Business as usual: Record number of fossil fuel lobbyists at COP28

Dubai (AFP) – NGOs may have slammed the record number of fossil fuel lobbyists at UN climate talks in Dubai, but the industry won't be browbeaten, with the OPEC cartel hosting a chat on "climate initiatives" and one of the heads of the "Big Oil" majors sparring with protesters.


Issued on: 05/12/2023 -

The COP28 climate conference is being hosted by oil-rich UAE

 © KARIM SAHIB / AFP

Activists were already up in arms over the appointment of Sultan Al Jaber, the head of Emirati national oil company ADNOC, as president of COP28.

The oil-rich hosts made no secret of their desire to give the fossil fuel industry a voice at the talks where the fate of oil, gas and coal is at the heart of deliberations.

On Tuesday, the umbrella group Kick Big Polluters Out (KBPO) claimed 2,456 people tied to fossil fuel interests have signed up to COP28 -- about four times the number from last year's UN talks in Egypt.

If taken as a group they outnumber "every country delegation" apart from the UAE and Brazil, which will host COP30 in 2025, the coalition said.

But Majid Jafar, CEO of Emirati firm Crescent Petroleum, said the United Arab Emirates was actually trying to be "inclusive", not only to "have all industries present but really having the Global South frame the debate upfront."

The UAE turned the UN talks into the largest COP ever, with more than 80,000 registered participants ranging from government officials to an array of businesses and climate activists.

Under new UN rules, attendees had to provide information about their employer and their relationship -- financial or otherwise -- with the entity applying for accreditation on their behalf.

"Do you really think Shell or Chevron or ExxonMobil are sending lobbyists to passively observe these talks?" said Alexia Leclercq, co-founder of the NGO Start:Empowerment.

"Big Polluters' poisonous presence has bogged us down for years, keeping us from advancing the pathways needed to keep fossil fuels in the ground," Leclercq said.
Oil CEO challenged

According to KBPO, France brought TotalEnergies CEO Patrick Pouyanne, Italy included a team from Italian energy giant ENI, while the European Union brought employees of oil giants BP and ExxonMobil.

Pouyanne was approached by an activist asking him about reports that TotalEnergies has been "party to the bullying and intimidation" that resulted in communities in Uganda signing over their land.

"You think this is true?" Pouyanne replied, according to video footage posted on X, formerly Twitter. "We act in Uganda according to a code of conduct."

When asked in a separate video released by NGO 350.org his reaction to the detention of seven students opposed to an oil pipeline project in Uganda, Pouyanne said his team in the country was in contact with the authorities to get their release.

Pouyanne had already been ambushed by activists at COP27 in Egypt.
'It will be fine'

Exchanges were much more cordial in other corners of COP28's sprawling Expo City complex.

Groups of people mingled at the pavilion of the Geneva-based International Emissions Trading Association (IETA) -- a non-profit business group whose members include BP, Chevron and ExxonMobil.

IETA brought 116 people including representatives from Shell and Norway's Equinor, according to KBPO.

In a booth inside a large pavilion, Saudi-led OPEC made a presentation on "climate initiatives".

A screen reminded the small audience that the focus must be on an "all-peoples, all fuels and all-technologies approach" and that it backed technology to capture and store emissions.

One of the participants, Satya Widya Yudha, an energy industry representative in the National Energy Council of Indonesia, said that technology remained expensive.

An OPEC representative replied that "more investment is required".

When asked his thoughts on critics who denounce the presence of fossil fuel lobbyists, Yudha told AFP: "As long as they commit to reduce their emissions, it will be fine."

© 2023 AFP

COP28: Arab Coordination Group allocates $10 billion for energy transition

Countries at the COP28 climate conference in Dubai are considering calling for a formal phaseout of fossil fuels as part of the UN summit's final deal to tackle global warming, a draft negotiating text seen on Tuesday shows. The Arab Coordination Group (ACG) said on the sidelines of the summit that it would allocate $10 billion to support energy transition until 2030, UAE state news agency (WAM) said on Tuesday.

Issued on: 05/12/2023 - 

Activists protest fossil fuels at the COP28 UN Climate Summit on Tuesday, December 5, 2023, in Dubai, United Arab Emirates. 

© Rafiq Maqbool, AP

By:FRANCE 24

• Arab Coordination Group allocates $10 billion to support energy transition

The Arab Coordination Group (ACG) said on the sidelines of the UN's COP28 climate summit that it would allocate $10 billion to support energy transition until 2030, UAE state news agency (WAM) said on Tuesday.

The funding by ACG, an alliance comprising regional and international development institutions, was meant "to drive a comprehensive and affordable transition to renewable energy in developing countries", WAM added.

• Up to 63 countries back COP28 pledge to curb cooling emissions

The United States, Canada and Kenya were among 63 countries to join a pledge on Tuesday to deeply cut cooling-related emissions at the United Nations climate summit in Dubai.

The Global Cooling Pledge marks the world's first collective focus on climate-warming emissions from cooling, which includes refrigeration for food and medicine and air conditioning. It commits countries to reduce by 2050 their cooling-related emissions by at least 68% compared to 2022 levels, along with a suite of other targets including establishing minimum energy performance standards by 2030.

"We want to lay out a pathway to reduce cooling-related emissions across all sectors but increase access to sustainable cooling," US climate envoy John Kerry told COP28.

• UAE's 'repressive environment' complicating COP28 activism, Amnesty International says

Restrictions on speech and protest in the United Arab Emirates are complicating UN approval of an Amnesty event at COP28 demanding the release of Emirati political prisoners, the group's secretary-general said Tuesday.

Speaking on the sidelines of the United Nations climate talks in Dubai, Agnes Callamard said the obstacles hampering activist actions within an UN-managed Blue Zone at the COP venue are slightly larger than previous years despite no changes to the guidelines. "The UN has been trying to find ways for us to do our actions. It is taking a lot of steps and negotiations... but it is working within an environment that is making them... much more complicated," Callamard told reporters at the COP28 venue.

In previous years, "the obstacles we confronted may have been a bit less", she said, adding that "the number of negotiations and hurdles to me indicate that the interpretation of the (UN) rules are largely driven by the (UAE) environment in which we operate".

Responding to Callamard's comments, the UAE's COP28 team said applications for Blue Zone actions were reviewed "exclusively" by the UN.

Amnesty and Human Rights Watch accuse the UAE of jailing 64 Emirati political prisoners, including rights activists, many of whom authorities accuse of having links to outlawed groups such as the Muslim Brotherhood.

(FRANCE 24 with AFP, AP & Reuters)

Developing nations need 'trillions' as climate finance takes centre stage at Cop28

Money pledges grabbed the spotlight at Cop28 in Dubai on Monday as delegates turned their focus to the yawning gap in the need for climate finance and what's on offer.

Issued on: 04/12/2023 - 

People are silhouetted against a logo for the COP28 U.N. Climate Summit, Wednesday, Nov. 29, 2023, in Dubai, United Arab Emirates. 

(AP Photo/Rafiq Maqbool) AP - Rafiq Maqbool

By:RFI

The United Arab Emirates – the host of this year's conference – pledged $270 billion in green finance by 2030 through its banks, and several development banks made fresh moves to scale up their funding efforts, including by agreeing to pause debt repayments when disaster strikes.

But leaders of the region's biggest economy and the world's biggest oil producer – Saudi Arabia – have so far not attended the UN summit, in sharp contrast to their participation in last year's Cop27 conference in the Egyptian resort of Sharm el-Sheikh.

Saudi Prince Abdulaziz bin Salman, energy minister and the key climate negotiator for the kingdom, was a no-show at the Saudi Green Initiative.

De facto ruler Crown Prince Mohammad bin Salman also did not deliver a keynote speech to world leaders as scheduled on Friday.

Trillions needed for developing nations 

The amount of cash needed for energy transition, climate adaptation and disaster relief is overwhelming.

A report released Monday estimates that emerging markets and developing nations will need $2.4 trillion a year in investment to cap emissions and adapt to the challenges posed by climate change.

"The world is not on track to realise the goals of the Paris Agreement. The reason for this failure is a lack of investment, particularly in emerging market and developing countries outside China," said the report's co-author Nicholas Stern, who chairs the Grantham Research Institute on Climate Change and the Environment. 

"The central challenge is to accelerate and implement the fostering and financing of this investment from a range of sources."

• Cop27 reaches landmark deal on climate damage fund, but little else

Billions more for 'disaster fund'

Meanwhile, vulnerable countries that are already being hit by costly climate disasters are asking for billions more through a newly formed disaster fund, although current pledges are only around $700 million.

"Unless we have an urgent set of decision-making, we are going to suffer what every parent suffers from – exciting expectations and being unable to deliver," said Barbados Prime Minister Mia Mottley, who has become a prominent voice in global discussions about mobilising climate finance.

In a news conference, she urged countries to go beyond voluntary pledges and pleas to charities and private investors and instead to consider taxes as a way to boost climate funding.

A global 0.1 percent tax on financial services, for example, could raise $420 billion, she said, while a 5 percent tax on global oil and gas profits in 2022 would have yielded around $200 billion.

"The planet needs global governance not in a big stick way, but in a simple way of us cooperating with each other to be able to work with the institutions that we have," she added.

Other delegates, including UN Secretary-General Antonio Guterres, have called for an end to fossil fuel subsidies which have hit a record $7 trillion per year.

Cop28: Space agencies to showcase new technologies to battle climate change

Space technologies will feature prominently at this year’s Cop28 summit in Dubai, with space agencies showcasing different applications in the field of Earth science and observations.


Issued on: 05/12/2023 - 

The COP28 summit will feature space technologies. 

© AFP - GIUSEPPE CACACE

By:Dhananjay Khadilkar

“There will be dedicated events that will present what our missions do and what data can contribute in support to climate. Today, for example, we are working on over 25 climate variables in the context of the United Nations Framework Convention on Climate Change (UNFCCC) with these programs, and we will present the results of the climate variables,” Simonetta Cheli, who heads ESA’s Earth observation programme," told RFI.

Speaking about the increasing relevance of space technologies in the efforts to fight climate change, Cheli said Earth observation missions have important applications such as monitoring and better management of natural resources such as water resources as well as the ones which could become scarce.

“We can use the technologies and the data from Earth observation satellites to, for example, improve the forecast of agriculture, food security, and also everything that is related to natural disaster management,” she said.

Cheli said satellite technology is also used to monitor greenhouse gas emissions.

“For example, ESA’s Sentinel-5P Precursor mission can be used to detect individual methane emissions. ESA is also building two dedicated satellites that will look at anthropogenic carbon dioxide emissions.”

03:18

No agreement in sight as Cop28 teams wrangle over phasing out fossil fuels

The debate over the future of fossil fuels, the biggest cause of global warming, is the key battle at the Cop28 climate summit hosted by the oil-rich United Arab Emirates. As neighbouring Saudi Arabia – the world's biggest oil exporter – ruled out phasing down oil, gas and coal, and activists sounded the alarm over fossil fuel lobbying at the talks, the chances of agreeing an ambitious deal looked slim.


Issued on: 05/12/2023 -

Environmental activists display signs in a hallway during the United Nations climate summit in Dubai on 5 December 2023. 

© AFP / KARIM SAHIB

By:RFI

The latest version of a potential agreement includes two drastically different options: phasing out fossil fuels or not addressing the issue at all, negotiators said on Tuesday, as they headed back into tough talks due to end next week.

The draft gives three options in total: an "orderly and just" phase-out, faster efforts to phase out fossil fuel projects that do not capture and store emissions, or "no text" on the subject.

An earlier draft that proposed a "phase-down/out" was badly received by delegates, a Latin American negotiator told French news agency AFP.

"Everyone was extremely unhappy with the first draft," the negotiator said, requesting anonymity.

"When we started talking... everything collapsed... There is pretty much nothing on the way forward," the delegate added.

Saudi resistance

Saudi Arabia has already said it will "absolutely not" agree to phasing down fossil fuels, never mind phasing them out.

"I assure you not a single person – I'm talking about governments – believes in that," Energy Minister Prince Abdulaziz bin Salman told Bloomberg in Riyadh.

"I would like to put that challenge for all of those who... come out publicly saying we have to (phase down)... Call them and ask them how they are gonna do that."

The Cop28 president, Sultan Al Jaber – who is also head of the UAE's national oil company – says he believes that "the phase-down and the phase-out of fossil fuel is inevitable".Cop28 president insists he 'respects climate science' amid fossil fuel polemic
Fossil fuel lobby

But climate campaigners fear business interests will prevail at the UN summit – which as well as being hosted by an oil producer has also opened the doors to a record number of fossil fuel lobbyists.

According to NGO umbrella group Kick Big Polluters Out, 2,456 people tied to fossil fuel interests received accreditation to attend the latest talks, roughly four times the number at Cop27 last year.

If taken as a group they outnumber every country delegation apart from Brazil and the UAE, the group said.

All Cop delegates are required to be hosted by a government or registered organisation.

According to the campaigners, France brought the head of its fossil fuel giant TotalEnergies, Italy included a team from Italian energy giant Eni, while the European Union brought employees of oil giants BP and ExxonMobil.

'Zero confidence'

Dozens of people protested inside the Cop28 venue on Tuesday, holding up signs reading "Phase out fossil fuels now" and "Stop funding fossil fuels".

"If the United Nations continues to allow the fossil fuel industry to lead climate mitigation and to lead Cop... I have zero confidence that Cop will be successful," Thomas Harmy Joseph, a member of the US-based Indigenous Environmental Network, told AFP.

Environmental activists demonstrate outside the Cop28 United Nations climate summit in Dubai on 5 December 2023. 

© AFP / KARIM SAHIB

Scientists, activists and several governments say oil, gas and coal must be phased out and replaced with solar, wind and other renewable technology to prevent the planet from overheating.Nations rally behind renewables with pledges to triple capacity by 2030

An agreement on the role of fossil fuels is seen as key to the success of the UN talks, which end on 12 December.

(with AFP)

Planet tipping points pose 'unprecedented' threat to humanity: report

Paris (AFP) – Humanity faces an "unprecedented" risk from tipping points that could unleash a domino effect of irreversible catastrophes across the planet, researchers warned Wednesday.

Issued on: 06/12/2023 -

Over the edge? The melting Greenland and West Antarctic icesheets are of Earth's two tipping points teetering on the point of no return, the report warned 

© Olivier MORIN / AFP/File

The most comprehensive assessment ever conducted of Earth's invisible tripwires was released as leaders meet for UN climate talks in Dubai with 2023 set to smash all heat records.

While many of the 26 tipping points laid out in the report -- such as melting ice sheets -- are linked to global warming, other human activities like razing swathes of the Amazon rainforest could also push Earth's ecosystems to the brink.

Five of these are showing signs of tipping -- from melting ice sheets threatening catastrophic sea level rise, to mass die-off of tropical coral reefs -- the report warned.

Some may have already begun to irrecoverably transform.

Once the world crosses the threshold for just one tipping point, dealing with the immediate humanitarian disaster could distract attention away from stopping the others, creating a "vicious cycle" of mass hunger, displacement and conflict, the report warned.

Tim Lenton, an Earth system scientist at the University of Exeter and lead author of the report, told AFP that these tipping points pose a "threat of a magnitude that is unprecedented for humanity".

But it was not all bad news.

The report also highlighted a range of positive tipping points -- such as electric vehicles, renewable energy and changing to plant-based diets -- that have the potential to swiftly build momentum and tip things back the other way.

Recent fires in the Amazon rainforest suggest it could be closing to tipping than researchers previously thought 

© MICHAEL DANTAS / AFP/File

"Imagine leaning back on a chair to that balance point where a small nudge can make a big difference," Lenton said.

"You could end up sprawled on your back on the floor -- or if you're lucky, back upright."
On the brink

A key concern is if the melting West Antarctic and Greenland ice sheets collapse.

That could raise sea levels two metres by 2100, exposing nearly half a billion people to frequent coastal flooding, the report said.

The Greenland ice sheet has been shrinking at such a rate that it might already be too late.

"Is it past the tipping point or could it stop shrinking? No one's quite sure," Lenton said.

One of the biggest threats could be the collapse of a vast system of ocean currents which would lead to food and water crises, the researchers warned

© Olivier MORIN / AFP/File

The other three tipping points most at risk are dying tropical coral reefs, melting permafrost and an ocean current called the North Atlantic subpolar gyre circulation.

Another ocean tipping point is the Atlantic Meridional Overturning Circulation (AMOC), a vast system that regulates the global transfer of heat from the tropics into the northern hemisphere.

The new report said it was plausible -- though unlikely -- that the AMOC would collapse this century.

This destabilising change could lead to vast regions getting far less rain, potentially halving the area worldwide where wheat and corn can be grown, it said.

"If that goes, suddenly there will be a global food security crisis and comparable water crisis as major monsoon systems in the tropics basically fail in India and West Africa. That will be a humanitarian catastrophe," Lenton said.
'Dire'

Recent massive fires in the Amazon rainforest and Canada's boreal forests suggest they are also more immediately at risk of tipping than previously thought, he added.

Lenton compared the job of the more than 200 researchers who created the over-400 page Global Tipping Points Report to risk assessors analysing a new aeroplane.

AMOC collapsing was like spotting something that could cause that plane to "fall out of the sky", he said.

The mass-death of tropical coral reefs is one of the tipping points feared to be on the brink © Lillian SUWANRUMPHA / AFP/File

But there's no way to redesign the Earth to make it safer.

Co-author Manjana Milkoreit from the University of Oslo said that "our global governance system is inadequate to deal with the coming threats and implement the solutions urgently required."

The authors called for tipping points to be included in the global stocktake being debated at the COP28 talks, as well as in national targets to combat climate change.

They also urged more effort to push tipping points in the right direction, such as changing policies on energy, transport, food and green ammonia used for fertiliser.

Sarah Das, a scientist at the US Woods Hole Oceanographic Institution, who was not involved in the report, said the science was now "crystal clear".

"The risks for humanity in crossing tipping points into these unexplored states is dire, and the impact to human lives potentially horrific," she said.

© 2023 AFP

2023 set to be hottest year on record, says climate monitor

This year will be the hottest in recorded history after an "extraordinary" November became the sixth record-breaking month in a row, Europe's climate monitor said Wednesday, piling pressure on the COP28 talks to act on climate change.


Issued on: 06/12/2023 -

A dead fish along the dry river banks of the Mississippi river in West Memphis, on October 13, 2023. 

© Ulysse Bellier, AFP

By: NEWS WIRES

This year will be the hottest in recorded history after an "extraordinary" November became the sixth record-breaking month in a row, Europe's climate monitor said Wednesday, piling pressure on the COP28 talks to act on climate change.

Last month smashed the previous November heat record, pushing 2023's global average temperature to 1.46 degrees Celsius warmer than pre-industrial levels, the EU's Copernicus Climate Change Service said.

There had been warnings this year could take the title of hottest year from 2016 -- particularly after records toppled in September and October -- but this marks the first time it has been confirmed.

November also contained two days that were 2C warmer than pre-industrial levels. Not one such day had ever before been recorded.

Samantha Burgess, deputy head of the Copernicus service, said that 2023 has "now had six record-breaking months and two record-breaking seasons".

"The extraordinary global November temperatures, including two days warmer than 2C above pre-industrial (levels), mean that 2023 is the warmest year in recorded history," she said.

Scientists say data from ice cores, tree rings and the like suggests this year could be the warmest in more than 100,000 years.
To phase out or down?

The announcement of the record comes as negotiators from nearly 200 countries at the COP28 talks in Dubai debate the text of a final draft agreement that responds to a damning stocktake of progress on limiting warming.

A crucial aspect of this is the fate of oil, gas and coal -- the main drivers of human-caused planet heating.

Battle lines at the talks in oil-rich UAE have previously been drawn on whether to agree to "phase out" or "phase down" fossil fuels.

But a new phrase committing to an "orderly and just" phase-out of fossil fuels could signal a consensus candidate, giving countries different timelines to cut emissions depending on their level of development and reliance on hydrocarbons.

But there is another option: no mention at all of fossil fuels, which reflects opposition from nations including Saudi Arabia and China, according to several observers who attended the closed meetings.

Another draft paragraph urging a "rapid phase out of unabated coal power this decade" has also faced opposition from China, South Africa and Vietnam, the observers said.

A new version of the draft text is expected on Wednesday morning that will then be sifted through at the talks, which are due to end on December 12.
'Temperature will keep rising'

Meanwhile, 2023 has seen a series of devastating extreme weather events linked to climate change, even as the world's carbon emissions continue to rise.

According to Copernicus, whose records go back to 1940, the first 11 months of this year have been 0.13C hotter than in 2016, the previous warmest year.

Global temperatures in the second half of this year are believed to have been partly propelled by the El Nino weather pattern, which has caused fewer "anomalies" so far in 2023 than in 2015-2016, the Copernicus service said.

September to November, the three months marking autumn in the northern hemisphere, were the hottest ever "by a large margin," according to Copernicus.

November alone was 1.75C warmer than pre-industrial levels -- and marked a significant 0.85C increase over 1991-2020, Copernicus said.

Such numbers could suggest that world is coming uncomfortably close to warming 1.5 degrees Celsius since pre-industrial times, which is a key threshold in the Paris climate agreement

However to actually breach the Paris limit, global temperatures would need to stay above 1.5C over decades.

"As long as greenhouse gas concentrations keep rising we can't expect different outcomes," Copernicus head Carlo Buontempo said.

"The temperature will keep rising and so will the impacts of heatwaves and droughts," he added.

Also on Wednesday, researchers warned of 26 Earth "tipping points" such as melting ice sheets, that have the potential to unleash a domino effect of irreversible catastrophes across the planet.

(AFP)

Primary care lessons for Canada from OECD countries

Peer-Reviewed Publication

CANADIAN MEDICAL ASSOCIATION JOURNAL

To improve primary care, Canada can learn from Organisation for Economic Co-operation and Development (OECD) countries with high rates of patients attached to primary care clinicians, write authors in an analysis in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.221824.

It is well known in Canada that there is a crisis in primary care, with about 17% of people reporting that they were without a regular primary care clinician before the COVID-19 pandemic. The pandemic made the situation worse, with some family physicians retiring early, a situation common in other countries also.

The authors looked at 9 countries where more than 95% of people have a family doctor, primary care clinician or place of care, including France, Germany, New Zealand, United Kingdom, Denmark, Netherlands, Finland, Italy and Norway, and consider lessons for Canada.

Canada's health spending was in the middle of the pack, although the percentage of health spending that was public was the lowest at 70%, a figure unchanged since the 1990s. Canada had similar numbers of family physicians per capita but the lowest number of total physicians per capita and spent less of the total health budget on primary care.

"Other countries have designed their system so that everyone has access to primary care. We need to do the same," says Dr. Tara Kiran, a family physician at St. Michael's Hospital, Unity Health Toronto and the Fidani Chair of Improvement and Innovation at the University of Toronto. "At the core, we need to guarantee access to primary care and increase how much we spend on it."

Historical factors, such as physicians negotiating to remain autonomous at introduction of Medicare, have also affected Canada's health system.

Key lessons for Canada:

• Accountability — In countries with high rates of primary care attachment, family doctors have stronger contractual agreements and accountability to government, insurers or both, whereas in Canada, they are private contractors with little system accountability. These countries also have more family doctors, or general practitioners, working in office-based, generalist practices compared with Canada, where many family doctors work in other parts of the system (e.g., providing emergency or hospital care) or in focused practice (e.g., sports medicine).
• Funding — A higher proportion of the total health budget should be spent on primary care. Medicare coverage in Canada could be extended to prescription medications, dental care and expanded mental health care to reduce the burden on physicians to provide care in these areas. Canada also needs more physicians per capita.
• System organization — Canada should move to a model where residents are guaranteed access to a primary care practice near their home and ensure that these practices are funded appropriately.
• Information systems — Practice efficiency can be improved and patient communications can be streamlined with online booking, secure messaging and a single patient health record accessible across Canada by patients and clinicians.
• Practice organization and physician payment — Governments and medical associations should shift primary care physicians to capitation or salary payments and away from fee for service, which is how most family physicians currently are paid in Canada. More organized after-hours care, fewer walk-in clinics and expanded roles for other health professionals can enable our primary care resources to be used more efficiently.

"These international examples can inform bold policy reform in Canada to advance a vision of primary care for all," the authors conclude.

---

JOURNAL

Canadian Medical Association Journal

DOI

10.1503/cmaj.221824 

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Primary care for all: lessons for Canada from peer countries with high primary care attachment"

ARTICLE PUBLICATION DATE

4-Dec-2023

New rule for emergency departments to safely reduce use of CTs after falls in older patients

Peer-Reviewed Publication

CANADIAN MEDICAL ASSOCIATION JOURNAL

How do emergency department staff determine whether older adults who have fallen need imaging? A new decision rule will help emergency department physicians determine which older adults need imaging for head injuries, describes new research in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.230634.

With aging populations, emergency departments are managing an increasing number of older adults who fall; falling on level ground, like in one's house, is a common cause of a brain bleed. Computed tomography (CT) of the head is commonly used to assess patients who have fallen, but sending every patient who has fallen for a head scan is inefficient and costly.

"Overuse of CT in this population prolongs the emergency department visit, which has been shown to increase the rate of delirium while also diverting resources from other emergency patients," writes Dr. Kerstin de Wit, Queen's University, Kingston, Ontario, with coauthors from the Network of Canadian Emergency Researchers. "Furthermore, not all emergency departments have 24-hour on-site CT scanning facilities, meaning that some of these patients may be transferred to another centre."

A team of emergency department physicians from across Canada and in the United States developed the Falls Decision Rule, which can be used to identify patients for whom it is safe to forgo a head CT to rule out intracranial bleeding after a fall. The researchers included 4308 patients aged 65 years or older from 11 emergency departments in Canada and the US who visited the emergency department within 48 hours of falling. The median age was 83 years, 64% were female, 26% took anticoagulant medication and 36% took antiplatelet medication, both of which increase the risk of bleeding.

The rule, which if used would avoid head CT in 20% of the study population, can be applied to all older adults who have fallen, whether or not they sustained a head injury or can recall the fall.

This new rule complements the widely used Canadian CT Head rule, which applies to patients with disorientation, amnesia or loss of consciousness.

---

JOURNAL

Canadian Medical Association Journal

DOI

10.1503/cmaj.230634 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Derivation of the Falls Decision Rule to exclude intracranial bleeding without head CT in older adults who have fallen

ARTICLE PUBLICATION DATE

4-Dec-2023

 LGBTQ+ HEALTH

Lesbian, gay, and bisexual survivors of adolescent and young adult cancers often have chronic health conditions

Study results indicate the need for tailored efforts to improve their long-term health

Peer-Reviewed Publication

WILEY

Lesbian, gay, and bisexual (LGB) adolescents and young adult cancer survivors in the United States are more likely to report experiencing chronic health conditions than their heterosexual peers with a history of cancer as well as their LGB peers without a past cancer diagnosis. The findings come from a survey-based study published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

Previous studies have indicated that minority sexual orientation and gender identity populations have higher prevalence rates of many chronic conditions—including heart disease, stroke, hypertension, diabetes, lung disease, and kidney disease—than heterosexual populations. To assess the burden of chronic health conditions among survivors of adolescent and young adult cancer with minoritized sexual orientations, a team led by Michael E. Roth, MD, of The University of Texas MD Anderson Cancer Center, analyzed 2013–2020 data from the National Health Interview Survey, an ongoing household survey with interviews conducted throughout the United States either face‐to‐face or over the telephone.

The team’s analysis included information on 170 LGB cancer survivors (diagnosed between the ages of 15 and 39 years) who were matched to 1,700 LGB individuals without a history of cancer and 1,700 heterosexual cancer survivors.

LGB cancer survivors were more likely than LGB individuals without a history of cancer and heterosexual cancer survivors to report at least one chronic health condition (71.0%, 51.0%, and 59.0% of individuals, respectively) and more than two chronic health conditions (21.0%, 7.7%, and 15.1%, respectively). These elevated risks were seen for conditions including cardiovascular disease, arthritis, and pulmonary disease.

After adjusting for sociodemographic variables, LGB cancer survivors had 2.45-times higher odds of having chronic health conditions than LGB individuals without a history of cancer and 2.16-times higher odds than heterosexual survivors.

“This study highlights significant health disparities that affect the LGB cancer survivor community and points to the need for specialized care and attention for these individuals during and after their cancer treatment to address their heightened risk of chronic health issues,” said Dr. Roth. “This could hopefully lead to more equitable health care for sexual and gender minority populations.” 

 

Additional information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the CANCER Newsroom upon online publication. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com 

Full Citation:
“Risk of Chronic Health Conditions in Lesbian, Gay, and Bisexual Survivors of Adolescent and Young Adult Cancers.” Amy M. Berkman, Eunju Choi, Christabel K. Cheung, Susan K. Peterson, J. Andrew Livingston, Susan K. Parsons, John M. Salsman, Clark R. Andersen, Qian Lu, Michelle A. T. Hildebrandt, and Michael E. Roth. CANCER; Published Online: December 4, 2023 (DOI: 10.1002/cncr.35015). 

URL Upon Publication: http://doi.wiley.com/10.1002/cncr.35015  

Author Contact: Katrina Burton, Program Director in the Public Relations office at The University of Texas MD Anderson Cancer Center, at KBurton@mdanderson.org

About the Journal     
CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online. Follow CANCER on Twitter @JournalCancer and Instagram @ACSJournalCancer, and stay up to date with the American Cancer Society Journals on LinkedIn.

About Wiley      
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JOURNAL

Cancer

DOI

10.1002/cncr.35015 

ARTICLE TITLE

Risk of Chronic Health Conditions in Lesbian, Gay, and Bisexual Survivors of Adolescent and Young Adult Cancers

ARTICLE PUBLICATION DATE

4-Dec-2023