Quantity and quality of conflict of interest policies at German medical schools - a cross sectional study and survey

Objectives: To assess the quantity and evaluate the quality of policies and curricula focusing on conflicts of interests (COI) at medical schools across Germany. Design: Cross-sectional study, survey of medical schools, standardised web search. Setting: Medical schools, Germany. Participants: 38 German medical schools. Interventions: We collected relevant COI policies, including teaching activities, by conducting a search of the websites of all 38 German medical schools using standardised keywords for COI policies and teaching. Further, we surveyed all medical schools’ dean’s offices. Finally, we adapted a scoring system for results we obtained with 13 categories based on prior similar studies. Main outcomes and measures: Presence or absence of COI-related policies, including teaching activities at medical school. The secondary outcome was the achieved score on a scale from 0 to 26, with high scores representing restrictive policies and sufficient teaching activities. Results: We identified relevant policies for one medical school via the web search. The response rate of the deans’ survey was 16 of 38 (42.1%). In total, we identified COI-related policies for 2 of 38 (5.3%) German medical schools, yet no policy was sufficient to address all COI-related categories that were assessed in this study. The maximum score achieved was 12 of 26. 36 (94.7%) schools scored 0. No medical school reported curricular teaching on COI. Conclusions: Our results indicate a low level of action by medical schools to protect students from undue commercial influence. No participating dean was aware of any curriculum or instruction on COI at the respective school and only two schools had policies in place. The German Medical Students Association and international counterparts have called for a stronger focus on COI in the classroom. We conclude that for German medical schools, there is still a long way to go

National Planetary Health learning objectives for Germany: A steppingstone for medical education to promote transformative change

Physicians play an important role in adapting to and mitigating the adverse health effects of the unfolding climate and ecological crises. To fully harness this potential, future physicians need to acquire knowledge, values, skills, and leadership attributes to care for patients presenting with environmental change-related conditions and to initiate and propel transformative change in healthcare and other sectors of society including, but not limited to, the decarbonization of healthcare systems, the transition to renewable energies and the transformation of transport and food systems. Despite the potential of Planetary Health Education (PHE) to support medical students in becoming agents of change, best-practice examples of mainstreaming PHE in medical curricula remain scarce both in Germany and internationally. The process of revising and updating the Medical Licensing Regulations and the National Competency-based Catalog of Learning Objectives for Medical Education in Germany provided a window of opportunity to address this implementation challenge. In this article, we describe the development and content of national Planetary Health learning objectives for Germany. We anticipate that the learning objectives will stimulate the development and implementation of innovative Planetary Health teaching, learning and exam formats in medical schools and inform similar initiatives in other health professions. The availability of Planetary Health learning objectives in other countries will provide opportunities for cross-country and interdisciplinary exchange of experiences and validation of content, thus supporting the consolidation of Planetary Health learning objectives and the improvement of PHE for all health professionals globally.</p

Impact of unseasonable flooding on women's food security and mental health in rural Sylhet, Bangladesh: a longitudinal observational study

Background Climate change will lead to more frequent and intensive flooding. In April, 2017, unseasonably early flooding led to the inundation of low-lying cropland before the rice harvest in northeastern Bangladesh. We describe coping strategies and quantify short-term and medium-term effects of flooding events on food security and depressive symptoms of women. Methods This observational study is part of the cluster-randomised Food and Agricultural Approaches to Reducing Malnutrition trial (FAARM; NCT02505711). Women self-reported flooding exposure on behalf of their households when surveyed (approximately 6 months after the event). Remote sensing analysis was used to detect the extent of the flooding. We collected data on household food security at baseline, depressive symptoms 4–5 months before the flooding, and coping strategies immediately after the event. We followed up on these outcome measurements for depressive symptoms and food security for up to 2·5 years after the flooding event. We used multilevel regression adjusting for intervention allocation and pre-flooding measures to quantify the flood's effect on household food security and women's mental health. Findings The FAARM trial included 2700 young women in 96 settlements in rural Sylhet, Bangladesh. 1335 (56%) of 2405 women reported that their household being greatly affected, with many losing a large part of their rice harvest. Borrowing money with interest was the most common coping strategy, with households paying back on average 1·5 times the borrowed amount. Greatly affected households had higher odds of food insecurity, with a decreasing effect with increasing time after the flood (odds ratio: 2·4 [p<0·0001] 0·5 years after; 1·6 [p<0·0001] 2·0 years after]; and 1·3 [p=0·012] 2·5 years after). Women in such households also had 1·45 times higher odds of depression (p=0·0001) 2·5 years after the flooding event. Interpretation The 2017 flooding event negatively affected food security and the mental health of women in rural Sylhet, Bangladesh, and few affected women received formal government support. To reduce the impact of future floods, livelihood adaptations and expansion of financial protection programmes are essential measures to pursue. Funding German Federal Ministry for Education and Research (Berlin, Germany) and UK Department for International Development (London, UK)

The Planetary Health Academy—a virtual lecture series for transformative education in Germany

The planetary crises require health professionals to understand the interlinkages between health and environmental changes, and how to reduce ecological harm (ie, ecological footprint) and promote positive change (ie, ecological handprint). However, health professions’ education and training are mostly lacking these aspects. In this Viewpoint, we report findings from the evaluation of the Planetary Health Academy, the first open online lecture series for transformative planetary health education in Germany. In a retrospective online survey, 458 of 3656 Planetary Health Academy participants reported on their emotions towards climate change, attitudes towards health professionals’ responsibilities, self-efficacy, and the contribution of the Planetary Health Academy to their knowledge and actions. Additionally, motivators and barriers to acting were assessed. Our findings provide insights that can inform future efforts for transformative education. Combined with network and movement building, education could act as a social tipping element toward actions to mitigate global environmental changes

Improving clinical trial transparency at UK universities: Evaluating 3 years of policies and reporting performance on the European Clinical Trial Register

Background: January 2019, the House of Commons’ Science and Technology Committee sent letters to UK universities admonishing them to achieve compliance with results reporting requirements for Clinical Trials of Investigative Medicinal Products by summer 2019. This study documents changes in the clinical trial policies and Clinical Trials of Investigative Medicinal Product reporting performance of 20 major UK universities following that intervention. Methods: Freedom of Information requests were filed in June 2018 and June 2020 to obtain clinical trial registration and reporting policies covering both Clinical Trials of Investigative Medicinal Products and all other clinical trials. Two independent reviewers assessed policies against transparency benchmarks based on World Health Organization best practices. To evaluate universities’ trial reporting performance, we used a public online tracking tool, the European Union Trials Tracker, which assesses universities’ compliance with regulatory Clinical Trials of Investigative Medicinal Product disclosure requirements on the European Clinical Trial Register. Specifically, we evaluated whether universities were adhering to the European Union requirement to post summary results on the trial registry within 12 months of completion. Results: Mean policy strength increased from 2.8 to 4.9 points (out of a maximum of 7 points) between June 2018 and June 2020. In October 2018 the average percentage of due Clinical Trials of Investigative Medicinal Products that had results available on the European trial registry across university sponsors included in the cohort was 29%. By June 2021, this had increased to 91%, with 5 universities achieving a reporting performance of 100%. All 20 universities reported more than 70% of their due trial results on the European trial registry. Interpretation: Political pressure appears to have a significant positive impact on UK universities’ clinical trial reporting policies and performance. Similar approaches could be used to improve reporting performance for other types of sponsors, other types of trials, and in other countries

Klimawandel und gesundheitliche Chancengerechtigkeit: Eine Public-Health-Perspektive auf Klimagerechtigkeit

Bolte G, Dandolo L, Gepp S, Hornberg C, Lopez Lumbi S. Klimawandel und gesundheitliche Chancengerechtigkeit: Eine Public-Health-Perspektive auf Klimagerechtigkeit. Journal of Health Monitoring . 2023;8(S6).Hintergrund: Der Diskurs zu Klimagerechtigkeit hat sich aus den theoretischen Ansätzen und Diskussionen zu Umweltgerechtigkeit entwickelt. Für das Konzept von Umwelt- und Klimagerechtigkeit ist zentral, dass Umwelt- und Klimafragen nicht losgelöst von Fragen der sozialen Gerechtigkeit gesehen werden können. Methode: Für die systematische Analyse von Klimagerechtigkeit wurde ein konzeptionelles Modell zum Zusammenhang zwischen Klimawandelfolgen, sozialen Dimensionen, Anpassungskapazitäten, biologischer Empfindlichkeit und gesundheitlicher Chancengerechtigkeit entwickelt. Auf Basis einer explorativen Literaturrecherche und der Auswertung der Einzelbeiträge des Sachstandsberichts Klimawandel und Gesundheit wurde die Evidenz in Deutschland zu sozialen Ungleichheiten in der Exposition gegenüber Klimawandelfolgen und der Vulnerabilität für deren direkte und indirekte gesundheitliche Wirkungen zusammengefasst. Ergebnisse: Dieser Beitrag gibt einen Überblick über die internationale Debatte und Beispiele für die Evidenz zu Klimagerechtigkeit in Deutschland. Klimagerechtigkeit im Sinne vermeidbarer, ungerechter sozialer Ungleichheiten in der Exposition, Vulnerabilität sowie in den Effekten von Klimaschutz- und Klimaanpassungsmaßnahmen auf gesundheitliche Ungleichheiten wird in Deutschland noch wenig thematisiert. Schlussfolgerungen: Eine konsequente Integration von Gerechtigkeitsfragen in die Klimapolitik ist notwendig. Mit Bezug auf die internationale Literatur werden Handlungsoptionen und Forschungsbedarfe aufgezeigt