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Zhang D, Kou W, Luo S, Chen J, An X, Fang S, Liang X. The effect of ambient temperature on lipid metabolism in children: From a prospective cohort study. ENVIRONMENTAL RESEARCH 2024; 261:119692. [PMID: 39068968 DOI: 10.1016/j.envres.2024.119692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Dyslipidemia is increasingly recognized as an essential risk factor for cardiovascular diseases. However, few studies illustrated the effects of ambient temperature exposure (TE) on lipid levels in children. The study aimed to examine the association between ambient TE and lipid levels in children. METHODS Based on a prospective cohort, a total of 2423 children (with 4466 lipids measure person-time) were collected from 2014 to 2019. The meteorological observation data and adjusted variables were collected. Mixed-effect models and generalized additive mixed model (GAMM) were applied to investigate the association between ambient TE and lipid levels. RESULTS A significant negative association was observed between TE and low-density lipoprotein cholesterol (LDL-C) or total cholesterol (TC) levels both in all children [LDL-C, β(95%CI) = -0.350(-0.434,-0.265), P < 0.001; TC, β(95%CI) = -0.274(-0.389,-0.160), P < 0.001] and by different sex group. However, no significant association was found in low-density lipoprotein cholesterol (HDL-C) or triglycerides (TG) levels. The estimated optimal ambient TEs for LDL-C were 18.273 °C and 18.024 °C for girls and boys, respectively. For TC, the optimal ambient TEs were 17.949 °C and 18.024 °C, respectively. With ambient TE decreased, the risk of dyslipidemia increased for both boys [OR = 0.032(0.006,0.179), P < 0.001] and girls [OR = 0.582(0.576,0.587), P < 0.001]. CONCLUSION This study provided a comprehensive illustration about the associations between ambient TE and lipid levels in different sex and ages from a prospective cohort study. The findings will provide evidence for the government to prevent dyslipidemia in vulnerable children through regulating TE.
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Affiliation(s)
- Di Zhang
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China; School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Wei Kou
- Department of Pediatric Otolaryngology Head and Neck Surgery, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Shunqing Luo
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
| | - Jingyu Chen
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
| | - Xizhou An
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
| | - Shenying Fang
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China.
| | - Xiaohua Liang
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China.
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2
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Mo H, Wang S. Assessing the spatiotemporal evolution and socioeconomic determinants of PM 2.5-related premature deaths in China from 2000 to 2021. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 946:174323. [PMID: 38955281 DOI: 10.1016/j.scitotenv.2024.174323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/12/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024]
Abstract
China's swift socioeconomic development has led to extremely severe ambient PM2.5 levels, the associated negative health outcomes of which include premature death. However, a comprehensive explanation of the socioeconomic mechanism contributing to PM2.5-related premature deaths has not yet to be fully elucidated through long-term spatial panel data. Here, we employed a global exposure mortality model (GEMM) and the system generalized method of moments (Sys-GMM) to examine the primary determinants contributing to premature deaths in Chinese provinces from 2000 to 2021. We found that in the research period, premature deaths in China increased by 46 %, reaching 1.87 million, a figure that decreased somewhat after the COVID-19 outbreak. 62 thousand premature deaths were avoided in 2020 and 2021 compared to 2019, primarily due to the decline in PM2.5 concentrations. Premature deaths have increased across all provinces, particularly in North China, and a discernible spatial agglomeration effect was observed, highlighting effects on nearby provinces. The findings also underscored the significance of determinants such as urbanization, import and export trade, and energy consumption in exacerbating premature deaths, while energy intensity exerted a mitigating influence. Importantly, a U-shaped relationship between premature deaths and economic development was unveiled for the first time, implying the need for vigilance regarding potential health impact deterioration and the implementation of countermeasures as the per capita GDP increases in China. Our findings deserve attention from policymakers as they shed fresh insights into atmospheric control and Health China action.
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Affiliation(s)
- Huibin Mo
- Shenzhen Key Laboratory of Ecological Remediation and Carbon Sequestration, Institute of Environment and Ecology, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
| | - Shaojian Wang
- School of Geography and Planning, Sun Yat-sen University, Guangzhou 510006, China.
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3
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Palmeiro-Silva Y, Aravena-Contreras R, Izcue Gana J, González Tapia R, Kelman I. Climate-related health impact indicators for public health surveillance in a changing climate: a systematic review and local suitability analysis. LANCET REGIONAL HEALTH. AMERICAS 2024; 38:100854. [PMID: 39171197 PMCID: PMC11334688 DOI: 10.1016/j.lana.2024.100854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 08/23/2024]
Abstract
Climate change challenges public health. Effective management of climate-related health risks relies on robust public health surveillance (PHS) and population health indicators. Despite existing global and country-specific indicators, their integration into local PHS systems is limited, impacting decision-making. We conducted a systematic review examining population health indicators relevant to climate change impacts and their suitability for national PHS systems. Guided by a registered protocol, we searched multiple databases and included 41 articles. Of these, 35 reported morbidity indicators, and 39 reported mortality indicators. Using Chile as a case study, we identified three sets of indicators for the Chilean PHS. The high-priority set included vector-, food-, and water-borne diseases, as well as temperature-related health outcomes indicators due to their easy integration into existing PHS systems. This review highlights the importance of population health indicators in monitoring climate-related health impacts, emphasising the need for local contextual factors to guide indicator selection. Funding This research project was partly funded by ANID Chile and University College London. None of these sources had any involvement in the research conceptualisation, design, or interpretation of the results.
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Affiliation(s)
| | | | - José Izcue Gana
- Institute for Global Prosperity, University College London, London, United Kingdom
| | | | - Ilan Kelman
- Institute for Global Health, University College London, London, United Kingdom
- Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
- University of Agder, Norway
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4
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Habash M, Moore D. The surgical outpatient clinic and the environment. Surgeon 2024; 22:267-269. [PMID: 38964981 DOI: 10.1016/j.surge.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/02/2024] [Accepted: 06/10/2024] [Indexed: 07/06/2024]
Abstract
Rising global temperatures will have a radical impact on the environment where global warming is associated with weather extremes such as thunderstorms and droughts which can affect the regional ecosystems. The healthcare sector is a major emitter of greenhouse gasses. Within healthcare, the outpatient clinic is responsible for a considerable sum of emissions. These can be organized under scopes 1, 2 and 3 as described in the Greenhouse Gas Protocol where scope 1 accounts for direct emissions from healthcare facilities, scope 2 is emissions from purchased electricity and scope 3 is indirect emissions including procurement and waste. Emissions and mitigation strategies from the surgical outpatient clinic are outlined under each scope of the Greenhouse Gas Protocol. These include using insulation materials, renovating or building new facilities, incorporating renewable energy sources and utilizing more efficient appliances. Telehealth and virtual clinics have been shown to be an effective method of delivering care while avoiding the combustion of fossil fuels to facilitate patient transport. In addition, virtual set-ups are cost effective and have not been proven to compromise patient safety when implemented correctly.
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Affiliation(s)
- Mohammed Habash
- Children's Health Ireland at Crumlin, Cooley Road, Crumlin, Dublin, Ireland.
| | - David Moore
- Children's Health Ireland at Crumlin, Cooley Road, Crumlin, Dublin, Ireland
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5
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Verón GL, Manjon AA, Arévalo L, Santiago J, Vazquez-Levin MH. Impact of heat waves on semen quality: A retrospective study in Argentina between 2005 and 2023. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 943:173813. [PMID: 38848914 DOI: 10.1016/j.scitotenv.2024.173813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/04/2024] [Accepted: 06/04/2024] [Indexed: 06/09/2024]
Abstract
Heat waves, defined as periods with daily temperatures surpassing the historical average for a specific region, have become more frequent worldwide in recent years. Previous studies have reported a negative association between temperature and semen quality, but the focus has mainly been on Asian and European populations. The study included 54,926 men (18-60 years) undergoing routine semen analysis between 2005 and 2023 at CEUSA-LAEH andrology unit, in Buenos Aires, Argentina. Hourly temperature readings were provided by the Servicio Meteorológico Nacional. R programming (R Studio v2022.07.2) was used to define heat waves, calculate key characteristics, visualize results, and perform statistical tests at the IBYME laboratory. During the period studied, a total of 124 days had heat waves (defined after at least 3 consecutive days with 32.3 °C and 22 °C). Men exposed to heat waves during spermatogenesis exhibited lower sperm number (concentration and count; P < 0.0001) and decreased normal morphology (percentage of normal sperm and normal motile count; P < 0.05) compared to those not exposed. These differences were most pronounced between semen samples from years with several heat waves (2013, 2023) and none (2005, 2007, 2016), displaying 4-5 times higher fold changes (P < 0.05). Further analysis employing multiple regression revealed a significantly negative association between semen quality and heat wave length, suggesting that a prolonged exposure may be more detrimental than an acute exposure. Subsequent analysis focusing on prolonged exposure (≥6-days heat wave) during spermatogenesis revealed a negative (P < 0.05) association between early exposure (spermatocytogenesis: 64-90 days prior semen collection) and semen quality. This study underscores the negative association between early exposure to heat waves during sperm development and semen quality, raising concerns about its possible association with the worldwide declining male fertility. A comprehensive collaborative approach is crucial, involving global governmental policies, sustainable practices, and coordinated efforts across scientific, healthcare, and policy domains.
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Affiliation(s)
- Gustavo Luis Verón
- Instituto de Biología y Medicina Experimental (IBYME), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Ania Antonella Manjon
- Instituto de Biología y Medicina Experimental (IBYME), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | | | | | - Mónica Hebe Vazquez-Levin
- Instituto de Biología y Medicina Experimental (IBYME), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
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Chen T, Wang T, Xue L, Brasseur G. Heatwave exacerbates air pollution in China through intertwined climate-energy-environment interactions. Sci Bull (Beijing) 2024; 69:2765-2775. [PMID: 38945745 DOI: 10.1016/j.scib.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 04/12/2024] [Accepted: 04/13/2024] [Indexed: 07/02/2024]
Abstract
Climate change is increasing the frequency and intensity of heatwaves, raising concerns about their detrimental effects on air quality. However, a role for heatwave-human-environment interactions in air pollution exacerbation has not been established. In the summer of 2022, record-breaking heatwaves struck China and Europe. In this study, we use integrated observational data and machine learning to elucidate the formation mechanism underlying one of the most severe ozone pollution seasons on record in central eastern China, an area that encompasses approximately half of China's total population and sown land. Our findings reveal that the worsened ozone and nitrogen dioxide pollution resulted from a mismatch between energy demand and supply, which was driven by both heatwaves and energy policy-related factors. The observed adverse heatwave-energy-environment feedback loop highlights the need for the diversification of clean energy sources, more resilient energy structures and power policies, and further emission control to confront the escalating climate challenge in the future.
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Affiliation(s)
- Tianshu Chen
- Department of Civil and Environmental Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Tao Wang
- Department of Civil and Environmental Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China.
| | - Likun Xue
- Environment Research Institute, Shandong University, Qingdao 266237, China; Big Data Research Center for Ecology and Environment, Shandong University, Qingdao 266237, China.
| | - Guy Brasseur
- Environmental Modelling Group, Max Planck Institute for Meteorology, Hamburg 20146, Germany; National Center for Atmospheric Research, Boulder, CO 80307, USA; Department of Civil and Environmental Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China
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7
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Rangel T, Johnson SE, Joubert P, Timmerman R, Smith S, Springer G, Schenk E. Comparisons of healthcare personnel relating to awareness, concern, motivation, and behaviours of climate and health: A cross-sectional study. J Adv Nurs 2024. [PMID: 39242360 DOI: 10.1111/jan.16387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 07/09/2024] [Accepted: 07/31/2024] [Indexed: 09/09/2024]
Abstract
AIM(S) To describe a sample of healthcare professionals' responses to the valid and reliable Climate and Health Tool and compare participant characteristics relating to Climate and Health Tool subscales. DESIGN Observational, cross-sectional, multi-site study. METHODS An electronic survey containing the Climate and Health Tool was administered to healthcare professionals across a large, multi-state health system in the Western United States with a committed effort to reducing carbon emissions. RESULTS One thousand three hundred and sixty-three participants reported moderately elevated levels of awareness and concern around climate impacts on health and motivation to participate in climate protective actions. Respondents reported moderate levels of climate-protecting behaviours at home and low levels at work. Females were more concerned and motivated. Medical staff and respondents reporting familiarity with system environmental initiatives reported more awareness and behaviours at home to preserve climate health. CONCLUSION Healthcare professionals are concerned and motivated to decrease climate impacts on health yet take little action at work to preserve the climate. Because of the intersection of climate change, health, and healthcare, healthcare organizations should prioritize and support meaningful action for healthcare professionals to meet community climate health needs. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Healthcare organizations committed to contributing to climate solutions can use this research to increase healthcare professionals' education, engagement, and impact to preserve the climate and health of communities. IMPACT Healthcare is a major contributor to carbon emissions, yet healthcare professionals' awareness, motivation, concern, and behaviours related to climate change and health were not clear. Our research showed healthcare professionals are aware and concerned about climate impacts on health but reported low levels of workplace behaviours to protect the climate. The findings of our research will impact healthcare professionals and healthcare organizations to focus efforts on climate-preserving behaviours. REPORTING METHOD This manuscript followed the STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION None.
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Affiliation(s)
- Teresa Rangel
- Providence Central Division, Spokane, Washington, USA
| | | | - Patricia Joubert
- Providence Saint John's Health Center, Santa Monica, California, USA
| | | | | | - Gale Springer
- Providence Regional Medical Center Everett, Everett, Washington, USA
| | - Elizabeth Schenk
- Providence, Renton, Washington, USA
- Washington State University, Spokane, Washington, USA
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8
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Ryan PH, Newman N, Yolton K, Meinzen-Derr J, Glauser T, Cheng TL. A call for solutions-oriented research and policy to protect children from the effects of climate change. Pediatr Res 2024:10.1038/s41390-024-03559-9. [PMID: 39242938 DOI: 10.1038/s41390-024-03559-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 08/22/2024] [Indexed: 09/09/2024]
Affiliation(s)
- Patrick H Ryan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nicholas Newman
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kimberly Yolton
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jareen Meinzen-Derr
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tracy Glauser
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tina L Cheng
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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9
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Brook A, Rendall G, Hearty W, Meier P, Thomson H, Macnamara A, Westborne R, Campbell M, McCartney G. What is the relationship between changes in the size of economies and mortality derived population health measures in high income countries: A causal systematic review. Soc Sci Med 2024; 357:117190. [PMID: 39178721 DOI: 10.1016/j.socscimed.2024.117190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/31/2024] [Accepted: 08/04/2024] [Indexed: 08/26/2024]
Abstract
CONTEXT The economy has been long recognised as an important determinant of population health and a healthy population is considered important for economic prosperity. AIM To systematically review the evidence for a causal bidirectional relationship between aggregate economic activity (AEA) at national level for High Income Countries, and 1) population health (using mortality and life expectancy rates as indicators) and 2) inequalities in population health. METHODS We undertook a systematic review of quantitative studies considering the relationship between AEA (GDP, GNI, GNP or recession) and population health (mortality or life expectancy) and inequalities for High Income Countries. We searched eight databases and grey literature. Study quality was assessed using an adapted version of the Effective Public Health Practice Project's Quality Assessment tool. We used Gordis' adaptation of the Bradford-Hill framework to assess causality. The studies were synthesised using Cochrane recommended alternative methods to meta-analysis and reported following the Synthesis without Meta-analysis (SWiM) guidelines. We assessed the certainty of the evidence base in line with GRADE principles. FINDINGS Of 21,099 records screened, 51 articles were included in our analysis. There was no evidence for a consistent causal relationship (either beneficial or harmful) of changes in AEA leading to changes in population health (as indicated by mortality or life expectancy). There was evidence suggesting that better population health is causally related to greater AEA, but with low certainty. There was insufficient evidence to consider the causal impact of AEA on health inequalities or vice versa. CONCLUSIONS Changes in AEA in High Income Countries did not have a consistently beneficial or harmful causal relationship with health, suggesting that impacts observed may be contextually contingent. We tentatively suggest that improving population health might be important for economic prosperity. Whether or not AEA and health inequalities are causally linked is yet to be established.
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Affiliation(s)
- Anna Brook
- Sheffield Centre for Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Georgia Rendall
- Public Health Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, Scotland, UK.
| | - Wendy Hearty
- Public Health Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, Scotland, UK.
| | - Petra Meier
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, Scotland, UK.
| | - Hilary Thomson
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, Scotland, UK.
| | - Alexandra Macnamara
- Leeds University Teaching Hospitals NHS Trust, St. James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK.
| | - Rachel Westborne
- Sheffield Centre for Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Mhairi Campbell
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, Scotland, UK.
| | - Gerry McCartney
- School of Social and Political Sciences, University of Glasgow, 40 Bute Gardens, Glasgow, G12 8RT, Scotland, UK.
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10
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Schilcher AV, Roth M, Steindor FA, Helweh R, Geerling G. "Dirty Dry Eye"- A waste volume analysis from topical therapy in keratoconjunctivitis sicca. Graefes Arch Clin Exp Ophthalmol 2024; 262:2917-2924. [PMID: 38520515 PMCID: PMC11377519 DOI: 10.1007/s00417-024-06431-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024] Open
Abstract
PURPOSE The healthcare system is responsible for around 5% of CO2 emissions globally and in Germany. So far, there are no data on the amount of waste from dry eye disease (DED) therapy in ophthalmology. The aim of this project was to evaluate the amount and type of waste from single- and multi-dose units (SDU/MDU) generated by eyedrops used to treat DED in Germany. METHODS The net waste weight (outer/inner packaging, instruction leaflet, empty container) from factory-sealed products was determined using a precision scale. Based on prescription data from PharMaAnalyst, a database of medical prescriptions from over 70 million patients in Germany, the total annual waste volume for 2016-2021 and the net weight of a 30-day treatment were calculated. RESULTS The total annual waste volume increased significantly (p < 0.0001) from 7.13 tons in 2016 to 20.64 tons in 2021. A 30-day treatment with MDUs (without/with filter) results in a significantly lower mean waste volume (paper: SDU 24.3 ± 18.7 g; MDU 4.8 ± 1.7 g/8.8 g ± 1.7 g; SDU/MDU p = 0.0003, with filter p = 0.0034; plastic: SDU 35.0 ± 4.0, MDU 6.6 ± 0.7 g/ 15.1 g ± 5.8 g, SDU/MDU p < 0.0001, with filter p < 0.0001). CONCLUSION Prescription-based treatment of DED in Germany causes an increasing and substantial waste volume. The use of SDUs is considerably more resource-intensive than MDUs. Due to the large and rising number of patients suffering from DED improvements in packaging could considerably reduce the CO2 footprint of DED treatment.
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Affiliation(s)
| | - Mathias Roth
- Department of Ophthalmology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Friedrich A Steindor
- Department of Ophthalmology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Ranya Helweh
- Department of Ophthalmology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Gerd Geerling
- Department of Ophthalmology, University Hospital Duesseldorf, Duesseldorf, Germany
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11
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O'Reilly D, Livada A, Steiner L, Drew RJ, Mc Callion N. Beyond the incubator: applying a "one health" approach in the NICU. Pediatr Res 2024:10.1038/s41390-024-03534-4. [PMID: 39215199 DOI: 10.1038/s41390-024-03534-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 08/07/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
A "one health" approach recognises that human health, animal health and planetary health are closely interlinked and that a transdisciplinary approach is required to fully understand and maintain global health. While, by necessity, Neonatal Intensive Care has traditionally focused on the acutely unwell newborn, the avoidance of long-term harm is core to many management decisions. The COVID 19 pandemic and climate crisis have brought into sharp relief the importance of a "one health" approach as part of long-term health promotion in the holistic care of neonates, who may survive to experience the burden of future environmental crises. This narrative review seeks to integrate what we know about "one health" issues in the neonatal intensive care unit, notably antimicrobial resistance and climate change, and suggest "everyday changes" which can be utilised by practitioners to minimise the impact of neonatal intensive care on these global health issues. Many of the changes suggested not only represent important improvements for planetary health but are also core to good neonatal practice. IMPACT: Neonatal patients are likely to bear the burden of future environmental crises including pandemics and climate related disasters. While the focus of intensive care practitioners is acute illness, awareness of "one health" problems are important for our smallest patients as part of preventing long-term harm. High quality neonatal care can benefit both the planet and our patients.
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Affiliation(s)
- Daniel O'Reilly
- Department of Neonatology, Rotunda Hospital, Dublin 1, Ireland.
- School of Biomolecular and Biomedical Science, University College Dublin, Dublin 4, Ireland.
| | - Alison Livada
- Medical Scientist Training Program, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Laurie Steiner
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Richard J Drew
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Dublin, Ireland
- Clinical Innovation Unit, Rotunda Hospital, Dublin 1, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Naomi Mc Callion
- Department of Neonatology, Rotunda Hospital, Dublin 1, Ireland
- Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
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12
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Twabi HH, Jafali J, Mndala L, Riches J, Monk EJM, Phiri D, Makuluni R, Gadama L, Kachale F, Bilesi R, Mbewe M, Likaka A, Chapuma C, Kumwenda M, Maseko B, Ndamala C, Kuyere A, Munthali L, Henrion MYR, Msefula C, Lissauer D, Odland ML. Cyclone Freddy and its impact on maternal health service utilisation: Cross-sectional analysis of data from a national maternal surveillance platform in Malawi. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003565. [PMID: 39197033 PMCID: PMC11356452 DOI: 10.1371/journal.pgph.0003565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 08/02/2024] [Indexed: 08/30/2024]
Abstract
Climate change poses a significant threat to women's health in sub-Saharan Africa, yet the impact of climate change on maternal health is rarely reported in the region. Using an existing Maternal Surveillance Platform (MATSurvey), we estimated the immediate impact of Cyclone Freddy on maternal health care service indicators in Malawi. We analysed facility-level data for pregnant women up to 42 weeks post-partum using the national MATSurvey database. We compared incidences of service utilisation before (1 January to 19 February 2023) and after (20 February to 30 March 2023) the cyclone using a negative binomial regression approach. Between 1 January and 30 March 2023, a total of 37,445 live births, 50,048 antenatal clinic attendances, 23,250 postnatal clinic attendances, 84 maternal deaths, and 1,166 neonatal deaths were recorded by 33 facilities in the MatSurvey database. There was an immediate reduction in service utilisation in the post-cyclone period, including the postnatal attendance per week (pre-cyclone median: 355.0 [IQR 279.0-552.0], post-cyclone median: 261.0 [IQR 154.3-305.5], RR 0.56 [95% CI 0.44-0.71, p <0.001]) and the antenatal attendance per week (pre-cyclone median: 860.0 [IQR 756.5-1060.0], post-cyclone median: 656.5 [IQR 486.5-803.3], RR 0.66 [95% CI 0.55-0.78, p <0.001]). Stratified analyses by geographical zones revealed a stronger reduction in postnatal clinic attendance in the Southwest (RR 0.50 [95% CI 0.29-0.85, p = 0.010]) and the North (RR 0.29 [95% CI 0.15-0.56, p <0.001]). Cyclone Freddy resulted in an immediate decline in utilisation of maternal health services in cyclone-affected regions in Malawi. We observe evidence of catastrophic climate events impacting on the healthcare of women and their babies. Policymakers, researchers, and health systems need to ensure that essential women's health services are maintained during these events and improve measures to support service resilience in the face of climate change.
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Affiliation(s)
- Hussein H. Twabi
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi
| | - James Jafali
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi
| | - Leonard Mndala
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi
| | - Jennifer Riches
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi
| | | | - Deborah Phiri
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi
| | | | - Luis Gadama
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | | | - Andrew Likaka
- Ministry of Health, Lilongwe, Malawi
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Chikondi Chapuma
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi
| | - Moses Kumwenda
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi
| | - Bertha Maseko
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi
| | | | - Annie Kuyere
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi
| | - Laura Munthali
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi
| | - Marc Y. R. Henrion
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi
- Universidade Federal de Pernambuco, Recife, Brazil
| | | | - David Lissauer
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi
| | - Maria Lisa Odland
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynaecology, St. Olavs University Hospital, Trondheim Norway
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Ur Rehman M, Moussa R, Siaw Lin C, Ahmed N, Rehman A, Malik K, Ahmed J. Cost-Effectiveness of Routine Histopathological Analysis of Doughnuts after Colorectal Surgery Three-Year Single-Centre Experience. Int J Surg Oncol 2024; 2024:9837336. [PMID: 39188852 PMCID: PMC11347031 DOI: 10.1155/2024/9837336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 07/02/2024] [Accepted: 07/22/2024] [Indexed: 08/28/2024] Open
Abstract
Aim This study aimed to assess the impact of routine histological examination of stapled colorectal anastomotic doughnuts in patients undergoing rectal cancer surgery (RCS). Justification of biopsy examination could form part of the strategies of NHS net zero practice with effort to reduce wastage and carbon footprint. Method A data analysis of all patients undergoing RCS during 2019-2021 at our institute was performed. We also analysed the cost of preparing and reviewing histology slides. Results 52 patients underwent anterior resection during the aforementioned period. Doughnuts were sent in 37 (71%) patients. 23 (62%) patients were male, and 14 (38%) were female. The median age at diagnosis was 68 (range 54-84) years. All resected specimens were adenocarcinomas. Of the 37 patients, 18 (49%) underwent low anterior resection and 19 (51%) underwent high anterior resection. Proximal doughnuts were sent in 26 (70%) patients, whereas distal doughnuts were sent in all cases. Mean distal microscopic resection margin from tumour was 22 mm (range 6-45 mm). Each doughnut required 3 slides, each costing £50 and requiring 82 minutes to fix and read. This incurred a cost of £13,650 and required 19,656 hours of preparation time. All of the doughnuts as well as resection margins were negative for malignancy. Conclusion Routine histopathological examination of doughnuts is time and cost-intensive however provides little or no clinical value (particularly analysis of the proximal doughnut). Distal doughnuts should only be sent for histological examination in exceptional circumstances.
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Affiliation(s)
- Masood Ur Rehman
- Department of Colorectal SurgeryNorthampton General Hospital, Northamptonshire, UK
| | - Reem Moussa
- Department of Colorectal SurgeryNorthampton General Hospital, Northamptonshire, UK
| | - Cindy Siaw Lin
- Department of Colorectal SurgeryNorthampton General Hospital, Northamptonshire, UK
| | - Naeem Ahmed
- Department of Colorectal SurgeryNorthampton General Hospital, Northamptonshire, UK
| | - Abdul Rehman
- Department of Colorectal SurgeryNorthampton General Hospital, Northamptonshire, UK
| | - Kamran Malik
- Department of Colorectal SurgeryNorthampton General Hospital, Northamptonshire, UK
| | - Jamil Ahmed
- Department of Colorectal SurgeryNorthampton General Hospital, Northamptonshire, UK
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14
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Zaragoza Bernal JM. Mental health, subjective experiences and environmental change. MEDICAL HUMANITIES 2024; 50:417-420. [PMID: 38649267 PMCID: PMC11347227 DOI: 10.1136/medhum-2023-012879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/25/2024]
Abstract
This article responds to Coope's call for the medical humanities to address the climate crisis as a health issue. Coope proposes three areas for progress towards ecological thinking in healthcare, with a focus on ecological mental health. The article emphasises the need to understand the cultural dimensions of mental health and proposes an interdisciplinary approach that integrates insights from the arts and humanities. It examines the impact of climate change on mental health, drawing on The Rockefeller Foundation - Lancet Commission on Planetary Health and recent studies. The discussion focuses on the intersection of mental health, subjective experience and environmental change. Focusing on emotional experiences as constructed from biological and cultural elements, the article proposes a holistic approach to mental health. It proposes two converging lines of research, in constant interaction: first, a historical and cultural research of those concepts, practices and symbols related to the environment, emphasising a cultural history of nature; and second, a synchronous research, drawing on anthropology, sociology and participatory art-based research, to understand how these aforementioned elements influence our current relations with nature. The article concludes by emphasising the urgency of developing narratives and histories that redirect temporal trajectories towards a better future, while respecting and acknowledging diverse narratives of individual experience. It calls for collaborative efforts from the medical humanities to contribute to a more comprehensive understanding of the complex relationship between mental health, nature and ecological crisis.
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15
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Jabaudon M, Vallabh B, Bacher HP, Badenes R, Kehl F. Balancing patient needs with environmental impacts for best practices in general anesthesia: Narrative review and clinical perspective. Anaesth Crit Care Pain Med 2024; 43:101389. [PMID: 38710324 DOI: 10.1016/j.accpm.2024.101389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/09/2024] [Accepted: 04/17/2024] [Indexed: 05/08/2024]
Abstract
Discussions of the environmental impacts of general anesthetics have focused on greenhouse gas (GHG) emissions from inhaled agents, with those of total intravenous anesthesia (TIVA) recently coming to the forefront. Clinical experts are calling for the expansion of research toward life cycle assessment (LCA) to comprehensively study the impact of general anesthetics. We provide an overview of proposed environmental risks, including direct GHG emissions from inhaled anesthetics and non-GHG impacts and indirect GHG emissions from propofol. A practical description of LCA methodology is also provided, as well as how it applies to the study of general anesthesia. We describe available LCA studies comparing the environmental impacts of a lower carbon footprint inhaled anesthetic, sevoflurane, to TIVA/propofol and discuss their life cycle steps: manufacturing, transport, clinical use, and disposal. Significant hotspots of GHG emission were identified as the manufacturing and disposal of sevoflurane and use (attributed to the manufacture of the required syringes and syringe pumps) for propofol. However, the focus of these studies was solely on GHG emissions, excluding other environmental impacts of wasted propofol, such as water/soil toxicity. Other LCA gaps included a lack of comprehensive GHG emission estimates related to the manufacturing of TIVA plastic components, high-temperature incineration of propofol, and gas capture technologies for inhaled anesthetics. Considering that scarce LCA evidence does not allow for a definite conclusion to be drawn regarding the overall environmental impacts of sevoflurane and TIVA, we conclude that current anesthetic practice involving these agents should focus on patient needs and established best practices as more LCA research is accumulated.
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Affiliation(s)
- Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand and iGReD, Université Clermont Auvergne, CNRS, INSERM, Clermont-Ferrand, France.
| | - Bhadrish Vallabh
- Global Medical Affairs, AbbVie Biopharmaceuticals GmbH, Dubai, United Arab Emirates
| | - H Peter Bacher
- Global Medical Affairs, AbbVie Inc., North Chicago, IL, USA
| | - Rafael Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care and Pain Clinic, Hospital Clínico Universitario de Valencia, University of Valencia, Valencia, Spain
| | - Franz Kehl
- Department of Anesthesia and Intensive Care Medicine, Klinikum Karlsruhe, Karlsruhe, Germany
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Englander K, Cox K, Smith T, Diab A, Ganam S, Sujka J, DuCoin C. The Financial Implications of a Single-Use Device Reprocessing Program at a Tertiary Referral Center Surgical Department. Am Surg 2024; 90:2127-2129. [PMID: 38561960 DOI: 10.1177/00031348241241679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The operating room has been identified as one of the primary contributors to waste and energy expenditure in the health care system. The primary objective of our study was to evaluate the efficacy of single-use device reprocessing and report the cost savings, waste diversion, and reduction in carbon emissions. Data was collected from January 2021 to April 2023. Medline collected the data for analysis and converted it from an Excel file format to SPSS (Version 27) for analysis. Descriptive frequencies were used for data analysis. We found a mean monthly cost savings of $16,051.68 and a mean 700.68 pounds of waste a month diverted, resulting in an estimated yearly saving of $2354.29 in disposal costs and a reduction of 1112.65 CO2e emissions per month. This program has made significant contributions to cost savings and environmental efforts.
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Affiliation(s)
| | - Kaitlyn Cox
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Teagen Smith
- Department of Biostatistics, University of South Florida, Tampa, FL, USA
| | - Adbul Diab
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Samer Ganam
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Joseph Sujka
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Christopher DuCoin
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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17
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Angelov S, Jimenez CK, Wall V, O'Croínin D. An assessment of sustainable transport infrastructure in a national healthcare system. Surgeon 2024; 22:203-208. [PMID: 37923666 DOI: 10.1016/j.surge.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Healthcare contributes significantly to carbon dioxide emissions, which can be reduced by promoting sustainable mobility amongst staff commuting. This study aims to investigate the national sustainable transport infrastructure for staff of healthcare facilities and utilise this data to develop a novel scoring and ranking system. METHODS This was an empirical retrospective observational study. Data was collected on all 47 hospitals sustainable transport infrastructure. A working group calculated the weighted scores for each sustainable transport data point. These scores were used to calculate the Total and Active Sustainability Scores for each hospital, allowing a ranking to be formed. RESULTS 7 of 47 (15 %) hospitals had EV charging on campus. 17 of 47 (36 %) hospitals had secure bike parking. 2 of 47 (4 %) hospitals had a "bike hub". 18 of 47 (38 %) hospitals had a bike lane. 13 of 22 (59 %) city hospitals had bike sharing facilities. 42 of 47 (89 %) hospitals had one public transport route. City hospitals ranked higher in both Total & Active Sustainability Scores. DISCUSSION This study explored a new concept of measuring sustainable transport infrastructure. Frameworks examining sustainability are available, however, none allowed for ranking of hospitals. This study highlights the lack of both research in this field and sustainable transport infrastructure in hospitals.
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Affiliation(s)
- Sophia Angelov
- Mercy University Hospital, Greenville Place, Cork, T12 WE28, Ireland.
| | | | - Vincent Wall
- Mater Misericordiae University Hospital, Eccles Street, D07 R2WY, Ireland.
| | - Dónall O'Croínin
- Mercy University Hospital, Greenville Place, Cork, T12 WE28, Ireland.
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18
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Chen-Xu J, Corda MO, Varga O, Viegas S. Health burden and costs attributable to the carbon footprint of the health sector in the European Union. ENVIRONMENT INTERNATIONAL 2024; 190:108828. [PMID: 38906089 DOI: 10.1016/j.envint.2024.108828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/16/2024] [Accepted: 06/17/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND The healthcare sector has an environmental impact of around 4.6% of global CO2 emissions, contributing to aggravating the climate crisis. However, the impact of the health sector's emissions on human health is not regularly assessed. We aim to estimate the health burden and associated costs of the health sector's carbon footprint within the European Union (EU). METHODS We calculated disability-adjusted life years (DALYs) and associated costs based on human health damage factors (DALYs/kg-CO2e) by considering four scenarios. Three scenarios for shared socioeconomic pathways (S1 - high growth, S2 - baseline, and S3 - low growth) represented variations of global society, demographics, and economics until 2100. A fourth scenario (S4) considered the current EU's 55% reduction goal of greenhouse gas emissions. The healthcare sector's emissions per capita (in CO2-equivalent) in 2019 were extracted from the Lancet Countdown, and population data were retrieved from Eurostat for the same year. RESULTS In the EU, 365,047 DALYs (95%CI: 194,692-535,403) are expected to be caused by the health sector's emissions at baseline (S2). In an S1 scenario, the burden would slightly decrease to 316,374 DALYs (95%CI: 170,355-462,393), whereas a S3 scenario would increase 486,730 DALYs (95%CI: 243,365-681,422). If EU's carbon goals are met, the burden could be substantially reduced to 164,271 DALYs (95%CI: 87,611-240,931). Costs can amount to 25.6 billion euros, when considering DALYs monetisation. CONCLUSION CO2 emissions from the health sector are expected to significantly impact human health. Therefore, it is important to ensure that EU climate policies for public buildings are in line with the Paris Agreement, increase funding for climate mitigation programs within the healthcare sector, and review clinical practices at the local level.
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Affiliation(s)
- José Chen-Xu
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, REAL, CCAL, NOVA University Lisbon, Lisbon, Portugal; Public Health Unit, Local Health Unit Baixo Mondego, Figueira da Foz, Portugal.
| | - Mariana O Corda
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, REAL, CCAL, NOVA University Lisbon, Lisbon, Portugal; Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, Almada, Portugal
| | - Orsolya Varga
- Syreon Research Institute, Budapest, Hungary; Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Susana Viegas
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, REAL, CCAL, NOVA University Lisbon, Lisbon, Portugal
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Beks H, Clayden S, Wong Shee A, Manias E, Versace VL, Beauchamp A, Mc Namara KP, Alston L. Low-value health care, de-implementation, and implications for nursing research: A discussion paper. Int J Nurs Stud 2024; 156:104780. [PMID: 38744150 DOI: 10.1016/j.ijnurstu.2024.104780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 03/13/2024] [Accepted: 04/19/2024] [Indexed: 05/16/2024]
Abstract
Globally, the nursing profession constitutes the largest proportion of the health workforce; however, it is challenged by widespread workforce shortages relative to need. Strategies to promote recruitment of the nursing workforce are well-established, with a lesser focus on strategies to alleviate the burden on the existing workforce. This burden may be exacerbated by the impact of low-value health care, characterised as health care that provides little or no benefit for patients, or has the potential to cause harm. Low-value health care is a global problem, a major contributor to the waste of healthcare resources, and a key focus of health system reform. Evidence of variation in low-value health care has been identified across countries and system levels. Research on low-value health care has largely focused on the medical profession, with a paucity of research examining either low-value health care or the de-implementation of low-value health care from a nursing perspective. The objective of this paper is to provide a scholarly discussion of the literature around low-value health care and de-implementation, with the purpose of identifying implications for nursing research. With increasing pressures on the global nursing workforce, research identifying low-value health care and developing approaches to de-implement this care, is crucial.
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Affiliation(s)
- H Beks
- Deakin Rural Health, Deakin University, Australia.
| | - S Clayden
- Deakin Rural Health, Deakin University, Australia; South West Healthcare, Australia
| | - A Wong Shee
- Deakin Rural Health, Deakin University, Australia; Grampians Health, Australia
| | - E Manias
- Deakin Rural Health, Deakin University, Australia; School of Nursing and Midwifery, Monash University, Australia
| | - V L Versace
- Deakin Rural Health, Deakin University, Australia
| | - A Beauchamp
- School of Rural Health, Monash University, Australia
| | | | - L Alston
- Deakin Rural Health, Deakin University, Australia; Colac Area Health, Australia
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20
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Eckelman MJ, Weisz U, Pichler PP, Sherman JD, Weisz H. Guiding principles for the next generation of health-care sustainability metrics. Lancet Planet Health 2024; 8:e603-e609. [PMID: 39122328 DOI: 10.1016/s2542-5196(24)00159-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 06/10/2024] [Accepted: 06/27/2024] [Indexed: 08/12/2024]
Abstract
Metrics for health-care sustainability are crucial for tracking progress and understanding the advantages of different operations or systems as the health-care sector addresses the climate crisis and other environmental challenges. Measurement of the key metrics of absolute energy use and greenhouse gas emissions now has substantial momentum, but our overall measurement framework generally has serious deficiencies. Because existing metrics are often borrowed from other sectors, many are unconnected to the specifics of health-care provision or existing health system performance indicators, the potential negative effects of health care on public health are largely absent, a consistent and standardised set of health-care sustainability measurement concepts does not yet exist, and current dynamics in health systems such as privatisation are largely ignored. The next generation of health-care sustainability metrics must address these deficiencies by expanding the scope of observation and the entry points for interventions. Specifically, metrics should be standardised, reliable, meaningful, integrated with data management systems, fair, and aligned with the core mission of health care. Incentives with the potential to contradict sustainability goals must be addressed in future planning and implementation if the next generation of metrics is to be effective and incentivise positive systemic change.
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Affiliation(s)
- Matthew J Eckelman
- Department of Civil & Environmental Engineering, Northeastern University, Boston, MA, USA; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA.
| | - Ulli Weisz
- Social Metabolism and Impacts, Potsdam Institute for Climate Impact Research, Member of the Leibniz Association, Potsdam, Germany
| | - Peter-Paul Pichler
- Social Metabolism and Impacts, Potsdam Institute for Climate Impact Research, Member of the Leibniz Association, Potsdam, Germany
| | - Jodi D Sherman
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Helga Weisz
- Social Metabolism and Impacts, Potsdam Institute for Climate Impact Research, Member of the Leibniz Association, Potsdam, Germany; Department of Cultural History and Theory and Department of Social Sciences, Humboldt Universität zu Berlin, Berlin, Germany.
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21
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Bignier C, Havet L, Brisoux M, Omeiche C, Misra S, Gonsard A, Drummond D. Climate change and children's respiratory health. Paediatr Respir Rev 2024:S1526-0542(24)00056-3. [PMID: 39107182 DOI: 10.1016/j.prrv.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 08/09/2024]
Abstract
Climate change has significant consequences for children's respiratory health. Rising temperatures and extreme weather events increase children's exposure to allergens, mould, and air pollutants. Children are particularly vulnerable to these airborne particles due to their higher ventilation per unit of body weight, more frequent mouth breathing, and outdoor activities. Children with asthma and cystic fibrosis are at particularly high risk, with increased risks of exacerbation, but the effects of climate change could also be observed in the general population, with a risk of impaired lung development and growth. Mitigation measures, including reducing greenhouse gas emissions by healthcare professionals and healthcare systems, and adaptation measures, such as limiting outdoor activities during pollution peaks, are essential to preserve children's respiratory health. The mobilisation of society as a whole, including paediatricians, is crucial to limit the impact of climate change on children's respiratory health.
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Affiliation(s)
| | | | | | | | | | - Apolline Gonsard
- Service de pneumologie et d'allergologie pédiatrique, hôpital universitaire Necker-Enfants-Malades, AP-HP, Paris, France
| | - David Drummond
- Université Paris Cité, Paris, France; Service de pneumologie et d'allergologie pédiatrique, hôpital universitaire Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Inserm UMR 1138, équipe HeKA, Centre de Recherche des Cordeliers, France.
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22
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Drapeau HF, Singh P, Benyaminov F, Wright K, Spence JC, Nuzhat S, Walsh A, Islam K, Azarm Z, Lee KK. Meteorological gaps in audits of pedestrian environments: a scoping review. BMC Public Health 2024; 24:2010. [PMID: 39068394 PMCID: PMC11282675 DOI: 10.1186/s12889-024-19441-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 07/10/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Weather and season are determinants of physical activity. Therefore, it is important to ensure built environments are designed to mitigate negative impacts of weather and season on pedestrians to prevent these losses. This scoping review aims to identify built environment audits of pedestrian environments developed for use during a specific weather condition or season. Secondly, this review aims to investigate gaps in the inclusion of relevant weather mitigating built environment features in pedestrian environment audit tools. METHODS Following a standard protocol, a systematic search was executed in CINAHL, Medline and Web of Science to identify built environment audit tools of pedestrian spaces. These databases were chosen since they are well-known to comprehensively cover health as well as multi-disciplinary research publications relevant to health. Studies were screened, and data were extracted from selected documents by two independent reviewers (e.g., psychometric properties and audit items included). Audit items were screened for the inclusion of weather mitigating built environment features, and the tool's capacity to measure temperature, precipitation, seasonal and sustainability impacts on pedestrians was calculated. RESULTS The search returned 2823 documents. After screening and full text review, 27 articles were included. No tool was found that was developed specifically for use during a specific weather condition or season. Additionally, gaps in the inclusion of weather mitigating items were found for all review dimensions (thermal comfort, precipitation, seasonal, and sustainability items). Poorly covered items were: (1) thermal comfort related (arctic entry presence, materials, textures, and colours of buildings, roads, sidewalk and furniture, and green design features); (2) precipitation related (drain presence, ditch presence, hazards, and snow removal features); (3) seasonal features (amenities, pedestrian scale lighting, and winter destinations and aesthetics); and (4) sustainability features (electric vehicle charging stations, renewable energy, car share, and bike share facilities). CONCLUSIONS Current built environment audit tools do not adequately include weather / season mitigating items. This is a limitation as it is important to investigate if the inclusion of these items in pedestrian spaces can promote physical activity during adverse weather conditions. Because climate change is causing increased extreme weather events, a need exists for the development of a new built environment audit tool that includes relevant weather mitigating features.
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Affiliation(s)
- H F Drapeau
- Housing for Health, Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - P Singh
- Housing for Health, Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - F Benyaminov
- Housing for Health, Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - K Wright
- Housing for Health, Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - J C Spence
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - S Nuzhat
- Housing for Health, Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - A Walsh
- Housing for Health, Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - K Islam
- Housing for Health, Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Z Azarm
- Housing for Health, Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - K K Lee
- Housing for Health, Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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Mead ES, Teeling SP, McNamara M. A Realist Review Protocol into the Contexts and Mechanisms That Enable the Inclusion of Environmental Sustainability Outcomes in the Design of Lean Healthcare Improvement Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:868. [PMID: 39063445 PMCID: PMC11276605 DOI: 10.3390/ijerph21070868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/28/2024] [Accepted: 06/30/2024] [Indexed: 07/28/2024]
Abstract
Healthcare makes a significant contribution to the social, economic and environmental benefits of communities. It is correspondingly a significant employer and consumer of both energy and consumables, often at high costs. Lean, a quality improvement methodology focuses on the elimination of non-value add (NVA) activities (steps that do not add value from the perspective of the customer) to improve the flow of people, information or goods. Increasingly, Lean thinking is evolving from its initial focus on eliminating NVA to a more holistic approach that encompasses sustainability. However, little work has been undertaken intentionally, including environmental sustainability outcomes in Lean healthcare interventions. Realist review methodology facilitates an understanding of the extent to which an intervention works, for whom, in what context, why and how, and has proven useful in research relating to Lean interventions in healthcare settings. This protocol provides details for a realist review that will enable an understanding of the specific contexts in which certain mechanisms are activated that enable the inclusion of environmental sustainability outcomes in the design of Lean healthcare improvement interventions.
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Affiliation(s)
- Elaine Shelford Mead
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 VIW8 Dublin, Ireland
| | - Seán Paul Teeling
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 VIW8 Dublin, Ireland
- Centre for Person-Centered Practice Research Division of Nursing, School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh EH21 6UU, UK
| | - Martin McNamara
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 VIW8 Dublin, Ireland
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24
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Cappelli F, Castronuovo G, Grimaldi S, Telesca V. Random Forest and Feature Importance Measures for Discriminating the Most Influential Environmental Factors in Predicting Cardiovascular and Respiratory Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:867. [PMID: 39063444 PMCID: PMC11276884 DOI: 10.3390/ijerph21070867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/06/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Several studies suggest that environmental and climatic factors are linked to the risk of mortality due to cardiovascular and respiratory diseases; however, it is still unclear which are the most influential ones. This study sheds light on the potentiality of a data-driven statistical approach by providing a case study analysis. METHODS Daily admissions to the emergency room for cardiovascular and respiratory diseases are jointly analyzed with daily environmental and climatic parameter values (temperature, atmospheric pressure, relative humidity, carbon monoxide, ozone, particulate matter, and nitrogen dioxide). The Random Forest (RF) model and feature importance measure (FMI) techniques (permutation feature importance (PFI), Shapley Additive exPlanations (SHAP) feature importance, and the derivative-based importance measure (κALE)) are applied for discriminating the role of each environmental and climatic parameter. Data are pre-processed to remove trend and seasonal behavior using the Seasonal Trend Decomposition (STL) method and preliminary analyzed to avoid redundancy of information. RESULTS The RF performance is encouraging, being able to predict cardiovascular and respiratory disease admissions with a mean absolute relative error of 0.04 and 0.05 cases per day, respectively. Feature importance measures discriminate parameter behaviors providing importance rankings. Indeed, only three parameters (temperature, atmospheric pressure, and carbon monoxide) were responsible for most of the total prediction accuracy. CONCLUSIONS Data-driven and statistical tools, like the feature importance measure, are promising for discriminating the role of environmental and climatic factors in predicting the risk related to cardiovascular and respiratory diseases. Our results reveal the potential of employing these tools in public health policy applications for the development of early warning systems that address health risks associated with climate change, and improving disease prevention strategies.
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Affiliation(s)
| | - Gianfranco Castronuovo
- School of Engineering, University of Basilicata, Viale dell’Ateneo Lucano 10, 85100 Potenza, Italy;
| | | | - Vito Telesca
- School of Engineering, University of Basilicata, Viale dell’Ateneo Lucano 10, 85100 Potenza, Italy;
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25
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Donahue LM, Petit HJ, Thiel CL, Sullivan GA, Gulack BC, Shah AN. A Life Cycle Assessment of Reusable and Disposable Surgical Caps. J Surg Res 2024; 299:112-119. [PMID: 38749314 DOI: 10.1016/j.jss.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/06/2024] [Accepted: 04/15/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Surgical cap attire plays an important role in creating a safe and sterile environment in procedural suites, thus the choice of reusable versus disposable caps has become an issue of much debate. Given the lack of evidence for differences in surgical site infection (SSI) risk between the two, selecting the cap option with a lower carbon footprint may reduce the environmental impact of surgical procedures. However, many institutions continue to recommend the use of disposable bouffant caps. METHODS ISO-14044 guidelines were used to complete a process-based life cycle assessment to compare the environmental impact of disposable bouffant caps and reusable cotton caps, specifically focusing on CO2 equivalent (CO2e) emissions, water use and health impacts. RESULTS Reusable cotton caps reduced CO2e emissions by 79% when compared to disposable bouffant caps (10 kg versus 49 kg CO2e) under the base model scenario with a similar reduction seen in disability-adjusted life years. However, cotton caps were found to be more water intensive than bouffant caps (67.56 L versus 12.66 L) with the majority of water use secondary to production or manufacturing. CONCLUSIONS Reusable cotton caps have lower total lifetime CO2e emissions compared to disposable bouffant caps across multiple use scenarios. Given the lack of evidence suggesting a superior choice for surgical site infection prevention, guidelines should recommend reusable cotton caps to reduce the environmental impact of surgical procedures.
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Affiliation(s)
- Laura M Donahue
- Division of Hospital Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Hayley J Petit
- Rush University Medical Center, Rush Medical College, Chicago, Illinois
| | - Cassandra L Thiel
- Departments of Population Health and Ophthalmology, NYU Langone Health, New York, New York; Clinically Sustainable Consulting, LLC, Middleton, Wisconsin
| | - Gwyneth A Sullivan
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Brian C Gulack
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Ami N Shah
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois.
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Zhou L, Wei Y, Ge Y, Li Y, Liu K, Gao Y, Song B, Li Y, Zhang D, Bo Y, Zhang J, Xu Y, Duan X. Global, regional, and national burden of stroke attributable to extreme low temperatures, 1990-2019: A global analysis. Int J Stroke 2024; 19:676-685. [PMID: 38425241 DOI: 10.1177/17474930241238636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Extreme ambient temperatures have been linked to increased risks of stroke morbidity and mortality. However, global estimates of the burden of stroke due to extreme low temperatures are not well-defined. AIMS This study aimed to determine the global burden of stroke due to extreme low temperatures and its spatiotemporal trend from 1990 to 2019. METHODS Based on the Global Burden of Disease Study 2019, we obtained global, regional, and national data on deaths, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized rate of DALYs (ASDR) of stroke attributed to extreme low temperatures, further stratified by age, sex, and sociodemographic index (SDI). RESULTS Globally, in 2019, an estimated 474,000 stroke deaths with the corresponding ASMR (6.2 (95% uncertainty interval (UI): 4.6-7.9)) and ASDR (103.9 (95% UI: 77.0-134.5)) per 100,000 population, were attributable to extreme low temperatures. The most significant burden was observed in Central Asia, followed by Eastern Europe and East Asia. From 1990 to 2019, the global burden of stroke and its subtypes (ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage) attributable to extreme low temperatures exhibited a decrease in both ASMR and ASDR. Significant decreases in stroke burden occurred in the high-SDI regions, high-income Asia Pacific, and subarachnoid hemorrhage cases. Moreover, the ASMR and ASDR increased with age and were higher in males than females. CONCLUSION The global stroke burden due to extreme low temperatures remains high despite a decreasing trend over the past three decades. The stroke burden due to extreme low temperatures was more notable for Central Asia, older people, and the male sex.
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Affiliation(s)
- Lue Zhou
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, China
- Henan Key Laboratory of Cerebrovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yujie Wei
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yahao Ge
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yapeng Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, China
- Henan Key Laboratory of Cerebrovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kai Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, China
- Henan Key Laboratory of Cerebrovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuan Gao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, China
- Henan Key Laboratory of Cerebrovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, China
- Henan Key Laboratory of Cerebrovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yusheng Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, China
- Henan Key Laboratory of Cerebrovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Daping Zhang
- Department of Cardiology, Huaihe Hospital of Henan University, Kaifeng, China
| | - Yacong Bo
- Department of Nutrition, College of Public Health, Zhengzhou University, Zhengzhou, China
- NHC Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Zhengzhou, China
| | - Junxi Zhang
- NHC Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Zhengzhou, China
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, China
- Henan Key Laboratory of Cerebrovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoran Duan
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Oerther S, Breitbach A, Pole D. Teaching global interdependence to health professions students during the Anthropocene epoch: Findings from documentary analysis of an interprofessional education course. Nurse Educ Pract 2024; 78:104025. [PMID: 38917559 DOI: 10.1016/j.nepr.2024.104025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024]
Abstract
AIM(S) To examine the effects of new course material that incorporated the Anthropocene and The Centers for Disease Control's (CDC) 'Climate Effects on Health' framework into an IPE course to enhance students' understanding global interdependence. BACKGROUND Teaching global interdependence with a suitable framework and relevant content in an introductory Interprofessional Education course in undergraduate programs is challenging when these early learners who do not have significant clinical experience. Therefore, it is necessary to adapt these courses to provide a framework that all students can relate to regardless of previous experience. DESIGN The design for this study was qualitative document analysis. METHOD The required introductory IPE course was for students on the programs offered by the College of Health Sciences and the School of Nursing. Students (n = 142) from seven health professions programs, including athletic training (n=9), nursing (n=70), nutrition and dietetics (n=8), occupational therapy (n=15), physical therapy (n=31), radiation therapy (n=2) and magnetic resonance imaging and pre-professional students from other majors (n=5) were enrolled in this IPE course. The study used data derived from the final reflections submitted by the students. The CQI analysis focused on students enrolled in a dedicated interprofessional course related to health professions. RESULTS Ways interprofessional teams can address global challenges like the Anthropocene, climate-related illnesses and severe weather events were revealed in student responses. Three themes that emerged from the student responses included: public health collaborations, holistic health promotion and policy advocacy. CONCLUSION Incorporating the concept of Anthropocene and the 'Climate Effects on Health' framework into an IPE course can be a promising approach to shaping students' perception and enhancing their knowledge about global interdependence. By doing so, students can gain a deeper understanding of how human activities have an impact on the climate and ecology of the planet and how severe weather can lead to various health problems.
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Affiliation(s)
- Sarah Oerther
- Goldfarb School of Nursing, Barnes-Jewish College, 4483 Duncan Ave., St. Louis, MO 63100, United States.
| | - Anthony Breitbach
- Doisy College of Health Sciences, Saint Louis University, 3437 Caroline Mall, St. Louis, MO 63104, United States
| | - David Pole
- Saint Louis University School of Medicine, Center for Interprofessional Education & Research, 1312 Carr Lane Ave, Suite 110, St. Louis, MO 63104, United States
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Hensher M, McCartney G, Ochodo E. Health Economics in a World of Uneconomic Growth. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:427-433. [PMID: 38637451 PMCID: PMC11178562 DOI: 10.1007/s40258-024-00883-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/20/2024]
Abstract
Multiple, accelerating and interacting ecological crises are increasingly understood as constituting a major threat to human health and well-being. Unconstrained economic growth is strongly implicated in these growing crises, and it has been argued that this growth has now become "uneconomic growth", which is a situation where the size of the economy is still expanding, but this expansion is causing more harm than benefit. This article summarises the multiple pathways by which uneconomic growth can be expected to harm human health. It describes how health care systems-especially through overuse, low value and poor quality care-can themselves drive uneconomic growth. Health economists need to understand not only the consequences of environmental impacts on health care, but also the significance of uneconomic growth, and pay closer attention to the growing body of work by heterodox economists, especially in the fields of ecological and feminist economics. This will involve paying closer heed to the existence and consequences of diminishing marginal returns to health care consumption at high levels; the central importance of inequalities and injustice in health; and the need to remedy health economists' currently limited ability to deal effectively with low value care, overdiagnosis and overtreatment.
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Affiliation(s)
- Martin Hensher
- Henry Baldwin Professorial Research Fellow in Health System Sustainability, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - Gerry McCartney
- School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Eleanor Ochodo
- Stellenbosch University, Stellenbosch, Western Cape, South Africa
- Kenya Medical Research Institute, Nairobi, Kenya
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Ha S, Abatzoglou JT, Adebiyi A, Ghimire S, Martinez V, Wang M, Basu R. Impacts of heat and wildfire on preterm birth. ENVIRONMENTAL RESEARCH 2024; 252:119094. [PMID: 38723988 DOI: 10.1016/j.envres.2024.119094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Climate change continues to increase the frequency, intensity, and duration of heat events and wildfires, both of which are associated with adverse pregnancy outcomes. Few studies simultaneously evaluated exposures to these increasingly common exposures. OBJECTIVES We investigated the relationship between exposure to heat and wildfire smoke and preterm birth (PTB). METHODS In this time-stratified case-crossover study, participants consisted of 85,806 California singleton PTBs (20-36 gestational weeks) from May through October of 2015-2019. Birthing parent ZIP codes were linked to high-resolution daily weather, PM2.5 from wildfire smoke, and ambient air pollution data. Heat day was defined as a day with apparent temperature >98th percentile within each ZIP code and heat wave was defined as ≥2 consecutive heat days. Wildfire-smoke day was defined as a day with any exposure to wildfire-smoke PM2.5. Conditional logistic regression was used to calculate the odds ratio (OR) and 95% confidence intervals (CI) comparing exposures during a hazard period (lags 0-6) compared to control periods. Analyses were adjusted for relative humidity, fine particles, and ozone. RESULTS Wildfire-smoke days were associated with 3.0% increased odds of PTB (ORlag0: 1.03, CI: 1.00-1.05). Compared with white participants, associations appeared stronger among Black, Hispanic, Asian, and American Indians/Alaskan Native participants. Heatwave days (ORlag2: 1.07, CI: 1.02-1.13) were positively associated with PTB, with stronger associations among those simultaneously exposed to wildfire smoke days (ORlag2: 1.19, CI: 1.11-1.27). Similar findings were observed for heat days and when other temperature metrics (e.g., maximum, minimum) were used. DISCUSSION Heat and wildfire increased PTB risk with evidence of synergism. As the occurrence and co-occurrence of these events increase, exposure reduction among pregnant people is critical, especially among racial/ethnic minorities.
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Affiliation(s)
- Sandie Ha
- Department of Public Health, School of Social Sciences, Humanities and Arts, Health Science Research Institute, University of California, 5200 N Lake Rd, 95343, Merced, CA, USA.
| | - John T Abatzoglou
- Department of Management of Complex Systems, School of Engineering, University of California, Merced, USA
| | - Adeyemi Adebiyi
- Department of Life and Environmental Sciences, School of Natural Sciences, University of California, Merced, USA
| | - Sneha Ghimire
- Department of Public Health, School of Social Sciences, Humanities and Arts, Health Science Research Institute, University of California, 5200 N Lake Rd, 95343, Merced, CA, USA
| | - Valerie Martinez
- Department of Public Health, School of Social Sciences, Humanities and Arts, Health Science Research Institute, University of California, 5200 N Lake Rd, 95343, Merced, CA, USA
| | - Meng Wang
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Rupa Basu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA
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Bréchat PH, Fagerlin A, Ariotti A, Lee AP, Warrier S, Gregovich N, Briot P, Srivastava R. A Hexagonal Aim as a Driver of Change for Health Care and Health Insurance Systems. Milbank Q 2024. [PMID: 38923086 DOI: 10.1111/1468-0009.12702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/26/2024] [Accepted: 04/24/2024] [Indexed: 06/28/2024] Open
Abstract
Policy Points Improving health systems requires simultaneous pursuit of a patient centered approach aligned with the health professional: improving the experience of care, improving the health of populations, reducing per capita costs of care - Triple Aim - and improving the work life of the care providers - Quadruple Aim -. Reinforcing the recently defined Fifth Aim as equity through "health democracy" to represent the wants, needs and responsibility of the population in taking care of their health and their healthcare. Adding a Sixth Aim to take into account the increased health risks due to climate change. CONTEXT Improving health systems, such as the U.S. or French, requires simultaneous pursuit of a patient centered approach aligned with the health professional: improving the experience of care, improving the health of populations, reducing per capita costs of care - Triple Aim - and improving the work life of the care providers, including clinicians and staff - Quadruple Aim -. While these aims are already ambitious, they may be insufficient when considering the economic, social and environmental challenges to the health of our communities in the near and long term. METHODS A conceptual framework to provide additional ethical guardrails for health systems. RESULTS Recently, authors have articulated a Fifth Aim and we propose to add a Sixth Aim to the Quadruple Aim model. These additional aims are meant to account for our growing knowledge around the determinants of health and the challenging processes and structures of governance across a wide range of sectors in society including healthcare. We are strengthening the Fifth Aim defined as equity through "health democracy" to represent the wants, needs and responsibility of the population in taking care of their health and their healthcare. The Sixth Aim is to account for the increase in risk to population health due to climate change as well as the impact our health systems have on the environment. CONCLUSIONS As social tension and environmental changes seem to continue to impact the structure of our society this "Hexagonal Aim" taken together might provide additional ethical guiderails as we set our healthcare goals.
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Affiliation(s)
- Pierre-Henri Bréchat
- Center for Studies and Research in Administrative Sciences and Politics, Scientific Research National Center, University of Paris II Panthéon-Assas
- Law and Health Institute, National Institute of Health and Medical Research, Paris Cité University
- Assistance Publique-Hôpitaux de Paris
- Healthcare Delivery Institute, Intermountain Health
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah
- Salt Lake City, Informatics Decision-Enhancement and Analytic Sciences Center for Innovation
| | - Anthony Ariotti
- Department of Population Health Sciences, University of Utah
| | | | - Smitha Warrier
- Department of Anesthesia, University of Utah Health
- Environmental and Social Sustainability, University of Utah Health
| | | | - Pascal Briot
- Quality of care service, University Hospitals of Geneva
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Lui B, White RS, Bryant-Huppert J, Kelleher DC. Environmental sustainability in obstetric anesthesia. Int J Obstet Anesth 2024; 60:104216. [PMID: 39018740 DOI: 10.1016/j.ijoa.2024.104216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/15/2024] [Accepted: 06/06/2024] [Indexed: 07/19/2024]
Affiliation(s)
- B Lui
- Weill Cornell Medical College, New York, NY, USA
| | - R S White
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - J Bryant-Huppert
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - D C Kelleher
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
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Miller MR, Landrigan PJ, Arora M, Newby DE, Münzel T, Kovacic JC. Environmentally Not So Friendly: Global Warming, Air Pollution, and Wildfires: JACC Focus Seminar, Part 1. J Am Coll Cardiol 2024; 83:2291-2307. [PMID: 38839204 DOI: 10.1016/j.jacc.2024.03.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/06/2024] [Indexed: 06/07/2024]
Abstract
Environmental stresses are increasingly recognized as significant risk factors for adverse health outcomes. In particular, various forms of pollution and climate change are playing a growing role in promoting noncommunicable diseases, especially cardiovascular disease. Given recent trends, global warming and air pollution are now associated with substantial cardiovascular morbidity and mortality. As a vicious cycle, global warming increases the occurrence, size, and severity of wildfires, which are significant sources of airborne particulate matter. Exposure to wildfire smoke is associated with cardiovascular disease, and these effects are underpinned by mechanisms that include oxidative stress, inflammation, impaired cardiac function, and proatherosclerotic effects in the circulation. In the first part of a 2-part series on pollution and cardiovascular disease, this review provides an overview of the impact of global warming and air pollution, and because of recent events and emerging trends specific attention is paid to air pollution caused by wildfires.
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Affiliation(s)
- Mark R Miller
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
| | - Philip J Landrigan
- Global Observatory on Planetary Health, Boston College, Boston, Massachusetts, USA; Scientific Center of Monaco, Monaco
| | - Manish Arora
- Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany; German Center for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany
| | - Jason C Kovacic
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia; Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; School of Human Sciences, University of Western Australia, Perth, Australia
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Cogen JD, Perkins A, Mockler B, Barton KS, Schwartz A, Boos M, Radhakrishnan A, Rai P, Tandon P, Philipsborn R, Grow HM. Pediatric Resident and Program Director Views on Climate Change and Health Curricula: A Multi-Institution Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:654-662. [PMID: 38232072 DOI: 10.1097/acm.0000000000005633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
PURPOSE The American Academy of Pediatrics emphasized in a 2007 policy statement the importance of educating trainees on the impacts of climate change on children's health, yet few studies have evaluated trainee knowledge and attitudes about climate change-related health effects in children. This multi-institution study assessed pediatric resident and program director (1) knowledge/attitudes on climate change and health, (2) perspectives on the importance of incorporating climate and health content into pediatric graduate medical education, and (3) preferred topics/activities to include in climate and health curricula. METHOD This mixed-methods study employed an anonymous cross-sectional survey of pediatric residents and residency program directors from Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN)-affiliated programs. Multivariable regression models and factor analyses were used to examine associations among resident demographics and resident knowledge, attitudes, and interest in a climate change curriculum. A conventional content analysis was conducted for the open-ended responses. RESULTS Eighteen programs participated in the study with all program directors (100% response rate) and 663 residents (average response rate per program, 53%; overall response rate, 42%) completing respective surveys. Of the program directors, only 3 (17%) felt very or moderately knowledgeable about the association between climate change and health impacts. The majority of residents (n=423, 64%) agreed/strongly agreed that physicians should discuss global warming/climate change and its health effects with patients/families, while only 138 residents (21%) agreed/strongly agreed that they were comfortable talking with patients and families about these issues. Most residents (n=498, 76%) and program directors (n=15, 83%) agreed/strongly agreed that a climate change curriculum should be incorporated into their pediatrics training program. CONCLUSIONS Pediatric residents and program directors support curricula that prepare future pediatricians to address the impact of climate change on children's health; however, few programs currently offer specific training, despite identified needs.
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Chevance G, Minor K, Vielma C, Campi E, O'Callaghan-Gordo C, Basagaña X, Ballester J, Bernard P. A systematic review of ambient heat and sleep in a warming climate. Sleep Med Rev 2024; 75:101915. [PMID: 38598988 DOI: 10.1016/j.smrv.2024.101915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 01/31/2024] [Accepted: 02/20/2024] [Indexed: 04/12/2024]
Abstract
Climate change is elevating nighttime and daytime temperatures worldwide, affecting a broad continuum of behavioral and health outcomes. Disturbed sleep is a plausible pathway linking rising ambient temperatures with several observed adverse human responses shown to increase during hot weather. This systematic review aims to provide a comprehensive overview of the literature investigating the relationship between ambient temperature and valid sleep outcomes measured in real-world settings, globally. We show that higher outdoor or indoor temperatures are generally associated with degraded sleep quality and quantity worldwide. The negative effect of heat persists across sleep measures, and is stronger during the hottest months and days, in vulnerable populations, and the warmest regions. Although we identify opportunities to strengthen the state of the science, limited evidence of fast sleep adaptation to heat suggests rising temperatures induced by climate change and urbanization pose a planetary threat to human sleep, and therefore health, performance, and wellbeing.
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Affiliation(s)
| | - Kelton Minor
- Data Science Institute, Columbia University, New York, United States.
| | | | | | - Cristina O'Callaghan-Gordo
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain; Municipal Institute of Medical Research (IMIM-Hospital del Mar), Barcelona, Spain
| | - Xavier Basagaña
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Paquito Bernard
- Department of Physical Activity Sciences, Université du Québec à Montréal, Montréal, Québec, Canada; Research Center, University Institute of Mental Health at Montreal, Montréal, Québec, Canada
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Ohene-Botwe B, Amedu C, Antwi WK, Abdul-Razak W, Kyei KA, Arkoh S, Mudadi LS, Mushosho EY, Bwanga O, Chinene B, Nyawani P, Mutandiro LC, Piersson AD. Promoting sustainability activities in clinical radiography practice and education in resource-limited countries: A discussion paper. Radiography (Lond) 2024; 30 Suppl 1:56-61. [PMID: 38905726 DOI: 10.1016/j.radi.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE Urgent global action is required to combat climate change, with radiographers poised to play a significant role in reducing healthcare's environmental impact. This paper explores radiography-related activities and factors in resource-limited departments contributing to the carbon footprint and proposes strategies for mitigation. The rationale is to discuss the literature regarding these contributing factors and to raise awareness about how to promote sustainability activities in clinical radiography practice and education in resource-limited countries. KEY FINDINGS The radiography-related activities and factors contributing to the carbon footprint in resource-limited countries include the use of old equipment and energy inefficiency, insufficient clean energy to power equipment, long-distance commuting for radiological examinations, high film usage and waste, inadequate training and research on sustainable practices, as well as limited policies to drive support for sustainability. Addressing these issues requires a multifaceted approach. Firstly, financial assistance and partnerships are needed to adopt eco-friendly technologies and clean energy sources to power equipment, thus tackling issues related to old equipment and energy inefficiency. Transitioning to digital radiography can mitigate the environmental impact of high film usage and waste, while collaboration between governments, healthcare organisations, and international stakeholders can improve access to radiological services, reducing long-distance commuting. Additionally, promoting education programmes and research efforts in sustainability will empower radiographers with the knowledge to practice sustainably, complemented by clear policies such as green imaging practices to guide and incentivise the adoption of sustainable practices. These integrated solutions can significantly reduce the carbon footprint of radiography activities in resource-limited settings while enhancing healthcare delivery. CONCLUSION Radiography-related activities and factors in resource-limited departments contributing to the carbon footprint are multifaceted but can be addressed through concerted efforts. IMPLICATIONS FOR PRACTICE Addressing the challenges posed by old equipment, energy inefficiency, high film usage, and inadequate training through collaborative efforts and robust policy implementation is essential for promoting sustainable radiography practices in resource-limited countries. Radiographers in these countries need to be aware of these factors contributing to the carbon footprint and begin to work with the relevant stakeholders to mitigate them. Furthermore, there is a need for them to engage in education programmes and research efforts in sustainability to empower them with the right knowledge and understanding to practice sustainably.
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Affiliation(s)
- B Ohene-Botwe
- Department of Midwifery & Radiography, School of Health & Psychological Sciences, City, University of London, Northampton Square, London EC1V 0HB, United Kingdom.
| | - C Amedu
- Department of Midwifery & Radiography, School of Health & Psychological Sciences, City, University of London, Northampton Square, London EC1V 0HB, United Kingdom.
| | - W K Antwi
- Department of Radiography, School of Biomedical & Allied Health Sciences, University of Ghana, Ghana.
| | - W Abdul-Razak
- Department of Medical Imaging, Fatima College of Health Sciences, AI Ain, United Arab Emirates.
| | - K A Kyei
- Department of Radiography, School of Biomedical & Allied Health Sciences, University of Ghana, Ghana.
| | - S Arkoh
- Department of Radiology, York and Scarborough Teaching Hospitals NHS Trust, United Kingdom.
| | - L-S Mudadi
- Royal Papworth Hospital, NHS Foundation Trust, Cambridge, United Kingdom.
| | - E Y Mushosho
- Harare Institute of Technology, School of Allied Health Sciences, Harare, Zimbabwe.
| | - O Bwanga
- Radiology Department, Midlands University Hospital Tullamore, Ireland.
| | - B Chinene
- Harare Institute of Technology, School of Allied Health Sciences, Harare, Zimbabwe.
| | - P Nyawani
- Harare Institute of Technology, School of Allied Health Sciences, Harare, Zimbabwe.
| | - L C Mutandiro
- Harare Institute of Technology, School of Allied Health Sciences, Harare, Zimbabwe.
| | - A D Piersson
- Department of Imaging Technology & Sonography, University of Cape Coast, Central Region, Ghana.
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Rojas-Rueda D, McAuliffe K, Morales-Zamora E. Addressing Health Equity in the Context of Carbon Capture, Utilization, and Sequestration Technologies. Curr Environ Health Rep 2024; 11:225-237. [PMID: 38600409 DOI: 10.1007/s40572-024-00447-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE OF REVIEW To describe the role of health equity in the context of carbon capture, utilization, and sequestration (CCUS) technologies. RECENT FINDINGS CCUS technologies have the potential to both improve and worsen health equity. They could help reduce greenhouse gas emissions, a major contributor to climate change, but they could also have negative health impacts like air and noise pollution. More research is needed to fully understand the health equity implications of CCUS technologies. CCUS technologies have both health equity risks and benefits. Implementing misguided CCUS projects in vulnerable communities could exacerbate environmental injustice and health disparities and have the potential to increase carbon emissions. However, well-conceived projects could benefit communities through economic development. Governments, industry, and society should prioritize and expedite the reduction of CO2 emissions before considering carbon reductions via CCUS. Furthermore, CCUS projects must be thoroughly evaluated and should only proceed if they have demonstrated a net reduction in CO2 emissions and provide more benefits than risks to local communities. This underscores the importance of prioritizing health equity in the planning of CCUS projects.
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Affiliation(s)
- David Rojas-Rueda
- Department of Environmental and Radiological Health Sciences, Colorado State University, Environmental Health Building, 1601 Campus Delivery, Fort Collins, CO, 80523, USA.
- Colorado School of Public Health, Colorado State University, Environmental Health Building, 1601 Campus Delivery, Fort Collins, CO, 80523, USA.
| | - Kelly McAuliffe
- Colorado School of Public Health, Colorado State University, Environmental Health Building, 1601 Campus Delivery, Fort Collins, CO, 80523, USA
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Ghotra SS, Champendal M, Flaction L, Ribeiro RT, Sá Dos Reis C. Approaches to reduce medical imaging departments' environmental impact: A scoping review. Radiography (Lond) 2024; 30 Suppl 1:108-116. [PMID: 39146889 DOI: 10.1016/j.radi.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/30/2024] [Accepted: 08/01/2024] [Indexed: 08/17/2024]
Abstract
INTRODUCTION Global warming stands as a paramount public health issue of our time, and it is fundamental to explore approaches to green medical imaging departments/(MID). This study aims to map the existing actions in the literature that promote sustainable development in MID towards the promotion of environmental impact reduction. METHODS Following the JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), this literature search was conducted on MEDLINE, Embase and CINAHL to encompass studies published after 2013. Combinations of keywords and relevant terms related to environmental sustainability, recycling, medical waste, and greening radiology were applied for this review. Three independent reviewers screened abstracts, titles, and eligible full-text. Disagreement was solved through consensus. RESULTS 38 out of 4630 articles met all inclusion criteria, and four additional articles were identified and added through reference search. A third of the studies included were published after 2022, and most were conducted in developed countries (36/41). Articles focused on computed tomography (9/41), magnetic resonance imaging (6/41), interventional radiology (4/41), conventional radiography (4/41), ultrasound (2/41), mixed modalities (10/41), or not applicable to an imaging modality (6/41). Four principal categories were identified to decrease ecological footprint: energy consumption, waste management, justification and environmental pollution. CONCLUSION To minimise the environmental impact of MIDs raising awareness and promoting education is fundamental. Examinations must be justified adequately, energy consumption must be reduced, and waste management practices need to be implemented. Further studies are required to prioritise the most effective strategies, supporting decision-making among stakeholders. IMPLICATIONS FOR PRACTICE Several strategies are already possible to implement to reduce the environmental impact of MIDs and improve the healthcare outcomes for patients.
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Affiliation(s)
- S S Ghotra
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, 1011, Switzerland; Department of Radiology, Hospital of Yverdon-les-Bains (eHnv), 1400, Yverdon-les-Bains, Switzerland.
| | - M Champendal
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, 1011, Switzerland.
| | - L Flaction
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, 1011, Switzerland.
| | - R T Ribeiro
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, 1011, Switzerland.
| | - C Sá Dos Reis
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, 1011, Switzerland.
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Woolley G, Kroll K, Hoffman K, Ward A, Corneli A, Mudrak SV, Qureshi MU, Okeke NL, Chan C, Jones AAD, Tomaras GD, Reeves RK. The Climate Change Burden on Immune Health: Are Persons Living with HIV More at Risk? AIDS Res Hum Retroviruses 2024. [PMID: 38753709 DOI: 10.1089/aid.2024.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Climate change poses one of the most significant modern threats to overall human health,especially for vulnerable populations including persons living with HIV (PLWH). In this perspective, we specifically explore the concept of immune resilience in human health and how climate change phenomena - including extreme weather events, food insecurity, pollution, and emerging diseases - may exacerbate immune dysfunction and comorbidities faced by PLWH and hinder access to HIV treatment and prevention services. Multidisciplinary, collaborative efforts are urgently needed to quantify these impacts, develop mitigation strategies, and strengthen policies and funding to bolster immune resilience for PLWH in the face of accelerating climate change.
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Affiliation(s)
- Griffin Woolley
- Center for Human Systems Immunology, Duke University, Durham, North Carolina, USA
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Kyle Kroll
- Center for Human Systems Immunology, Duke University, Durham, North Carolina, USA
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Kate Hoffman
- Nicholas School of the Environment, Duke University, Durham, North Carolina, USA
| | - Ashley Ward
- Nicholas Institute for Energy, Environment & Sustainability, Duke University, Durham, North Carolina, USA
| | - Amy Corneli
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
- Center for AIDS Research, Duke University, Durham, North Carolina, USA
| | - Sarah V Mudrak
- Center for Human Systems Immunology, Duke University, Durham, North Carolina, USA
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - M Umar Qureshi
- Center for Human Systems Immunology, Duke University, Durham, North Carolina, USA
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - N Lance Okeke
- Center for AIDS Research, Duke University, Durham, North Carolina, USA
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Cliburn Chan
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | | | - Georgia D Tomaras
- Center for Human Systems Immunology, Duke University, Durham, North Carolina, USA
- Department of Surgery, Duke University, Durham, North Carolina, USA
- Center for AIDS Research, Duke University, Durham, North Carolina, USA
| | - R Keith Reeves
- Center for Human Systems Immunology, Duke University, Durham, North Carolina, USA
- Department of Surgery, Duke University, Durham, North Carolina, USA
- Center for AIDS Research, Duke University, Durham, North Carolina, USA
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Quartucci C, Wibowo R, Do V, Bose-O Reilly S, Nowak D, Weilnhammer V, Weinmann T, Rakete S. Assessment of subjective well-being of healthcare workers in response to heat and personal protective equipment under controlled conditions using a standardized protocol. J Occup Med Toxicol 2024; 19:16. [PMID: 38750499 PMCID: PMC11095016 DOI: 10.1186/s12995-024-00418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Due to climate change, the increasing frequency of hot summer days and heat waves can result in occupational heat strain, especially in non-air-conditioned workplaces. Healthcare workers (HCW) engaged in patient care are particularly affected, as they are additionally exposed to physical stress. The use of personal protective equipment (PPE) can aggravate heat strain in HCW. This study aimed to examine the subjective well-being of HCW when exposed to heat and PPE under controlled conditions. METHODS This study was designed as a randomized crossover trial. Participants performed standardized healthcare tasks in a climatic chamber for approximately 3.5 h at different indoor temperatures (22 °C and 27 °C) and varied working conditions (with or without PPE). The effects on participants' subjective well-being, encompassing thermal, physiological and psychological stress were assessed using a customized questionnaire. RESULTS Heat had a greater effect than PPE on thermal, physical and psychological stress. Conversely, PPE had a greater effect on physical demand and effort. For the majority of outcomes, combined exposure to heat and PPE resulted in the highest perceived discomfort. Furthermore, the participants reported increased sweating and other discomforts when working at elevated temperatures or with PPE. CONCLUSIONS In this study, heat and PPE, but particularly the combination of both factors, were identified as unfavorable working environments. Although the trials were conducted in a controlled environment, the outcomes provide valuable information about the effect of heat and PPE on HCW in a real-life setting. Furthermore, the design used in this study can be beneficial in evaluating the effect of mitigation strategies.
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Affiliation(s)
- Caroline Quartucci
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Institute for Occupational Health and Product Safety, Bavarian Health and Food Safety Authority, Environmental Health, Munich, Germany
| | - Razan Wibowo
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Institute for Occupational Health and Product Safety, Bavarian Health and Food Safety Authority, Environmental Health, Munich, Germany
| | - Viet Do
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Stephan Bose-O Reilly
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Public Health, Medical Informatics and Technology, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Hall in Tirol, Austria
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Veronika Weilnhammer
- Institute for Occupational Health and Product Safety, Bavarian Health and Food Safety Authority, Environmental Health, Munich, Germany
| | - Tobias Weinmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Stefan Rakete
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
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40
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Cho JH, Jin SY, Park S. Carbon footprint and cost reduction by endoscopic grading of gastric intestinal metaplasia using narrow-band imaging. J Gastroenterol Hepatol 2024; 39:942-948. [PMID: 38251795 DOI: 10.1111/jgh.16493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND AIM Gastric intestinal metaplasia (GIM) is a high-risk factor for the development of gastric cancer. Narrow-band imaging (NBI) enables endoscopic grading of GIM (EGGIM). In the era of climate change, gastrointestinal endoscopists are expected to reduce greenhouse gas emissions and medical waste. Based on the diagnostic performance of NBI endoscopy, this study measured the environmental impact and reduced cost of implementing EGGIM during gastroscopy. METHODS Using NBI endoscopy in 242 patients, EGGIM classification and operative link on GIM (OLGIM) staging were prospectively performed in five different areas (lesser and greater curvatures of the corpus and antrum, and the incisura angularis). We estimated the environmental impact and cost reduction of the biopsy procedures and pathological processing if EGGIM were used instead of OLGIM. RESULTS The diagnostic accuracy of NBI endoscopy for GIM was 93.0-97.1% depending on the gastric area. When a high EGGIM score ≥ 5 was the cut-off value for predicting OLGIM stages III-IV, the area under the curve was 0.862, sensitivity was 81.9%, and specificity was 90.4%. The reduction in the carbon footprint by EGGIM was -0.4059 kg carbon dioxide equivalents per patient, equivalent to 1 mile driven by a gasoline-powered car. The cost savings were calculated to be $47.36 per patient. CONCLUSIONS EGGIM is a reliable method for identifying high-risk gastric cancer patients, thereby reducing the carbon footprint and medical costs in endoscopy practice.
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Affiliation(s)
- Jun-Hyung Cho
- Digestive Disease Center, Soonchunhyang University Hospital, Seoul, South Korea
| | - So-Young Jin
- Department of Pathology, Soonchunhyang University Hospital, Seoul, South Korea
| | - Suyeon Park
- Department of Medical Biostatistics, Soonchunhyang University Hospital, Seoul, South Korea
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41
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Malcolm J, Dodd A, Shaikh M, Cassels-Brown A, Buchan JC. Reducing the carbon footprint of cataract surgery: co-creating solutions with a departmental Delphi process. Eye (Lond) 2024; 38:1349-1354. [PMID: 38155328 PMCID: PMC11076634 DOI: 10.1038/s41433-023-02902-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Climate change is arguably the greatest threat to global health of the 21st century. Although cataract surgery is a major contributor to global greenhouse gas emissions, recent literature review identified a paucity of evidence-based strategies for improving the environmental impact of cataract services. Our study aimed to assess the effectiveness of a departmental Delphi process for improving cataract services' environmental sustainability. METHODS All members of ophthalmology theatre teams in a UK teaching hospital were invited to participate in a three-stage Delphi process. Team members were surveyed for suggestions for reducing the department's environmental impact. Suggested interventions were refined during a plenary face-to-face discussion and ranked. The highest ranked interventions were combined into a mutually agreed action plan. Data on the economic and environmental cost of cataract services was collected prior to and six months after the Delphi process using the Eyefficiency mobile application. RESULTS Twenty-three interventions were suggested by a range of staff cadres. Interventions were ranked by 24 team members. The 2nd, 4th, 5th, 8th and 11th ranked interventions were combined into an "Eco-packs" project in collaboration with suppliers (Bausch + Lomb), saving 675 kg of waste and 350 kg of CO2 equivalent annually. CONCLUSIONS The Delphi process is an effective method for provoking departmental engagement with the sustainability agenda that we would encourage all ophthalmology departments to consider utilising. The baseline per case CO2 equivalent measured in our department was reproducible and could serve as a maximum benchmark to be improved upon.
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Affiliation(s)
- Jonathan Malcolm
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK.
| | - Amy Dodd
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - Mohammad Shaikh
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | | | - John C Buchan
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Royal College of Ophthalmologists' National Ophthalmology Database, 18 Stephenson Way, London, NW1 2HD, UK
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Borboudaki L, Linardakis M, Tsiligianni I, Philalithis A. Utilization of Health Care Services and Accessibility Challenges among Adults Aged 50+ before and after Austerity Measures across 27 European Countries: Secular Trends in the SHARE Study from 2004/05 to 2019/20. Healthcare (Basel) 2024; 12:928. [PMID: 38727485 PMCID: PMC11083176 DOI: 10.3390/healthcare12090928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/20/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
This study aimed to assess and compare the utilization of preventive and other health services and the cost or availability in different regions of Europe, before and during the economic crisis. The data used in the study were obtained from Wave 8 of the Survey of Health, Ageing and Retirement in Europe (2019/2020) and Wave 1 data (2004/5), with a sample size of 46,106 individuals aged ≥50 across 27 countries, adjusted to represent a population of N = 180,886,962. Composite scores were derived for preventive health services utilization (PHSU), health care services utilization (HCSU), and lack of accessibility/availability in health care services (LAAHCS). Southern countries had lower utilization of preventive services and higher utilization of other health services compared to northern countries, with a significant lack of convergence. Moreover, the utilization of preventive health services decreased, whereas the utilization of secondary care services increased during the austerity period. Southern European countries had a significantly higher prevalence of lack of accessibility. An increase in the frequency of lack of accessibility/availability in health care services was observed from 2004/5 to 2019/20. In conclusion, our findings suggest that health inequalities increase during crisis periods. Therefore, policy interventions could prioritize accessibility and expand health coverage and prevention services.
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Affiliation(s)
- Lena Borboudaki
- Department of Social Medicine, School of Medicine, University of Crete, 71500 Heraklion, Greece; (M.L.); (I.T.); (A.P.)
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Blaustein JR, Quisel MJ, Hamburg NM, Wittkopp S. Environmental Impacts on Cardiovascular Health and Biology: An Overview. Circ Res 2024; 134:1048-1060. [PMID: 38662864 PMCID: PMC11058466 DOI: 10.1161/circresaha.123.323613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Environmental stressors associated with human activities (eg, air and noise pollution, light disturbance at night) and climate change (eg, heat, wildfires, extreme weather events) are increasingly recognized as contributing to cardiovascular morbidity and mortality. These harmful exposures have been shown to elicit changes in stress responses, circadian rhythms, immune cell activation, and oxidative stress, as well as traditional cardiovascular risk factors (eg, hypertension, diabetes, obesity) that promote cardiovascular diseases. In this overview, we summarize evidence from human and animal studies of the impacts of environmental exposures and climate change on cardiovascular health. In addition, we discuss strategies to reduce the impact of environmental risk factors on current and future cardiovascular disease burden, including urban planning, personal monitoring, and mitigation measures.
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Affiliation(s)
- Jacob R. Blaustein
- New York University Grossman School of Medicine, Department of Medicine, Leon H. Charney Division of Cardiology, New York, USA
| | - Matthew J. Quisel
- Department of Medicine, Boston University Chobanian and Avedision School of Medicine
| | - Naomi M. Hamburg
- Section of Vascular Biology, Whitaker Cardiovascular Institute, Chobanian and Avedisian School of Medicine, Boston University, Boston, USA
| | - Sharine Wittkopp
- New York University Grossman School of Medicine, Department of Medicine, Leon H. Charney Division of Cardiology, New York, USA
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Nadarajah K, Somat A, Baeyens C, Pansu P. How social background and interest in science are linked to junior high school students' perceptions of the ecological transition. Front Psychol 2024; 15:1360166. [PMID: 38680282 PMCID: PMC11046707 DOI: 10.3389/fpsyg.2024.1360166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/12/2024] [Indexed: 05/01/2024] Open
Abstract
Junior high school students are tomorrow's key protagonists in the ecological transition. They need enlightened education to face the uncertainty and challenges of climate change. The development of climate change education programs requires a clear understanding of how young people perceive the issue. This study deals with social representations. Its aim was to understand how social background and interest in science are linked to the way young people perceive the concept of the ecological transition. Four hundred twenty-nine junior high school students took part in this study. Data were collected and subjected to prototypical analysis and factorial correspondence analysis. Three main findings emerged from the analysis: (1) the participants had significant knowledge of the ecological transition, (2) their awareness of the social aspects of climate change was limited, and (3) their representations of the ecological transition were linked to their interest in science and their parents' social background. To conclude, these results underline the importance of educating all social classes about effective solutions for the ecological transition. Our findings also highlight the need to consider existing representations and prior knowledge when designing educational programs on climate change issues.
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Affiliation(s)
- Kévin Nadarajah
- Laboratoire de Recherche sur les Apprentissages en Contexte (LaRAC), Univ. Grenoble Alpes, Grenoble, France
- Laboratoire de Psychologie: Cognition, Comportement, Communication (LP3C), Psychology, Rennes 2 University, Rennes, France
| | - Alain Somat
- Laboratoire de Psychologie: Cognition, Comportement, Communication (LP3C), Psychology, Rennes 2 University, Rennes, France
| | - Céline Baeyens
- Laboratoire Inter-Universitaire de Psychologie, Personnalité, Cognition, Changement Social (LIP/PC2S), Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, Grenoble, France
| | - Pascal Pansu
- Laboratoire de Recherche sur les Apprentissages en Contexte (LaRAC), Univ. Grenoble Alpes, Grenoble, France
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Nordin EJ, Dugan SM, Kusters AC, Schimek CA, Sherman KA, Ebert TJ. How an Audit-and-Feedback-Based Educational Program Contributed to a Reduction in Environmentally Harmful Waste Anesthetic Gases Among Anesthesiology Residents. J Grad Med Educ 2024; 16:175-181. [PMID: 38993317 PMCID: PMC11234298 DOI: 10.4300/jgme-d-23-00402.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/15/2023] [Accepted: 02/09/2024] [Indexed: 07/13/2024] Open
Abstract
Background Waste anesthetic gases (WAGs) contribute to greenhouse gas emissions. US anesthesiology resident education on how to reduce WAG-associated emissions is lacking, so we developed an electronic audit-and-feedback-based program to teach residents to reduce fresh gas flow (FGF) and WAG-associated emissions. Objective To assess the program's effectiveness, we measured individual and combined mean FGF of residents during their first, second, and last weeks of the 4-week rotation; then, we calculated the extrapolated annual emissions based on the combined resident mean FGFs. Resident attitudes toward the program were surveyed. Methods During 4-week rotations at a teaching hospital, anesthesia records were scanned to extract resident-assigned cases, FGF, and volatile anesthetic choice during the 2020-2021 academic year. Forty residents across 3 training years received weekly FGF data and extrapolated WAG-associated emissions data via email. Their own FGF data was compared to the low-flow standard FGF of ≤1 liter per minute (LPM) and to the FGF data of their peer residents on rotation with them. An online survey was sent to residents at the end of the project period. Results Between their first and last weeks on rotation, residents decreased their mean FGF by 22% (1.83 vs 1.42 LPM; STD 0.58 vs 0.44; 95% CI 1.67-2.02 vs 1.29-1.56; P<.0001). Ten of 18 (56%) residents who responded to the survey reported their individual case-based results were most motivating toward practice change. Conclusions An audit-and-feedback-based model for anesthesiology resident education, designed to promote climate-conscious practices with administration of volatile anesthetics, was effective.
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Affiliation(s)
- Emily J Nordin
- is a Medical Student, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shannon M Dugan
- is an Anesthesiology Research Coordinator, Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
| | - Andrew C Kusters
- is a Biomedical Engineer, Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
| | | | - Katherine A Sherman
- is a Statistician, Zablocki VA Medical Center, Milwaukee, Wisconsin, USA; and
| | - Thomas J Ebert
- is a Clinician Scientist, Medical College of Wisconsin, and Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
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Sonaiya S, Marino R, Agollari K, Sharma P, Desai M. Environmentally sustainable gastroenterology practice: Review of current state and future goals. Dig Endosc 2024; 36:406-420. [PMID: 37723605 DOI: 10.1111/den.14688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/10/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVES The health-care sector contributes 4.6% of global greenhouse gas emissions, with gastroenterology playing a significant role due to the widespread use of gastrointestinal (GI) endoscopy. In this review, we aim to understand the carbon footprint in gastroenterology practice associated with GI endoscopy, conferences and recruitment, identify barriers to change, and recommend mitigating strategies. METHODS A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted to explore the carbon footprint in gastroenterology practice, focusing on endoscopy, inpatient and outpatient settings, and recruitment practices. Recommendations for mitigating the carbon footprint were derived. RESULTS This narrative review analyzed 34 articles on the carbon footprint in gastroenterology practice. Carbon footprint of endoscopy in the United States is approximately 85,768 metric tons of CO2 emission annually, equivalent to 9 million gallons of gasoline consumed, or 94 million pounds of coal burned. Each endoscopy generates 2.1 kg of disposable waste (46 L volume), of which 64% of waste goes to the landfill, 28% represents biohazard waste, and 9% is recycled. The per-case manufacturing carbon footprint for single-use devices and reusable devices is 1.37 kg CO2 and 0.0017 kg CO2, respectively. Inpatient and outpatient services contributed through unnecessary procedures, prolonged hospital stays, and excessive use of single-use items. Fellowship recruitment and gastrointestinal conferences added to the footprint, mainly due to air travel and hotel stays. CONCLUSION Gastrointestinal endoscopy and practice contribute to the carbon footprint through the use of disposables such as single-use endoscopes and waste generation. To achieve environmental sustainability, measures such as promoting reusable endoscopy equipment over single-use endoscopes, calculating institutional carbon footprints, establishing benchmarking standards, and embracing virtual platforms such as telemedicine and research meetings should be implemented.
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Affiliation(s)
- Sneh Sonaiya
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Richard Marino
- Kansas City University School of Medicine, Kansas City, USA
| | - Klea Agollari
- Kansas City University School of Medicine, Kansas City, USA
| | | | - Madhav Desai
- Center for Interventional Gastroenterology, UTHealth McGovern Medical School, Houston, USA
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Cohen ES, Kouwenberg LHJA, Moody KS, Sperna Weiland NH, Kringos DS, Timmermans A, Hehenkamp WJK. Environmental sustainability in obstetrics and gynaecology: A systematic review. BJOG 2024; 131:555-567. [PMID: 37604701 DOI: 10.1111/1471-0528.17637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/04/2023] [Accepted: 07/29/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The healthcare sector is responsible for 4%-10% of global greenhouse gas emissions. Considering the broad range of care that obstetricians and gynaecologists provide, mitigation strategies within this specialty could result in significant reductions of the environmental footprint across the whole healthcare industry. OBJECTIVES The aim of this review was to identify for what services, procedures and products within obstetric and gynaecological care the environmental impact has been studied, to assess the magnitude of such impact and to identify mitigation strategies to diminish it. SEARCH STRATEGY The search strategy combined terms related to environmental impact, sustainability, climate change or carbon footprint, with the field of obstetrics and gynaecology. SELECTION CRITERIA Articles reporting on the environmental impact of any service, procedure or product within the field of obstetrics and gynaecology were included. Included outcomes covered midpoint impact categories, CO2 emissions, waste generation and energy consumption. DATA COLLECTION AND ANALYSIS A systematic literature search was conducted in the databases of MEDLINE (Ovid), Embase (Ovid) and Scopus, and a grey literature search was performed on Google Scholar and two websites of gynaecological associations. MAIN RESULTS The scope of the investigated studies encompassed vaginal births, obstetric and gynaecological surgical procedures, menstrual products, vaginal specula and transportation to gynaecological oncologic consultations. Among the highest yielding mitigation strategies were displacing disposable with reusable materials and minimising content of surgical custom packs. The lowest yielding mitigation strategy was waste optimisation, including recycling. CONCLUSIONS This systematic review highlights opportunities for obstetricians and gynaecologists to decrease their environmental footprint in many ways. More high-quality studies are needed to investigate the environmental impact of other aspects of women's and reproductive health care.
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Affiliation(s)
- Eva Sayone Cohen
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Quality of Care, Global Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Lisanne H J A Kouwenberg
- Quality of Care, Global Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Kate S Moody
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nicolaas H Sperna Weiland
- Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Anaesthesiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Dionne Sofia Kringos
- Quality of Care, Global Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Anne Timmermans
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Wouter J K Hehenkamp
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Durnall O, Martin N, Mulligan S, Dixon J. Environmental sustainability: the attitudes and experiences of UK students in the oral health care profession. Br Dent J 2024:10.1038/s41415-024-7135-z. [PMID: 38443612 DOI: 10.1038/s41415-024-7135-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/03/2023] [Indexed: 03/07/2024]
Abstract
Objective This study aims to provide insight into the attitudes and perspectives of undergraduate dental students from UK dental schools regarding environmental sustainability in dentistry (ESD) and the manner and extent in which ESD is included in the current undergraduate oral health care curricula.Methods This study is a multi-centre, nationally representive study involving a cross-sectional online survey of undergraduate Bachelor of Dental Surgery and dental hygiene and therapy students in UK-based dental schools. Data analysis was conducted through descriptive statistics and thematic analysis.Results In total, 263 students from 13 UK schools completed the survey, resulting in a national school response rate of 68.4%. Key findings are: 97.3% of students believe that the dental profession should be more actively engaged in environmental sustainability but students currently have very little exposure to ESD at an undergraduate level; and 76.8% of students expressed that they are concerned about the impact that oral health care provision has on the environment, but only 23% of students have independently researched ESD.Conclusions Students identify that oral health care professionals should become more engaged in efforts to mitigate the negative impacts from our activities on the environment, principally via education at all levels. The data from this study provide insight into the current level of awareness and concerns for the environmental impacts of oral health care provision, and are a powerful driver for the inclusion of ESD into the undergraduate curriculum in UK based dental schools.
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Walter TG, Bricknell LK, Preston RG, Crawford EGC. Climate Change Adaptation Methods for Public Health Prevention in Australia: an Integrative Review. Curr Environ Health Rep 2024; 11:71-87. [PMID: 38221599 PMCID: PMC10907446 DOI: 10.1007/s40572-023-00422-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE OF REVIEW Climate change poses a serious threat to human health and well-being. Australia is not immune to the public health impacts and continues to be underprepared, putting the population health at risk. However, there is a dearth in knowledge about how the Australian public health system will address the impacts of climate change. RECENT FINDINGS This integrative review synthesises tools, frameworks, and guidance material suitable for climate change adaptation from a preventive public health perspective. The literature search was conducted in electronic databases MEDLINE, PubMed, CINAHL, and Web of Science. Of 4507 articles identified, 19 articles met the inclusion criteria that focused on operational methods in public health and excluded the clinical context and reactive disaster response approaches. This review revealed that Australia is ill-prepared to manage climate change adverse health impacts due to ineffective adaptation strategies. The review highlights that Australia urgently requires effective adaptation strategies such as undertaking a National Adaptation Plan process and an improved understanding in managing complex health risks. Taking this action will strengthen the public health system and build health resilience especially for vulnerable populations. These findings will help understand and develop of the necessary adaptive strategies in Australia.
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Affiliation(s)
- Tony G Walter
- School of Health, Medical and Applied Sciences, Central Queensland University, 554-700 Yaamba Road, Norman Gardens, 4701, Australia.
| | - Lisa K Bricknell
- School of Health, Medical and Applied Sciences, Central Queensland University, 554-700 Yaamba Road, Norman Gardens, 4701, Australia
| | - Robyn G Preston
- School of Health, Medical and Applied Sciences, Central Queensland University, 538 Flinders Street, Townsville, QLD, 4810, Australia
| | - Elise G C Crawford
- School of Health, Medical and Applied Sciences, Central Queensland University, 554-700 Yaamba Road, Norman Gardens, 4701, Australia
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Baboudjian M, de La Taille A, Lechevallier E, Pradere B, Mallet R. Urologists and Sustainability: The First Survey from the French Sustainability Working Group. Eur Urol Focus 2024; 10:315-316. [PMID: 38395728 DOI: 10.1016/j.euf.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Affiliation(s)
- Michael Baboudjian
- Department of Urology, North Academic Hospital, AP-HM, Marseille, France.
| | - Alexandre de La Taille
- Department of Urology, University Hospital Henri Mondor, AP-HP, Université Paris-Est Créteil, Créteil France
| | - Eric Lechevallier
- Department of Urology and Kidney Transplantation, AP-HM, La Conception Academic Hospital, Marseille, France
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria; Department of Urology UROSUD, La Croix du Sud Hôpital, Quint Fonsegrives, France
| | - Richard Mallet
- Department of Urology, Hôpital Privé Francheville, Périgueux, France
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