Background: With deteriorating ecosystems, the health of mankind is at risk. Future health care professionals must be trained to recognize the interdependence of health and ecosystems to address the needs of their patients and communities. Health issues related to, e.g. climate change and air pollution, are not, however, generally included in medical education. Objectives: To assess the inclusion of climate change and air pollution in medical curricula and to guide the International Federation of Medical Students' Associations' (IFMSA) Vision of Climate Change in the Medical Curriculum. Methods: A study comprising three surveys (March 2019, August 2019, March 2020) explored medical students' perceptions of the current status of formal and non-formal elements of climate change and air pollution and health in their medical programs. Results: Respondents originated from 2817 medical schools in 112 countries. Only 15% of medical schools have incorporated climate change and health into the curriculum. Students led climaterelated activities in an additional 12% of medical schools. With regard to air pollution and health, only 11% of medical schools have formal education on the topic. Conclusions: It is crucial to acknowledge the current omissions from medical curricula and the importance of meaningful student involvement in curriculum transformation.

Issues. Numerous studies have examined the impact of the COVID-19 pandemic on alcohol use changes in Europe, with concerns raised regarding increased use and related harms. Approach. We synthesised observational studies published between 1 January 2020 and 31 September 2021 on self-reported changes in alcohol use associated with COVID-19. Electronic databases were searched for studies evaluating individual data from European general and clinical populations. We identified 646 reports, of which 56 general population studies were suitable for random-effects meta-analyses of proportional differences in alcohol use changes. Variations by time, sub-region and study quality were assessed in subsequent meta-regressions. Additional 16 reports identified were summarised narratively. Key Findings. Compiling reports measuring changes in overall alcohol use, slightly more individuals indicated a decrease than an increase in their alcohol use during the pandemic [3.8%, 95% confidence interval (CI) 0.00-7.6%]. Decreases were also reported more often than increases in drinking frequency (8.0%, 95% CI 2.7-13.2%), quantity consumed (12.2%, 95% CI 8.3-16.2%) and heavy episodic drinking (17.7%, 95% CI 13.6-21.8%). Among people with pre-existing high drinking levels/alcohol use disorder, high-level drinking patterns appear to have solidified or intensified. Implications. Pandemic-related changes in alcohol use may be associated with pre-pandemic drinking levels. Increases among high-risk alcohol users are concerning, suggesting a need for ongoing monitoring and support from relevant health-care services. Conclusion. Our findings suggest that more people reduced their alcohol use in Europe than increased it since the onset of the pandemic. However high-quality studies examining specific change mechanisms at the population level are lacking.

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