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Introduction: As one of the major contributors to global greenhouse gas emissions and the world’s third largest economy, Europe is a key stakeholder in the world’s response to climate change and has a global responsibility and opportunity to transition towards a low-carbon economy for healthier, more resilient societies with clean air and liveable cities. The Lancet Countdown in Europe is the first comprehensive assessment that monitors health and climate change over space and time in Europe reporting on 33 indicators focusing on (section 1) impact, exposure, and vulnerability; (section 2) adaption, planning and resilience; (section 3) mitigation actions and health co-benefits; (section 4) economics and finance; and (section 5) politics and governance. Results: Health risks (section 1) for almost all indicators tracked have been increasing. Illustratively, clinically relevant pollen seasons are starting 10-20 days earlier each year (1981-2020), the climatic suitability for water-borne and vector-borne diseases (e.g., malaria, dengue, Vibrio) have been rapidly increasing (1951-2020), and - assuming no adaptation - heat exposure is estimated to have increased by 57% between the first and second half of the 21st century. However, some encouraging trends for adaptation (section 2) could be observed - with countries adopting adaptation plans for health (15/22 assessed in 2021), cities recognising the threat of climate change to public health (118/197 assessed in 2021), or countries implementing early warning systems. Despite some progress in the reduction of the carbon intensity of energy systems and phasing out coal for electricity generation, European mitigations efforts remain inadequate to meet 2030 and 2050 reduction targets (section 3); European energy systems should decarbonise five times the current pace to reach net-zero CO2 emissions by 2050. Likewise, despite improvements in air pollution levels due to stringent air pollution emission controls, 94% of the European population is still estimated to live at PM2·5 concentrations higher than the WHO guideline (5 μg/m3 annual mean). Indicators in section 4 illustrate several substantial economic losses due to climate-related health impacts, including losses to due extreme events or reduced labour supply. Yet, European countries still provide overall subsidies to fossil fuels (total of €70·7 billion in 2019), providing further financial strains to meeting decarbonisation targets. Lastly, whilst strengthening the response to climate change requires key actors and institutions to engage with the health dimensions of climate change political, corporate, scientific, and individual engagement remains low (section 5) in the past decades. Conclusion: This data highlights the accelerating trends in health-related hazards, exposures, vulnerabilities and risk from climate change, and the insufficiently ambitious adaptation and mitigation actions in Europe. However, with health, wellbeing, and equity at its core, accelerated action in line with climate targets could support a healthy, climate-resilient future for all.

BACKGROUND: Arsenic exposure has been related to numerous adverse cardiovascular outcomes. The aim of this study was to investigate the cross-sectional and prospective association between arsenic exposure with echocardiographic measures of left ventricular (LV) geometry and functioning. METHODS: A total of 1337 young adult participants free of diabetes mellitus and cardiovascular disease were recruited from the SHFS (Strong Heart Family Study). The sum of inorganic and methylated arsenic concentrations in urine (ΣAs) at baseline was used as a biomarker of arsenic exposure. LV geometry and functioning were assessed using transthoracic echocardiography at baseline and follow-up. RESULTS: Mean follow-up was 5.6 years, and median (interquartile range) of ΣAs was 4.2 (2.8–6.9) μg/g creatinine. Increased arsenic exposure was associated with prevalent LV hypertrophy, with an odds ratio (95% CI) per a 2-fold increase in ΣAs of 1.47 (1.05–2.08) in all participants and of 1.58 (1.04–2.41) among prehypertensive or hypertensive individuals. Measures of LV geometry, including LV mass index, left atrial systolic diameter, interventricular septum, and LV posterior wall thickness, were positively and significantly related to arsenic exposure. Among measures of LV functioning, stroke volume, and ejection fraction were associated with arsenic exposure. CONCLUSIONS: Arsenic exposure was related to an increase in LV wall thickness and LV hypertrophy in young American Indians with a low burden of cardiovascular risk factors. The relationship was stronger in participants with prehypertension or hypertension, suggesting that potential cardiotoxic effects of arsenic might be more pronounced in individuals already undergoing cardiovascular adaptive mechanisms following elevated systemic blood pressure.

This paper seeks to demonstrate how the Holy Spirit, through common grace, may be actively working and using secular psychotherapy in light of the dual reality of belief and unbelief in this world. The Triune God desires to bring a world fallen in sin to his desired goal of reconciliation with Him through the redemptive work of Christ. The Holy Spirit works through common grace in order to help people experience the goodness of God to draw them to him. As such the Holy Spirit may work through secular psychotherapy to bless people in general, restrain sin in this world, prepare for salvation, or aid in the progressive sanctification of believers. The Holy Spirit's activity through secular psychotherapy entails for Christian counselors and scholars a challenging call to engage wisely with secular psychotherapy in order to bless humankind, to be a witness, and to use potential blessings for the sake of distinctly Christian psychotherapy.

The role of emotion with regard to human functioning and human well-being has been a topic of much consideration and debate throughout the ages. In both secular and Christian fields of study (e.g. philosophy, theology, biology, psychology, and psychotherapy) people have examined emotional experience from different vantage points. Since the second half of the 20th century renewed interest in the importance of affect in human life is especially notable in disciplines such as neuroscience, psychology, and psychotherapy. This is reflected, for example, in the development of a secular psychotherapeutic model that understands experiential engagement to be a crucial key to psychological change, namely Emotion-Focused Therapy (EFT). There is no distinctive Christian counseling model that has as its main paradigm emotion experience. Yet, several Christian models exists in which experiencing emotions is considered to be important in the process of change. The thesis of this work is that the theologically and psychologically sophisticated Christian emotion-focused model of therapy suggested in this dissertation will correct and enhance existent Christian and secular emotion-focused models. Chapter 1 covers the thesis of the dissertation, reasons why the dissertation makes a helpful contribution to the field, background information, methodology, and delimitations. Chapter 2 presents theological reflections on the topic of emotion, especially as it pertains to topics such as the nature of emotions, emotional health and disorder, and emotional healing. Chapter 3 consists of an examination of secular Emotion-Focused Therapy. This chapter will discuss this model and assess what aspects can or cannot be used by a Christian Emotion-Focused approach. In chapter 4 three contemporary Christian models that use emotion experience in their counseling approach are described and evaluated. These are Theophostic Prayer Ministry developed by Smith, Inner Healing Prayer as defined by Tan, and the Elijah House model of the Sandfords. The purpose of this dissertation is to contribute to the field of Christian psychology by proposing the necessary elements of a comprehensive Christian Emotion-Focused model that is a corrective to existent models. Based on the research of the previous chapters, a preliminary outline of such a model is presented in chapter 5.