges and shortcomings associated with different participation models. Interview participants were drawn from non-government organisations, local governments, schools, and sports clubs. Three distinct models of participation were identified, including short term programs for refugee-background children; ongoing programs for refugee-background children and youth; and integration into mainstream clubs. These models are discussed in terms of their relative challenges and benefits and their capacity to promote sustainable engagement and social inclusion for this population group.

To better understand why cooperation between health care professionals is still often problematic, we carried out 25 semistructured face-to-face expert interviews with physicians and nurses in different rural and urban areas in northern Germany. Using Mayring’s qualitative content analysis method to analyze the data collected, we found that doctors and nurses interpreted interprofessional conflicts differently. Nursing seems to be caught in a paradoxical situation: An increasing emphasis is placed on achieving interprofessional cooperation but the core areas of nursing practice are subject to increasing rationalization in the current climate of health care marketization. The subsequent and systematic devaluation of nursing work makes it difficult for physicians to acknowledge nurses’ expertise. We suggest that to ameliorate interprofessional cooperation, nursing must insist on its own logic of action thereby promoting its professionalization; interprofessional cooperation cannot take place until nursing work is valued by all members of the health care system.

Inflammatory cytokines are detected in the plasma of patients with renal cell carcinoma (RCC) and are associated with poor prognosis. However, the primary cell type involved in producing inflammatory cytokines and the biological significance in RCC remain unknown. Inflammation is associated with oxidative stress, upregulation of hypoxia inducible factor 1-alpha, and production of pro-inflammatory gene products. Solid tumors are often heterogeneous in oxygen tension together suggesting that hypoxia may play a role in inflammatory processes in RCC. Epithelial cells have been implicated in cytokine release, although the stimuli to release and molecular mechanisms by which they are released remain unclear. AMP-activated protein kinase (AMPK) is a highly conserved sensor of cellular energy status and a role for AMPK in the regulation of cell inflammatory processes has recently been demonstrated.We have identified for the first time that interleukin-6 and interleukin-8 (IL-6 and IL-8) are secreted solely from RCC cells exposed to hypoxia. Furthermore, we demonstrate that the NADPH oxidase isoform, Nox4, play a key role in hypoxia-induced IL-6 and IL-8 production in RCC. Finally, we have characterized that enhanced levels of IL-6 and IL-8 result in RCC cell invasion and that activation of AMPK reduces Nox4 expression, IL-6 and IL-8 production, and RCC cell invasion.Together, our data identify novel mechanisms by which AMPK and Nox4 may be linked to inflammation-induced RCC metastasis and that pharmacological activation of AMPK and/or antioxidants targeting Nox4 may represent a relevant therapeutic intervention to reduce IL-6- and IL-8-induced inflammation and cell invasion in RCC.

Metastatic renal cancer manifests multiple signatures of gene expression. Deviation in expression of mature miRNAs has been linked to human cancers. Importance of miR-21 in renal cell carcinomas is proposed from profiling studies using tumor tissue samples. However, the role of miR-21 function in causing renal cancer cell proliferation and invasion has not yet been shown. Using cultured renal carcinoma cells, we demonstrate enhanced expression of mature miR-21 along with pre-and pri-miR-21 by increased transcription compared to normal proximal tubular epithelial cells. Overexpression of miR-21 Sponge to quench endogenous miR-21 levels inhibited proliferation, migration and invasion of renal cancer cells. In the absence of mutation in the PTEN tumor suppressor gene, PTEN protein levels are frequently downregulated in renal cancer. We show that miR-21 targets PTEN mRNA 3'untranslated region to decrease PTEN protein expression and augments Akt phosphorylation in renal cancer cells. Downregulation of PTEN as well as overexpression of constitutively active Akt kinase prevented miR-21 Sponge-induced inhibition of renal cancer cell proliferation and migration. Moreover, we show that miR-21 Sponge inhibited the inactivating phosphorylation of the tumor suppressor protein tuberin and attenuated TORC1 activation. Finally, we demonstrate that expression of constitutively active TORC1 attenuated miR-21 Sponge-mediated suppression of proliferation and migration of renal cancer cells. Our results uncover a layer of post-transcriptional regulation of PTEN by transcriptional activation of miR-21 to force the canonical oncogenic Akt/TORC1 signaling conduit to drive renal cancer cell proliferation and invasion.

Germline mutations of FH, the gene that encodes for the tricarboxylic acid TCA (TCA) cycle enzyme fumarate hydratase, are associated with an inherited form of cancer referred to as Hereditary Leiomyomatosis and Renal Cell Cancer (HLRCC). Individuals with HLRCC are predisposed to the development of highly malignant and lethal renal cell carcinoma (RCC). The mechanisms of tumorigenesis proposed have largely focused on the biochemical consequences of loss of FH enzymatic activity. While loss of the tumor suppressor gene von Hippel Lindau (VHL) is thought to be an initiating event for the majority of RCCs, a role for FH in sporadic renal cancer has not been explored. Here we report that FH mRNA and protein expression are reduced in clear cell renal cancer, the most common histologic variant of kidney cancer. Moreover, we demonstrate that reduced FH leads to the accumulation of hypoxia inducible factor- 2α (HIF-2α), a transcription factor known to promote renal carcinogenesis. Finally, we demonstrate that overexpression of FH in renal cancer cells inhibits cellular migration and invasion. These data provide novel insights into the tumor suppressor functions of FH in sporadic kidney cancer.