The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health

Climate-related health impact indicators for public health surveillance in a changing climate: a systematic review and local suitability analysis

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.

Eco-sustainability in ophthalmology

PURPOSE OF REVIEW

The purpose of this review is to evaluate the current state of eco-sustainability in ophthalmology, highlighting key practices, recent advancements, and areas requiring improvement. This review aims to provide ophthalmologists with a comprehensive overview of sustainable practices that can reduce environmental impact.

RECENT FINDINGS

Recent studies have identified several areas within ophthalmology where sustainable practices can be implemented including multidose eyedrops, adjusting surgical packs, making package inserts available electronically, and reusing surgical instruments. Moreover, there is an increasing emphasis on waste reduction both in the surgical and clinical setting, by decreasing the use of unnecessary materials and implementing more efficient use of recycling programs. Telemedicine has also emerged as a sustainable option, reducing the carbon footprint associated with patient travel. Despite these advancements, significant challenges remain, particularly in balancing the cost and accessibility of sustainable options with traditional practices.

SUMMARY

Eco-sustainability in ophthalmology is gaining momentum as the medical community aims to reduce its environmental impact. While progress has been made, further efforts are required to overcome financial and logistical barriers to widespread implementation. Continued research, education, and policy development are essential to advancing eco-sustainable practices, ensuring that environmental considerations become an integral part of ophthalmic care.

Nursing students' and educators' perspectives on sustainability and climate change: An integrative review

AIM

To identify and synthesize research on the awareness, attitudes and action related to sustainability and climate change from the perspective of nursing students and educators globally.

DESIGN

Integrative review.

METHODS

The review was guided by Whittemore and Knafl. Included studies were appraised using the Mixed Methods Appraisal Tool. A deductive content analysis based on Elo and Kyngäs' methodology was employed.

DATA SOURCES

CINAHL, MEDLINE, EMBASE, Web of Science, British Education Index, GreenFILE and Scopus were searched up to the 8th November 2022.

RESULTS

Thirty-two studies were included in the review. Two studies included nursing educators in their samples, the rest focused solely on students. Findings suggest that whilst some students were aware of sustainability issues and felt that nurses have a responsibility to mitigate climate change, others showed limited awareness and believed that nurses have more important priorities. A global interest was seen among students for increased curricular content related to sustainability and climate change. Waste management and education of others were suggested actions students can take; however, barriers included lack of confidence and limited power.

CONCLUSION

There is a need for sustainability education within nursing curricula, accompanied by student support.

IMPLICATIONS FOR THE PROFESSION

The review acts as a starting point to make sustainable healthcare and climate change mitigation integral aspects of nursing.

IMPACT

Sustainability education within nursing curricula can positively impact on sustainable healthcare and climate change mitigation. More research is needed on the perspectives of nursing educators.

REPORTING METHOD

The review is reported according to the PRISMA guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Learning health systems on the front lines to strengthen care against future pandemics and climate change: a rapid review

BACKGROUND

An essential component of future-proofing health systems against future pandemics and climate change is strengthening the front lines of care: principally, emergency departments and primary care settings. To achieve this, these settings can adopt learning health system (LHS) principles, integrating data, evidence, and experience to continuously improve care delivery. This rapid review aimed to understand the ways in which LHS principles have been applied to primary care and emergency departments, the extent to which LHS approaches have been adopted in these key settings, and the factors that affect their adoption.

METHODS

Three academic databases (Embase, Scopus, and PubMed) were searched for full text articles reporting on LHSs in primary care and/or emergency departments published in the last five years. Articles were included if they had a primary focus on LHSs in primary care settings (general practice, allied health, multidisciplinary primary care, and community-based care) and/or emergency care settings. Data from included articles were catalogued and synthesised according to the modified Institute of Medicine's five-component framework for LHSs (science and informatics, patient-clinician partnerships, incentives, continuous learning culture, and structure and governance).

RESULTS

Thirty-seven articles were included, 32 of which reported LHSs in primary care settings and seven of which reported LHSs in emergency departments. Science and informatics was the most commonly reported LHS component, followed closely by continuous learning culture and structure and governance. Most articles (n = 30) reported on LHSs that had been adopted, and many of the included articles (n = 17) were descriptive reports of LHS approaches.

CONCLUSIONS

Developing LHSs at the front lines of care is essential for future-proofing against current and new threats to health system sustainability, such as pandemic- and climate change-induced events. Limited research has examined the application of LHS concepts to emergency care settings. Implementation science should be utilised to better understand the factors influencing adoption of LHS approaches on the front lines of care, so that all five LHS components can be progressed in these settings.

The use of time-dynamic patterns of temperature and flexible generalized models to clarify the relations between temperature and semen quality

BACKGROUND

Sperm quality has decreased over the last decades worldwide. It is affected, among others, by season and heat. This study aimed to address the association between ambient temperature and sperm quality by assessing its shape using flexible multivariate models and identifying distinct time-dynamic patterns of temperature change based on unsupervised analysis.

MATERIAL AND METHODS

A retrospective population-based study has been conducted, including all samples of males attending the Fertility and In-Vitro-Fertilization unit at a single medical center during 2016-2022. Flexible generalized models were fitted to characterize the relations between sperm quality and temperature while accounting for patients characteristics, and to identify temperature levels that correspond with the optimal sperm quality. This information was then used to estimate adjusted slope coefficients at specified time-windows.

RESULTS

In total, 4555 sperm samples were provided by 3229 individuals. Sperm concentration, motility and progressive motility were higher by 8 %, 11 % and 16 %, respectively, during the spring versus the fall season. Furthermore, their quality during early spermatogenesis improved with temperature, until a certain optimum around 23 °C-24 °C. Increasing temperature at later developmental stages was associated with lower sperm concentration and higher motility. Sperm concentration and motility were highest following a period of moderate gradual warming. Motility was higher and sperm concentration was lower, following a period with heatwaves or summer.

CONCLUSIONS

This study assessed temperature role in sperm production quality by considering both average and time-dynamic temperatures. It identified several temperature change patterns over time and stratified the analysis by them. The differences in the relations across stages of spermatogenesis were addressed. Several mechanisms may explain the associations found, including heat-induced apoptosis of the sperm cells, and destruction of sperm cells DNA integrity by over-production of reactive oxygen species. The gradual global warming necessitates exploration of individual response to outdoor temperature in relations to genetic predisposition, lifestyle, and other health characteristics.

Carbon Footprint of Total Intravenous and Inhalation Anesthesia in the Transcatheter Aortic Valve Replacement Procedure

OBJECTIVES

To quantify and compare the emissions for deep sedation with total intravenous anesthesia (TIVA) and general anesthesia with inhaled agents during the transcatheter aortic valve replacement procedure.

DESIGN

A retrospective study.

SETTING

A tertiary hospital in Boston, Massachusetts.

PARTICIPANTS

The anesthesia records of 604 consecutive patients who underwent the transcatheter aortic valve replacement procedure between January 1, 2018, and March 31, 2022, were reviewed and analyzed.

INTERVENTIONS

Data were examined and compared in the following 2 groups: general anesthesia with inhaled agents and deep sedation with TIVA.

MEASUREMENTS AND MAIN RESULTS

The gases, drugs, airway management devices, and anesthesia machine electricity were collected and converted into carbon dioxide emissions (CO2e). The carbon emissions of intravenous medications were converted with the CO2e data for anesthetic pharmaceuticals from the Parvatker et al. study. For inhaled agents, inhaled anesthetics and oxygen/air flow rate were collected at 15-minute intervals and calculated using the anesthetic gases calculator provided by the Association of Anesthetists. The airway management devices were converted based on life-cycle assessments. The electricity consumed by the anesthesia machine during general anesthesia was estimated from the manufacturer's data (Dräger, GE) and local Energy Information Administration data. The data were analyzed in the chi-squared test or Wilcoxon rank-sum test. There were no significant differences in the patients' demographic characteristics, such as age, sex, weight, height, and body mass index. The patients who received general anesthesia with inhaled agents had statistically higher total CO2e per case than deep sedation with TIVA (16.188 v 1.518 kg CO2e; p < 0.001), primarily due to the inhaled agents and secondarily to airway management devices. For deep sedation with TIVA, the major contributors were intravenous medications (71.02%) and airway management devices (16.58%). A subgroup study of patients who received sevoflurane only showed the same trend with less variation.

CONCLUSIONS

The patients who received volatile anesthesia were found to have a higher CO2e per case. This difference remained after a subgroup analysis evaluating those patients only receiving sevoflurane and after accounting for the differences in the duration of anesthesia. Data from this study and others should be collectively considered as the healthcare profession aims to provide the best care possible for their patients while limiting the harm caused to the environment.

Mental health impacts from repeated climate disasters: an australian longitudinal analysis

Background

Extreme weather events are becoming more frequent and intense under changing climatic conditions. Whilst there is substantial evidence that exposure to a single weather related disaster is detrimental for mental health, few studies have explored how exposure to multiple disasters impacts mental health.

Methods

We utilised 11 waves of data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey, yielding a sample of 16,629 observations from 2003 individuals. Fixed effects linear regression analysis was used to estimate the impact of experiencing multiple disasters on mental health. We tested for effect modification on this association by sex, rurality, employment and presence of a long-term health condition.

Findings

Exposure to multiple disasters was associated with a relative decrease in MHI-5 score compared to baseline by -1.8 points (95% CI -3.4, -0.3), whereas exposure to a single disaster was not associated with a decline in mental health scores. There was evidence of effect modification by employment status. Unemployed individuals had evidence of moderate reduction in MHI-5 scores when exposed to a single disaster (-4.3, 95% CI -7.0, -1.5).

Interpretation

Findings suggest that repeat exposure to disasters is associated with worsening mental health outcomes. As extreme weather events increase, these findings highlight the need for greater attention on climate change action, and mental health interventions targeting impacted populations.

Funding

Suicide Prevention Australia.

Microbial community structure of plant-based meat alternatives

A reduction in animal-based diets has driven market demand for alternative meat products, currently raising a new generation of plant-based meat alternatives (PBMAs). It remains unclear whether these substitutes are a short-lived trend or become established in the long term. Over the last few years, the trend of increasing sales and diversifying product range has continued, but publication activities in this field are currently limited mainly to market research and food technology topics. As their popularity increases, questions emerge about the safety and nutritional risks of these novel products. Even though all the examined products must be heated before consumption, consumers lack experience with this type of product and thus further research into product safety, is desirable. To consider these issues, we examined 32 PBMAs from Austrian supermarkets. Based on 16S rRNA gene amplicon sequencing, the majority of the products were dominated by lactic acid bacteria (either Leuconostoc or Latilactobacillus), and generally had low alpha diversity. Pseudomonadota (like Pseudomonas and Shewanella) dominated the other part of the products. In addition to LABs, a high diversity of different Bacillus, but also some Enterobacteriaceae and potentially pathogenic species were isolated with the culturing approach. We assume that especially the dominance of heterofermentative LABs has high relevance for the product stability and quality with the potential to increase shelf life of the products. The number of isolated Enterobacteriaceae and potential pathogens were low, but they still demonstrated that these products are suitable for their presence.

Impacts of heat exposure in utero on long-term health and social outcomes: a systematic review

BACKGROUND

Climate change, particularly global warming, is amongst the greatest threats to human health. While short-term effects of heat exposure in pregnancy, such as preterm birth, are well documented, long-term effects have received less attention. This review aims to systematically assess evidence on the long-term impacts on the foetus of heat exposure in utero.

METHODS

A search was conducted in August 2019 and updated in April 2023 in MEDLINE(PubMed). We included studies on the relationship of environmental heat exposure during pregnancy and any long-term outcomes. Risk of bias was assessed using tools developed by the Joanna-Briggs Institute, and the evidence was appraised using the GRADE approach. Synthesis without Meta-Analysis (SWiM) guidelines were used.

RESULTS

Eighteen thousand six hundred twenty one records were screened, with 29 studies included across six outcome groups. Studies were mostly conducted in high-income countries (n = 16/25), in cooler climates. All studies were observational, with 17 cohort, 5 case-control and 8 cross-sectional studies. The timeline of the data is from 1913 to 2019, and individuals ranged in age from neonates to adults, and the elderly. Increasing heat exposure during pregnancy was associated with decreased earnings and lower educational attainment (n = 4/6), as well as worsened cardiovascular (n = 3/6), respiratory (n = 3/3), psychiatric (n = 7/12) and anthropometric (n = 2/2) outcomes, possibly culminating in increased overall mortality (n = 2/3). The effect on female infants was greater than on males in 8 of 9 studies differentiating by sex. The quality of evidence was low in respiratory and longevity outcome groups to very low in all others.

CONCLUSIONS

Increasing heat exposure was associated with a multitude of detrimental outcomes across diverse body systems. The biological pathways involved are yet to be elucidated, but could include epigenetic and developmental perturbations, through interactions with the placenta and inflammation. This highlights the need for further research into the long-term effects of heat exposure, biological pathways, and possible adaptation strategies in studies, particularly in neglected regions. Heat exposure in-utero has the potential to compound existing health and social inequalities. Poor study design of the included studies constrains the conclusions of this review, with heterogenous exposure measures and outcomes rendering comparisons across contexts/studies difficult.

TRIAL REGISTRATION

PROSPERO CRD 42019140136.

[Health issues related to the environment and the role of caregivers]

The healthcare system and the practice of health care have unprecedented impacts on our environment. High carbon footprint, pollution and its consequences on health, the picture is not glorious. Even if they rarely identify themselves as such, healthcare professionals are key actors in the drive towards more sustainable practices. Their numbers, skills and activities give them privileged access to the population, communities and individuals of all ages and backgrounds. Thanks to their increasingly specialized training, they are in a position to accompany people on their health journey, prevent illness and promote healthy behaviours. These aspects are central to sustainability in healthcare.

Short-term changes in mental health help-seeking behaviors following exposure to multiple social stressors and a natural disaster

In 2020, unprecedented circumstances led to significant mental health consequences. Individuals faced mental health stressors that extended beyond the devastating impact of the COVID-19 pandemic, including widespread social unrest following the murder of George Floyd, an intense hurricane season in the Atlantic, and the politically divisive 2020 election. The objective of this analysis was to consider changes in help-seeking behavior following exposure to multiple social stressors and a natural disaster. Data from Crisis Text Line (CTL), a national text-based mental health crisis counseling service, was used to determine how help-seeking behavior changed in the wake of each event. Wilcoxon rank sum tests assessed changes in help-seeking behavior for each event in 2020 as compared to the same period in 2019. AutoRegressive Integrated Moving Average (ARIMA) models examined if changes in crisis conversation volumes following each event differed. Higher median conversation volumes noted for the COVID-19 pandemic (+1 to +5 conversations), Hurricane Laura (+1 to +7 conversations) and the 2020 Election (+1 to +26 conversations). ARIMA models show substantial increases in help-seeking behavior following the declaration of a national emergency for the COVID-19 pandemic (+4.3 to +38.2%) and following the 2020 election (+3 to +24.44%). Our analysis found that the mental health response following social stressors may be distinct from natural events, especially when natural disasters occur in the context of multiple social stressors. This analysis adds to the growing body of literature considering the mental health impact of exposure to multiple co-occurring societal stressors, like police violence and a global pandemic.

Synergistic interactions of nanoparticles and plant growth promoting rhizobacteria enhancing soil-plant systems: a multigenerational perspective

Sustainable food security and safety are major concerns on a global scale, especially in developed nations. Adverse agroclimatic conditions affect the largest agricultural-producing areas, which reduces the production of crops. Achieving sustainable food safety is challenging because of several factors, such as soil flooding/waterlogging, ultraviolet (UV) rays, acidic/sodic soil, hazardous ions, low and high temperatures, and nutritional imbalances. Plant growth-promoting rhizobacteria (PGPR) are widely employed in in-vitro conditions because they are widely recognized as a more environmentally and sustainably friendly approach to increasing crop yield in contaminated and fertile soil. Conversely, the use of nanoparticles (NPs) as an amendment in the soil has recently been proposed as an economical way to enhance the texture of the soil and improving agricultural yields. Nowadays, various research experiments have combined or individually applied with the PGPR and NPs for balancing soil elements and crop yield in response to control and adverse situations, with the expectation that both additives might perform well together. According to several research findings, interactive applications significantly increase sustainable crop yields more than PGPR or NPs alone. The present review summarized the functional and mechanistic basis of the interactive role of PGPR and NPs. However, this article focused on the potential of the research direction to realize the possible interaction of PGPR and NPs at a large scale in the upcoming years.

Applying Machine Learning Techniques to Implementation Science

Machine learning (ML) approaches could expand the usefulness and application of implementation science methods in clinical medicine and public health settings. The aim of this viewpoint is to introduce a roadmap for applying ML techniques to address implementation science questions, such as predicting what will work best, for whom, under what circumstances, and with what predicted level of support, and what and when adaptation or deimplementation are needed. We describe how ML approaches could be used and discuss challenges that implementation scientists and methodologists will need to consider when using ML throughout the stages of implementation.

Establishing and Defining an Approach to Climate Conscious Clinical Medical Ethics

An anthropocentric scope for clinical medical ethics (CME) has largely separated this area of bioethics from environmental concerns. In this article, we first identify and reconcile the ethical issues imposed on CME by climate change including the dispersion of related causes and effects, the transdisciplinary and transhuman nature of climate change, and the historic divorce of CME from the environment. We then establish how several moral theories undergirding modern CME, such as virtue ethics, feminist ethics, and several theories of justice, promote both a flourishing of human medical practice and the environment. We conclude by defining an expanded the scope of CME as inclusive of not only patients, families, physicians, and other health professionals but other humans, non-humans, and their shared environment. We then apply this scope and theory to a widely used framework for applying CME, the Four Topics model, to construct a climate conscious approach to CME.

The environmental awareness of nurses as environmentally sustainable health care leaders: a mixed method analysis

BACKGROUND

People worldwide are concerned with the possibility of climate change, microplastics, air pollution, and extreme weather affecting human health. Countries are implementing measures to reduce environmental impacts. Nurses play a vital role, primarily through Green Teams, in the process of promoting sustainable practices and minimizing the environmental footprint of health care facilities. Despite existing knowledge on this topic, assessing nurses' environmental awareness and behavior, including the barriers they face, is crucial with regard to improving sustainable health care practices.

AIM

To analyze the environmental awareness and behavior of nurses, especially nurse leaders, as members of the Green Team and to identify areas for improvement with regard to the creation of a sustainable environment.

METHODS

A sequential mixed-method study was conducted to investigate Spanish nurses. The study utilized an online survey and interviews, including participant observation. An online survey was administered to collect quantitative data regarding environmental awareness and behavior. Qualitative interviews were conducted with environmental nurses in specific regions, with a focus on Andalusia, Spain.

RESULTS

Most of the surveyed nurses (N = 314) exhibited moderate environmental awareness (70.4%), but their environmental behavior and activities in the workplace were limited (52.23% of participants rarely performed relevant actions, and 35.03% indicated that doing so was difficult). Nurses who exhibited higher levels of environmental awareness were more likely to engage in sustainable behaviors such as waste reduction, energy conservation, and environmentally conscious purchasing decisions (p < 0.05). Additionally, the adjusted model indicated that nurses' environmental behavior and activities in the workplace depend on the frequency of their environmental behaviors outside work as well as their sustainable knowledge (p < 0.01). The results of the qualitative study (N = 10) highlighted certain limitations in their daily practices related to environmental sustainability, including a lack of time, a lack of bins and the pandemic. Additionally, sustainable environmental behavior on the part of nursing leadership and the Green Team must be improved.

CONCLUSIONS

This study revealed that most nurses have adequate knowledge, attitudes, and behaviors related to environmental sustainability both inside and outside the workplace. Limitations were associated with their knowledge and behaviors outside of work. This study also highlighted the barriers and difficulties that nurses face in their attempts to engage in adequate environmental behaviors in the workplace. Based on these findings, interventions led by nurses and the Green Team should be developed to promote sustainable behaviors among nurses and address the barriers and limitations identified in this research.

Environmental Sustainability and Climate Change Content in Canadian Baccalaureate Nursing Programs

BACKGROUND

This study analyzed publicly available resources related to environmental and climate change material available within the Canadian Bachelor of Nursing Program curricula.

METHOD

This thematic review project contained two stages of data collection: (1) a comprehensive team-based review of Internet materials and (2) a digital survey of program faculties.

RESULTS

Most content reviewed included references to climate change. According to survey responses from program directors (n = 12), barriers to integrating climate change content included lack of institutional support, the perception that content was not important in undergraduate curriculum, a conviction that the material would be more appropriate for public health, and an overall lack of understanding of the topic by course authors.

CONCLUSION

With increasing emphasis on the importance of geopolitical health and climate change to many facets of nursing practice, nurse educators require support from colleagues and postsecondary institutions to incorporate this material into undergraduate nursing curricula. [J Nurs Educ. 2024;63(4):212-217.].

Effects of temperature anomaly on sperm quality: A multi-center study of 33,234 men

Backgrounds

Global fertility rates continue to decline and sperm quality is a prime factor affecting male fertility. Both extreme cold and heat have been demonstrated to be associated with decreased sperm quality, but no epidemiological studies have considered human adaptation to long-term temperature. Our aim was to conduct a multi-center retrospective cohort study to investigate exposure-response relationship between temperature anomaly (TA) that deviate from long-term climate patterns and sperm quality.

Methods

A total of 78,952 semen samples measured in 33,234 donors from 6 provincial human sperm banks in China were collected. This study considered heat and cold acclimatization to prolonged exposure in humans and explored the exposure-response relationship between TAs and sperm quality parameters (sperm concentrations, sperm count, progressive motility, progressive sperm count, total motility and total motile sperm count) during the hot and cold seasons, respectively. Linear mixed models and generalized linear models were built separately for specific centers to pool in a meta-analysis to obtain the pooled effect of TA on sperm quality, considering repeated measurements data structure and spatial heterogeneity.

Results

We identified an inverted U-shaped exposure-response relationship between TA and sperm quality during the hot season. Significant negative effect of anomalous cold on sperm quality during the hot season was found after additional adjustment for Body mass index, marital status and childbearing history. The heat-related TA in hot season was significantly negatively associated with sperm concentration, progressive sperm count and total motile sperm count (all P-values<0.05). After adjusting the relative humidity, the cold-related TA in cold season was negatively associated with the sperm total motility (P-values<0.05).

Conclusions

Our results suggest both heat-related and cold-related TAs are associated with decreased sperm quality. The findings highlight the importance of reducing exposure to anomalous temperatures to protect male fertility.

Climate Change Adaptation Methods for Public Health Prevention in Australia: an Integrative Review

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.

Easy-to-implement educational interventions to bring climate-smart actions to daily anesthesiologic practice: a cross-sectional before and after study

BACKGROUND

Anesthesia contributes significantly to a hospital's carbon footprint. Climate-smart actions have the potential to reduce greenhouse gas emissions. Prerequisites for sustainable behavior of providers are knowledge and awareness. We aimed to assess the change in anesthesiologists' climate-friendly behavior before and after educational interventions in three areas that every anesthesiologist can address in their daily clinical routine: 1) energy use; 2) recycling opportunities; 3) consumption of volatile anesthetics.

METHODS

We performed a cross-sectional before-and-after single center sub-study within the multicenter "Provider Education and Evaluation Project" at the Department of Anesthesiology, RWTH Aachen University hospital from May3 2021 to May 1 2022. Educational interventions consisted of stickers, posters and a presentation on climate-smart actions in anesthesiologists' work routine between the first and the second assessment. For each cross-sectional assessment, all central 28 ORs were observed for one week. During the before-and-after comparison we analyzed: 1) energy wasted in unoccupied ORs because of running computers and turned-on lights at 9 p.m.; 2) feasibility of recycling preoperative anesthesia plastic packaging by determining the difference between calculated weight of unseparated preoperative plastic waste in the first assessment and the weight of actual separated waste in the second assessment; 3) fresh gas flow in balanced anesthesia cases in steady state at 9 a.m., and purchased hypnotics converted to bottles/1000 general anesthesia cases in 2018-2022.

RESULTS

We observed a reduction of wasted energy by 44% in unoccupied ORs. Usage of low fresh gas flow settings increased from 55% to 75%. The average of purchased desflurane in 2018-2020 decreased by 72% in 2022. We calculated 10.33 kg of preoperative plastic waste per week but were unable to implement waste separation for infrastructural and logistical reasons.

CONCLUSIONS

We found that environment-friendly working behaviors increased after the implementation of educational interventions. The causality between the interventions and the observed improvements remains to be proven.

"I think they should give primary health care a little more priority". The primary health care in Caribbean SIDS: what can be said about adaptation to the changing climate? The case of Dominica- a qualitative study

BACKGROUND

Adaptation to climate change (CC) is a priority for Small Island Developing States (SIDS) in the Caribbean, as these countries and territories are particularly vulnerable to climate-related events. Primary health care (PHC) is an important contributor to CC adaptation. However, knowledge on how PHC is prepared for CC in Caribbean SIDS is very limited. The aim of this paper is to discuss health system adaptation to climate change, with a focus on PHC.

METHODS

We explored the perspectives of PHC professionals in Dominica on PHC adaptation to climate change. Focus group discussions (FGDs) were conducted in each of the seven health districts in Dominica, a Caribbean SIDS, between November 2021 and January 2022. The semi-structured interview guide was based on the Essential Public Health Functions: assessment, access to health care services, policy development and resource allocation. Data coding was organized accordingly.

RESULTS

Findings suggest that health care providers perceive climate change as contributing to an increase in NCDs and mental health problems. Climate-related events create barriers to care and exacerbate the chronic deficiencies within the health system, especially in the absence of high-level policy support. Healthcare providers need to take a holistic view of health and act accordingly in terms of disease prevention and health promotion, epidemiological surveillance, and ensuring the widest possible access to healthcare, with a particular focus on the environmental and social determinants of vulnerability.

CONCLUSION

The primary health care system is a key stakeholder in the design and operationalization of adaptation and transformative resilience. The Essential Public Health Functions should integrate social and climate and other environmental determinants of health to guide primary care activities to protect the health of communities. This study highlights the need for improved research on the linkages between climate events and health outcomes, surveillance, and development of plans informed by contextual knowledge in the SIDS.

Keeping Sane in a Changing Climate: Assessing Psychologists' Preparedness, Exposure to Climate-Health Impacts, Willingness to Act on Climate Change, and Barriers to Effective Action

Evidence of the impact of climate change on mental health is growing rapidly, and healthcare professionals are being called to be active participants in protecting the population's health. Yet, little is known about psychologists' understanding of climate-health impacts and their role in mitigation actions. We surveyed Australian psychologists (N = 59) to examine preparedness in identifying and managing the impact of climate change on mental health, exposure to climate-health impacts, willingness to act, and barriers to acting on climate change. Data was analysed through descriptive and associative methods. We found that participants are not prepared to identify and manage mental health presentations related to climate change, and they are not engaged in climate change mitigation. We identified that a lack of knowledge of climate-health impacts and tackling and mitigation strategies, in addition to ethical concerns, were the main barriers to engagement with communication and advocacy. With the impacts of climate change on mental health expected to soar, there is a clear and urgent need to prepare the psychological workforce to address this public health issue by establishing professional education programs and reframing climate change as a health crisis.

Optimization and characterization of hybrid bio-briquettes produced from the mixture of sawdust, sugarcane bagasse, and paddy straw

Biomass briquetting is a viable densification technique that converts waste biomass materials into useful products and alternative energy. This work explores the characteristics and optimization of hybrid bio-briquette production by combining crop residues (paddy straw) and solid biomass materials (sawdust and sugarcane bagasse). A total number of 20 briquettes were fabricated with three input factors: sawdust (SD), sugarcane bagasse (SB), and paddy straw (PS) based on the faced-centered central composite design (FCCCD) approach in the laboratory to investigate the calorific value (CV) and ash content (AC). The bomb calorimeter technique was used to evaluate the briquette's calorific value and ash content. The proposed work focused on optimizing the briquette input parameters (SD, SB, and PS) and output responses (CV and AC) using analysis of variance (ANOVA) and response surface methodology (RSM) and hybrid artificial neural network-integrated with multi-objective genetic algorithms (ANN-MOGA). This study shows that the MOGA-ANN-based model results in the best value of CV (17.07 MJ/kg) and AC (1.95%) with optimal input parameters SD (39.99 g), SB (29.02 g), and PS (69.02 g). The optimal results observed from the MOGA-ANN model have also been validated experimentally. The Fourier transform infrared (FTIR) spectroscopy investigation reveals that biomass briquettes are the sustainable and environment-friendly option of fossil fuels for power generation and indoor cooking. The study suggests a strategy for minimizing agro-waste, which may be converted into future fuel in the form of briquettes.

Age-Period-Cohort Analysis of Cardiovascular Mortality Attributable to Environmental Risks in China

INTRODUCTION

This study aimed to analyze changes in cardiovascular disease (CVD) mortality attributable to major environmental risks in China during 1990-2019, and their associations with age, period, and birth cohort.

METHODS

Mortality data were obtained from the Global Burden of Disease Study 2019. Major environmental risks included ambient particulate matter pollution (APMP), household air pollution from solid fuels (HAP), low temperature, high temperature, and lead exposure. Age-period-cohort modeling was used to estimate the overall annual percentage change in CVD mortality (net drift), annual percentage change for each age group (local drift), expected longitudinal age-specific rate (longitudinal age curve), period and cohort relative risks (RRs, period/cohort effects) between 1990 and 2019. Analyses were conducted in 2021-2022.

RESULTS

In China, five major environmental risks led to 1.62 million CVD deaths in 2019. Among these risks, the primary contributor to CVD mortality transited from HAP in 1990 to APMP in 2019. There was also an improvement in attributable CVD mortality rates for low temperature and lead exposure during 1990-2019, while an unfavorable trend was noted for high temperature. The longitudinal age curve demonstrated increased attributable CVD mortality rates with age groups for all environmental risks, with similar patterns for both sexes. Period and cohort RRs suggested generally improved risks of attributable CVD mortality for HAP, low temperature, and lead exposure, but worsening risks for APMP and high temperature in both genders, except for period risks after 2010-2014 for APMP in both sexes, period risks after 2000-2004 for high temperature in females, and cohort risks in cohorts born after 1955 for APMP and high temperature in females.

CONCLUSIONS

Over the study period, there was a significant improvement in attributable CVD mortality rates in China for HAP, low temperature and lead exposure, but an unfavorable trend was noted for APMP and high temperature.

Berberine Decreases Thrombosis Potential Induced by a High-choline Diet by Inhibiting CutC Enzyme

INTRODUCTION

Gut microbes influence thrombosis potential by generating trimethylamine N-oxide (TMAO). However, whether the antithrombotic effect of berberine is associated with TMAO generation remains unclear.

OBJECTIVE

The present study was designed to explore whether berberine decreases the TMAO-induced thrombosis potential and the possible mechanism underneath it.

METHODS

C57BL/6J female mice under a high-choline diet or standard diet were treated with/without berberine for 6 weeks. The TMAO level, carotid artery occlusion time following FeCl3 injury and platelet responsiveness were measured. The binding of berberine to the CutC enzyme was analysed with molecular docking, and molecular dynamics simulations were verified with enzyme activity assays.

RESULTS

The results showed that berberine increased the carotid artery occlusion time following FeCl3 injury and decreased the platelet hyperresponsiveness induced by a high-- choline diet, both offset by intraperitoneal injection of TMAO. The effect of berberine on thrombosis potential was associated with decreasing the generation of TMAO by inhibiting the CutC enzyme.

CONCLUSION

Targeting TMAO generation with berberine might be a promising therapy for ischaemic cardiac-cerebral vascular diseases.

Polysaccharide nanocomposites in wastewater treatment: A review

In modern times, wastewater treatment is vital due to increased water contamination arising from pollutants such as nutrients, pathogens, heavy metals, and pharmaceutical residues. Polysaccharides (PSAs) are natural, renewable, and non-toxic biopolymers used in wastewater treatment in the field of gas separation, liquid filtration, adsorption processes, pervaporation, and proton exchange membranes. Since addition of nanoparticles to PSAs improves their sustainability and strength, nanocomposite PSAs has gained significant attention for wastewater treatment in the past decade. This review presents a comprehensive analysis of PSA-based nanocomposites used for efficient wastewater treatment, focusing on adsorption, photocatalysis, and membrane-based methods. It also discusses potential future applications, challenges, and opportunities in adsorption, filtration, and photocatalysis. Recently, PSAs have shown promise as adsorbents in biological-based systems, effectively removing heavy metals that could hinder microbial activity. Cellulose-mediated adsorbents have successfully removed various pollutants from wastewater, including heavy metals, dyes, oil, organic solvents, pesticides, and pharmaceutical residues. Thus, PSA nanocomposites would support biological processes in wastewater treatment plants. A major concern is the discharge of antibiotic wastes from pharmaceutical industries, posing significant environmental and health risks. PSA-mediated bio-adsorbents, like clay polymeric nanocomposite hydrogel beads, efficiently remove antibiotics from wastewater, ensuring water quality and ecosystem balance. The successful use of PSA-mediated bio-adsorbents in wastewater treatment depends on ongoing research to optimize their application and evaluate their potential environmental impacts. Implementing these eco-friendly adsorbents on a large scale holds great promise in significantly reducing water pollution, safeguarding ecosystems, and protecting human health.

Climate change and kidney stones

PURPOSE OF REVIEW

Kidney stones affect an increasing proportion of the population. We suggest that these trends are in part influenced by exposure to higher temperatures as a result of climate change and urbanization. The changing epidemiology of kidney stones is a topic worthy of discussion due to the economic and healthcare burden the condition poses as well as the quality-of-life disruption faced by individuals with kidney stones.

RECENT FINDINGS

The relationship between heat and kidney stones is well supported. Exposure to high temperatures has been shown to increase risk for stone development within a short time frame. Effects are modified by factors such as sex, comorbid conditions, and population vulnerability and adaptability. Urban heat islands (UHIs) likely exaggerate the effect of increasing global surface temperature. The concentration of UHIs often coincides with historic redlining practices in the United States, potentially contributing to observed disparities in kidney health among minoritized populations. As global surface temperature increases and urbanization trends continue, a greater proportion of the world's population is exposed to significant temperature extremes each year, leading to the expectation that kidney stone prevalence will continue to increase.

SUMMARY

This work describes the effect of increasing global surface temperature as a result of climate change on kidney stone disease and kidney health. These effects may result in further perpetuation of significant kidney stone related social disparities. We suggest strategies to mitigate the effects of heat exposure on stone formation.

Impact of environmental factors on diabetes mortality: A comparison between inland and coastal areas

BACKGROUND

Diabetes mortality varies between coastal and inland areas in Shandong Province, China. However, evidence about the reasons for this disparity is limited. We assume that distinct environmental conditions may contribute to the disparities in diabetes mortality patterns between coastal and inland areas.

METHOD

Qingdao and Jinan were selected as typical coastal and inland cities in Shandong Province, respectively, with similar socioeconomic but different environmental characteristics. Data on diabetes deaths and environmental factors (i.e., temperature, relative humidity and air pollution particles with a diameter of 2.5 μm or less (PM2.5)) were collected from 2013 to 2020. Spatial kriging methods were used to estimate the aggregated diabetes mortality at the city level. A distributed lag non-linear model (DLNM) was used to quantify the possible cumulative and non-cumulative associations between environmental factors and diabetes mortality by age, sex and location.

RESULTS

In the coastal city (Qingdao), the maximum cumulative relative risks (RRs) of temperature and PM2.5 associated with diabetes deaths were 2.54 (95 % confidence interval (CI): 1.25-5.15), and 1.17 (95 % CI: 1.01-1.37) respectively, at lag 1 week. In the inland city (Jinan), only temperature exhibited significant cumulative associations with diabetes deaths (RR = 1.54, 95 % CI: 1.07-2.23 at 29 °C). Lower relative humidity (22 %-45 %) had a lag-specific association with diabetes deaths in inland areas at lag 3 weeks (RR = 1.33, 95 % CI: 1.03-1.70 at 22 %).

CONCLUSION

Despite the lower PM2.5 concentrations in the coastal location, diabetes mortality exhibited stronger links to environmental variables in the coastal city than in the inland city. These findings suggest that the control of air pollution could decrease the mortality burden of diabetes, even in the region with relatively good air quality. Additionally, the spatial estimation method is recommended to identify associations between environmental factors and diseases in studies with limited data.

The impact of climate change related extreme weather events on people with pre-existing disabilities and chronic conditions: a scoping review

PURPOSE

People with disabilities experience a disproportionate impact of extreme weather events and there is a critical need to better understand the impact that climate change has for them. Most previous reviews focus on the risk of acquiring a new disability or injury after a climate-related event and not the impact on people with pre-existing disabilities or chronic conditions, which is the purpose of this study.

METHODS

We conducted a scoping review while searching seven international databases that identified 45 studies meeting our inclusion criteria.

RESULTS

The studies included in our review involved 2 337 199 participants with pre-existing disabilities and chronic conditions across 13 countries over a 20-year period. The findings demonstrated the following trends: (1) the impact on physical and mental health; (2) the impact on education and work; (3) barriers to accessing health and community services (i.e., lack of access to services, lack of knowledge about people with disabilities, communication challenges, lack of adequate housing); and (4) coping strategies (i.e., social supports and connecting to resources) and resilience.

CONCLUSIONS

Our findings highlight the critical need for rehabilitation clinicians and other service providers to explore opportunities to support their clients in preparing for climate-related emergencies.

Psychological impact of the Spring 2019 flood among adult population of Iran

BACKGROUND

From March to April 2019, a flood occurred in several regions of Iran. The most affected provinces were Golestan, Lorestan, and Khuzestan.

AIMS

The present study aimed to determine the prevalence and determinants of psychological distress and depression among the affected adult population 6 months after the event.

METHODS

A cross-sectional household survey with face-to-face interview was carried out on a random sample of 1,671 adults aged above 15 years living in the flood-affected areas from August to September 2019. We applied GHQ-28 and PHQ-9 for the assessment of psychological distress and depression, respectively.

RESULTS

The prevalence of psychological distress and depression were 33.6% (95% CI [29.5, 37.7]) and 23.0% (95% CI [19.4, 26.7]), respectively. Determinants of psychological distress were a history of mental disorders (Adjusted odds ratio [AOR] = 4.7), primary (AOR = 2.9) or high school (AOR = 2.4) education (vs. university), no compensation received (AOR = 2.1), high damage to assets (AOR = 1.8), the house flooded more than 1 m (AOR = 1.8), female gender (AOR = 1.8), and limited access to health care services (AOR = 1.8). Determinants of depression were unemployment (AOR = 5.3) or being a housewife (AOR = 2.7), a history of mental disorders (AOR = 4.1), high damage to assets (AOR = 2.5), no compensation received (AOR = 2.0), the house flooded more than 1 m (AOR = 1.8), limited access to health care services (AOR = 1.8), and high wealth index (AOR = 1.7).

CONCLUSION

The results of this study revealed a high prevalence of psychological distress and depression in the flood-affected adult population. The high-risk group, particularly flood victims who had a history of mental disorders, and those exposed to severe damages of flood, should be prioritized for screening, and mental health services.

The mental health impacts of human-ecosystem-animal relationships: A systematic scoping review of Eco-, Planetary, and One Health approaches

The threats to human and animal health, biodiversity conservation, and our living planet's future are ever-present and increasingly more severe due to climate change and environmental degradation. There is an emerging discourse exploring the mental health dimensions contained within these changes. To better understand and respond to these impacts requires novel and creative methodological approaches built on conceptual frameworks that integrate perspectives from the social and natural sciences. Three of the most influential interdisciplinary frameworks at the human-animal-ecosystem interface include: One Health, EcoHealth, and Planetary Health. These frameworks report mental health as an integral component within overall health-related outcomes. However, a comprehensive synthesis of the state of the literature that examines how mental health is explored within these approaches does not currently exist. A systematic scoping review was therefore conducted to obtain clear understandings of patterns, gaps, and broad themes, and to highlight future research needs and considerations. Standardized PRISMA guidelines, including explicitly defined inclusion/exclusion criteria and dual screening/extractions, were used. 13 papers were included: seven using the One Health Framework, with Planetary and EcoHealth each represented by three. Trends observed include a predominate focus on companion animals as interventions, "sense of place" used as a component of mental well-being, and non-physical health-related measurements of animal well-being as an outcome within One Health research. The lack in retrieved studies also highlight the dearth in literature on mental health as a pillar of these three well established frameworks. Compiling what is known in the evidence-base as a launching point for scientific engagement, this review describes guidance for investigators on how to conduct mental health research within these framework parameters so that future studies can elucidate mechanisms underpinning the intersections between the biosphere and human mental-health and data-driven interventions and policy recommendations that simultaneously address mental health and global change can be proposed and enacted.

Health Problems of Increasing Man-Made and Climate-Related Disasters on Forcibly Displaced populations: A Scoping Review on Global Evidence

Forcibly displaced populations are among the most vulnerable groups in disasters. They experience poorer health conditions compared with nondisplaced individuals. However, a clear picture is lacking regarding the overall health problems encountered by disaster-induced mid- to long-term displaced people. This study investigated these disorders prevalence and identified their correlates among long-settled displaced populations worldwide. The current scoping review follows the PRISMA-ScR guidelines; a systematic search was conducted on PubMed, Web of Science, and CINAHL and included original peer-reviewed studies, commentary, reviews, and grey literature published in English between January 1990 to June 2022. In the thematic and content analysis, the authors applied the narrative review approach to identify themes and sub-themes. Forty-eight documents were identified as fully relevant to this study. The largest number of published papers were from Asia, followed by the Middle East, the United States, and Europe. IDPs in developed countries were the most researched populations. Human-made disasters were addressed by 89% of the included studies. The four main thematic categories included were "physical health," "mental health," "inadequate facilities," and "lack of healthy behaviour." The worsening of noncommunicable diseases had the highest prevalence, followed by communicable diseases. Due to their condition, forcibly displaced migrants face a triple burden of communicable diseases and noncommunicable diseases such as mental health issues. Health-related research and policy need to consider the links among disasters, health problems, and forced migration as a determinant of health in the new era of climate change-driven displacements.

Elevational homogenization of mountain parasitoids across six decades

Elevational gradients are characterized by strong environmental changes within small geographical distances, providing important insights on the response of biological communities to climate change. Mountain biodiversity is particularly sensitive to climate change, given the limited capacity to colonize new areas and the competition from upshifting lowland species. Knowledge on the impact of climate change on mountain insect communities is patchy, but elevation is known to influence parasitic interactions which control insect communities and functions within ecosystems. We analyzed a European dataset of bristle flies, a parasitoid group which regulates insect herbivory in both managed and natural ecosystems. Our dataset spans six decades and multiple elevational bands, and we found marked elevational homogenization in the host specialization of bristle fly species through time. The proportion of specialized parasitoids has increased by ca. 70% at low elevations, from 17 to 29%, and has decreased by ca. 20% at high elevations, from 48 to 37%. As a result, the strong elevational gradient in bristle fly specialization observed in the 1960s has become much flatter over time. As climate warming is predicted to accelerate, the disappearance of specialized parasitoids from high elevations might become even faster. This parasitoid homogenization can reshape the ecological function of mountain insect communities, increasing the risk of herbivory outbreak at high elevations. Our results add to the mounting evidence that symbiotic species might be especially at risk from climate change: Monitoring the effects of these changes is urgently needed to define effective conservation strategies for mountain biodiversity.

Asthma incidence can be influenced by climate change in Italy: findings from the GEIRD study-a climatological and epidemiological assessment

An association between climatic conditions and asthma incidence has been widely assumed. However, it is unclear whether climatic variations have a fingerprint on asthma dynamics over long time intervals. The aim of this study is to detect a possible correlation of the Summer North Atlantic Oscillation (S-NAO) index and the self-calibrated palmer drought severity index (scPDSI) with asthma incidence over the period from 1957 to 2006 in Italy. To this aim, an analysis of non-stationary and non-linear signals was performed on the time series of the Italian databases on respiratory health (ISAYA and GEIRD) including 36,255 individuals overall, S-NAO, and scPDSI indices to search for characteristic periodicities. The ISAYA (Italian Study on Asthma in Young Adults) and GEIRD (Gene Environment Interactions in Respiratory Diseases) studies collected information on respiratory health in general population samples, born between 1925 and 1989 and aged 20-84 years at the time of the interview, from 13 Italian centres. We found that annual asthma total incidence shared the same periodicity throughout the 1957-2006 time interval. Asthma incidence turned out to be correlated with the dynamics of the scPDSI, modulated by the S-NAO, sharing the same averaged 6 year-periodicity. Since climate patterns appear to influence asthma incidence, future studies aimed at elucidating the complex relationships between climate and asthma incidence are warranted.

Climate change and human health in Vietnam: a systematic review and additional analyses on current impacts, future risk, and adaptation

This study aims to investigate climate change's impact on health and adaptation in Vietnam through a systematic review and additional analyses of heat exposure, heat vulnerability, awareness and engagement, and projected health costs. Out of 127 reviewed studies, findings indicated the wider spread of infectious diseases, and increased mortality and hospitalisation risks associated with extreme heat, droughts, and floods. However, there are few studies addressing health cost, awareness, engagement, adaptation, and policy. Additional analyses showed rising heatwave exposure across Vietnam and global above-average vulnerability to heat. By 2050, climate change is projected to cost up to USD1-3B in healthcare costs, USD3-20B in premature deaths, and USD6-23B in work loss. Despite increased media focus on climate and health, a gap between public and government publications highlighted the need for more governmental engagement. Vietnam's climate policies have faced implementation challenges, including top-down approaches, lack of cooperation, low adaptive capacity, and limited resources.

Climate change and population health in Singapore: a systematic review

Gaseous emissions have contributed to global warming, an increase in the frequency of extreme weather events and poorer air quality. The associated health impacts have been well reported in temperate regions. In Singapore, key climate change adaptation measures and activities include coastal and flood protection, and mitigating heat impacts. We systematically reviewed studies examining climate variability and air quality with population health in Singapore, a tropical city-state in South-East Asia (SEA), with the aim to identify evidence gaps for policymakers. We included 14 studies with respiratory illnesses, cardiovascular outcomes, foodborne disease and dengue. Absolute humidity (3 studies) and rainfall (2 studies) were positively associated with adverse health. Extreme heat (2 studies) was inversely associated with adverse health. The effects of mean ambient temperature and relative humidity on adverse health were inconsistent. Nitrogen dioxide and ozone were positively associated with adverse health. Climate variability and air quality may have disease-specific, differing directions of effect in Singapore. Additional high quality studies are required to strengthen the evidence for policymaking. Research on effective climate action advocacy and adaptation measures for community activities should be strengthened.

Funding

There was no funding source for this study.

The Impact of Heat Waves on Health Care Services in Low- or Middle-Income Countries: Protocol for a Systematic Review

BACKGROUND

Heat waves significantly impact ecosystems and human health, especially that of vulnerable populations, and are associated with increased morbidity and mortality. Besides being directly related to climate-sensitive health outcomes, heat waves have indirectly increased the burden on our health care systems. Although the existing literature examines the impact of heat waves and morbidity, past research has mostly been conducted in high-income countries (HICs), and studies on the impact of heat waves on morbidity in low- or middle-income countries (LMICs) are still scarce.

OBJECTIVE

This paper presents the protocol for a systematic review that aims to provide evidence of the impact of heat waves on health care services in LMICs.

METHODS

We will identify peer-reviewed studies from 3 online databases, including the Web of Science, PubMed, and SCOPUS, published from January 2002 to April 2023, using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Quality assessment will be conducted using the Navigation Guide checklist. Key search terms include heatwaves, extreme heat, hospitalization, outpatient visit, burden, health services, and morbidity.

RESULTS

This systematic review will provide insight into the impact of heat waves on health care services in LMICs, especially on emergency department visits, ambulance call-outs, hospital admissions, outpatient department visits, in-hospital mortality, and health care operational costs.

CONCLUSIONS

The results of this review are anticipated to help policymakers and key stakeholders obtain a better understanding of the impact of heat waves on health care services and prioritize investments to mitigate the effects of heat waves in LMICs. This entails creating a comprehensive heat wave plan and ensuring that adequate infrastructure, capacity, and human resources are allocated in the health care sector. These measures will undoubtedly contribute to the development of resilience in health care systems and hence protect the health and well-being of individuals and communities.

TRIAL REGISTRATION

PROSPERO CRD42022365471; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=365471.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/44702.

Validating a measure for eco-anxiety in Portuguese young adults and exploring its associations with environmental action

BACKGROUND

Worsening environmental conditions may amplify people's emotional responses to an environmental crisis (eco-anxiety). In Portugal, young people seem to be especially concerned about climate change. However, this phenomenon needs to be interpreted using accurate instruments. Thus, this study aimed to validate the Portuguese version of the Hogg Eco-Anxiety Scale (HEAS) in young adults and examine the associations among eco-anxiety, sociodemographic characteristics, and pro-environmental behaviours.

METHODS

A survey was administered to 623 Portuguese university students aged between 18 and 25 years. The survey included our Portuguese translation of the HEAS (obtained through a back-translation and pretesting process), a sociodemographic assessment, and questions related to pro-environmental behaviours. Confirmatory factor analysis was conducted to assess the construct validity of the Portuguese version of the HEAS, and global fit indices were used to assess whether the original four-dimensional structure of the scale was reproduced. The reliability of the Portuguese version of the HEAS was evaluated by Cronbach's alpha and the intraclass correlation coefficient. Measurement invariance examined sex differences in scale interpretation. Linear regressions were used to detect whether sociodemographic variables predict eco-anxiety and whether eco-anxiety predicts pro-environmental behaviours.

RESULTS

The factorial structure of the original scale was replicated in the Portuguese version of the HEAS, showing good internal consistency, reliability over time and strict invariance between men and women. A higher paternal education level predicted greater eco-anxiety in children. Two dimensions of eco-anxiety-namely, rumination and anxiety about personal impacts on the environment-predicted higher engagement in pro-environmental behaviours.

CONCLUSIONS

The translated scale is an appropriate tool to measure eco-anxiety in the Portuguese context and should be used to collect evidence to drive environmental and health policies. An individual's education level should be considered a determinant of their emotional response to environmental conditions. Importantly, eco-anxiety can act as a protective emotional response to preserving the planet.

Climate change and public health in South America: a scoping review of governance and public engagement research

This scoping review examines peer-reviewed literature of governance and public engagement at the intersection of public health and climate change in South America. The review shows significant gaps in academic publications, particularly because health was mostly a secondary theme examined in the studies. The few studies about governmental interventions (e.g., policies and programs) suggest that these have not been effective. Regarding public engagement, no studies examined social media engagement with health and climate change, and only one examined news coverage. Finally, most articles focused primarily on individual countries, with few comparative or regional analyses of South America. Strategic action addressing climate change and its effects on public health needs to be based on empirical evidence.

Environmental violence: a tool for planetary health research

From climate change to toxic pollution and the interactive effects of multiple pollution streams, human health is under siege. Human-produced environmental risks to health and wellbeing are high and contributing to patterns of global morbidity, mortality, economic inequality, displacement, and insecurity. The implications of human-produced environmental harms to global health are complex just as are their causes. The concept of environmental violence offers a potentially robust frame for engaging this issue. We argue that a more specified and structured framework and definition of environmental violence-focusing on human-produced harms by way of pollution emissions-is both timely and beneficial for engaging the complexities of global public health. To clarify why and how this is the case, we review the literature for publications that use the term environmental violence and we subsequently propose a specific definition focused on human-produced pollution along with a framework for tracking and analysing environmental violence and its constituent components. Finally, we discuss the potential value of our framework for research and policy making regarding human health.

Future temperature-related excess mortality under climate change and population aging scenarios in Canada

OBJECTIVE

Climate change is expected to increase global temperatures. How temperature-related mortality risk will change is not completely understood, and how future demographic changes will affect temperature-related mortality needs to be clarified. We evaluate temperature-related mortality across Canada until 2099, accounting for age groups and scenarios of population growth.

METHODS

We used daily counts of non-accidental mortality for 2000 to 2015 for all 111 health regions across Canada, incorporating in the study both urban and rural areas. A two-part time series analysis was used to estimate associations between mean daily temperatures and mortality. First, current and future daily mean temperature time series simulations were developed from Coupled Model Inter-Comparison Project 6 (CMIP6) climate model ensembles from past and projected climate change scenarios under Shared Socioeconomic Pathways (SSPs). Next, excess mortality due to heat and cold and the net difference were projected to 2099, also accounting for different regional and population aging scenarios.

RESULTS

For 2000 to 2015, we identified 3,343,311 non-accidental deaths. On average, a net increase of 17.31% (95% eCI: 13.99, 20.62) in temperature-related excess mortality under a higher greenhouse gas emission scenario is expected for Canada in 2090-2099, which represents a greater burden than a scenario that assumed strong levels of greenhouse gas mitigation policies (net increase of 3.29%; 95% eCI: 1.41, 5.17). The highest net increase was observed among people aged 65 and over, and the largest increases in both net and heat- and cold-related mortality were observed in population scenarios that incorporated the highest rates of aging.

CONCLUSION

Canada may expect net increases in temperature-related mortality under a higher emissions climate change scenario, compared to one assuming sustainable development. Urgent action is needed to mitigate future climate change impacts.

Identifying gaps on health impacts, exposures, and vulnerabilities to climate change on human health and wellbeing in South America: a scoping review

There is an important gap in regional information on climate change and health, limiting the development of science-based climate policies in South American countries. This study aims to identify the main gaps in the existing scientific literature on the impacts, exposure, and vulnerabilities of climate change on population health. A scoping review was performed guided by four sub-questions focused on the impacts of climate change on physical and mental health, exposure and vulnerability factors of population to climate hazards. The main findings showed that physical impacts mainly included infectious diseases, while mental health impacts included trauma, depression, and anxiety. Evidence on population exposure to climate hazards is limited, and social determinants of health and individual factors were identified as vulnerability factors. Overall, evidence on the intersection between climate change and health is limited in South America and has been generated in silos, with limited transdisciplinary research. More formal and systematic information should be generated to inform public policy.

Funding

None.

Ambient temperature, heat stress and fetal growth: A review of placenta-mediated mechanisms

Pregnancy is increasingly considered a period of vulnerability for extreme heat exposure. Multiple lines of evidence support that heat stress is associated with placental insufficiency, poor fetal growth and decreased birth weight. In this narrative review, we first summarize evidence linking ambient temperature or experimentally-induced heat stress with fetal and placental growth outcomes in humans, ruminants and murine species. We then synthesize the literature on putative underlying biological pathways with a focus on the placenta. Reviewed mechanisms include: reduced uterine-placental blood flow, impaired supply of metabolic substrates to the fetus, activation of the maternal stress-response system, and disruption of other endocrine and immune system endpoints. Taken together, this body of evidence supports that exposure to extreme ambient heat likely has adverse consequences for placental development and function. However, research investigating placenta-mediated pathophysiological mechanisms in humans remains extremely limited.

Estimating the national carbon footprint of inhalers in healthcare

BACKGROUND

Metered dose inhalers (MDIs) contain greenhouse gases which have a disproportionate effect on the carbon footprint of healthcare. There are more environmentally friendly alternatives such as dry powder inhalers (DPIs) or soft mist inhalers (SMIs).

AIMS

This study aims to approximate the carbon footprint of inhalers dispensed in Irish healthcare.

METHODS

Health Market Research data was used to examine the number of inhalers sold in Ireland in 2019 via dispensing data from pharmacy IT systems. The carbon footprint per inhaler data was then used to calculate the total carbon footprint of each drug class, and an estimate for the total carbon footprint of inhalers sold in Ireland was generated.

RESULTS

4,427,287 inhalers were dispensed in Ireland in 2019 of which 2,608,433 (59%) were MDIs and 1,818,854 were DPIs/SMIs (41.1%). The total carbon equivalent of these inhalers was estimated to be 54,765 tCO2. MDIs account for 59% of inhaler units dispensed but account for 97% of inhaler-related carbon emissions.

CONCLUSION

Targeting inhaler prescribing offers the potential to significantly improve the carbon footprint of Irish healthcare. Establishing the current carbon footprint of the inhalers that are prescribed, dispensed, and disposed in Ireland is a necessary baseline to inform moving towards a net zero health service.

Solastalgia and Forest Fires

One of the important problems created by climate change is forest fires. Forest fires occur due to both natural and anthropogenic causes. Forest fires, which occur with the effects of climate change such as an increase in temperature, drought, heat waves, and climatic conditions, are increasing gradually. Acute and chronic effects caused by forest fires cause significant life changes. As a result of the fire, not only forests are damaged, but also flora, wildlife, water resources, soil, climate, areas used by people for recreational purposes, and settlements near and around forested areas. As a result, changes such as increases in temperature, pollution, epidemics, drought, food shortage, and forest fires, affect mental and physical health. While exposure to forest fires creates a direct traumatic effect; indirectly, it affects mental health for a number of social, political and economic reasons such as poverty, unemployment and housing. Forest fires also create an environmental change. This environmental change creates a sense of loss, the sense of belonging is lost, it cannot connect with the new environment, it becomes difficult to adapt and causes distress.Uncertainty about the future, helplessness, stress, anxiety, post-traumatic stress disorder and depression are common psychological problems due to climate change. It defines some new mental health concepts as the consequences of climate change affect mental health. "Solastalgia" is one pf these new concepts. Solastalgia is defined as a term that expresses the pain and distress caused by the loss of the thing/things that people find solace and environmental change. Solastalgia is a necessary concept for mental health professionals to understand the links between ecosystem health and human health, especially the cumulative effects of climatic and environmental change on mental, emotional and spiritual health.

Assessing China's development zones and carbon emissions

The present article evaluates establishment of development zones and its association with carbon emissions. In the process of industrialization, carbon emissions in underdeveloped regions of the world increase with economic growth. In order to promote economic growth in the western region and strengthen the management of enterprise pollution emissions, the Chinese government has set up hundreds of development zones. Existing research shows that development zone establishment can promote economic growth; however, literature is scarce when the relationship is tested across region. Based on the panel data of five provinces with relatively backward economy in western China from 2001 to 2017, this paper constructs a "multi-period difference-in-difference" (DID) model with the establishment of development zones as a "quasi-natural experiment" to test the relationship. Findings reveal that development zone establishment increases carbon emissions in the region, and has a significant inhibitory effect on carbon emissions at national level. The conclusions of this paper provide empirical evidence and policy implications for reducing carbon emissions in economically underdeveloped areas.

Non-Conventional Risk Factors: "Fact" or "Fake" in Cardiovascular Disease Prevention?

Cardiovascular diseases (CVDs), such as arterial hypertension, myocardial infarction, stroke, heart failure, atrial fibrillation, etc., still represent the main cause of morbidity and mortality worldwide. They significantly modify the patients' quality of life with a tremendous economic impact. It is well established that cardiovascular risk factors increase the probability of fatal and non-fatal cardiac events. These risk factors are classified into modifiable (smoking, arterial hypertension, hypercholesterolemia, low HDL cholesterol, diabetes, excessive alcohol consumption, high-fat and high-calorie diet, reduced physical activity) and non-modifiable (sex, age, family history, of previous cardiovascular disease). Hence, CVD prevention is based on early identification and management of modifiable risk factors whose impact on the CV outcome is now performed by the use of CV risk assessment models, such as the Framingham Risk Score, Pooled Cohort Equations, or the SCORE2. However, in recent years, emerging, non-traditional factors (metabolic and non-metabolic) seem to significantly affect this assessment. In this article, we aim at defining these emerging factors and describe the potential mechanisms by which they might contribute to the development of CVD.

Impact of Global Climate Change on Pulmonary Health: Susceptible and Vulnerable Populations

As fossil fuel combustion continues to power the global economy, the rate of climate change is accelerating, causing severe respiratory health impacts and large disparities in the degree of human suffering. Hotter and drier climates lead to longer and more severe wildland fire seasons, impairing air quality around the globe. Hotter temperatures lead to higher amounts of ozone and particles, causing the exacerbation of chronic respiratory diseases and premature mortality. Longer pollen seasons and higher pollen concentrations provoke allergic airway diseases. In arid regions, accelerated land degradation and desertification are promoting dust pollution and impairing food production and nutritional content that are essential to respiratory health. Extreme weather events and flooding impede healthcare delivery and can lead to poor indoor air quality due to mold overgrowth. Climate and human activities that harm the environment and ecosystem may also affect the emergence and spread of viral infections, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and associated morbidity and mortality exacerbated by air pollution. Children and elderly individuals are more susceptible to the adverse health effects of climate change. Geographical and socioeconomic circumstances, together with a decreased capacity to adapt, collectively increase vulnerability to the adverse effects of climate change. Successful mitigation of anthropogenic climate change is dependent on the commitment of energy-intensive nations to manage greenhouse gas emissions, as well as societal support and response to aggravating factors. In this review, we focus on the respiratory health impacts of global climate change, with an emphasis on susceptible and vulnerable populations and low- and middle-income countries.