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Sandal S, Ethier I, Onu U, Fung W, Bajpai D, Bilchut WH, Bagasha P, De Chiara L, Hafiz E, Smyth B, Kelly D, Pippias M, Jha V. Climate Change, Kidney Health, and Environmentally Sustainable Kidney Care: A Multinational Survey of Health Care Professionals. J Am Soc Nephrol 2024; 35:1084-1094. [PMID: 38768364 DOI: 10.1681/asn.0000000000000402] [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: 02/29/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024] Open
Abstract
Key Points
A multinational survey of health care professionals on the kidney health impacts of climate change and the environmental burden of kidney care was conducted.Most participants reported knowledge gaps and high level of concern on these interconnected issues.Only a minority report personal or organizational initiatives in environmentally sustainable kidney care; this did not vary by country income level.
Background
Given the threat of climate change to kidney health and the significant environmental effect of kidney care, calls are increasing for health care professionals and organizations to champion climate advocacy and environmentally sustainable kidney care. Yet, little is known about their engagement, and existing literature is primarily emerging from high-income countries.
Methods
We conducted a cross-sectional survey to understand the knowledge, attitude, and practice of health care professionals on the interconnectedness of climate change and kidney health; to identify personal and organizational initiatives in sustainable kidney care and strategies to increase their engagement; and to compare responses by their country's income level as classified by the World Bank.
Results
Participants (n=972) represented 108 countries, with 64% from lower- or middle-income countries. Ninety-eight percent believed that climate change is happening, yet <50% possessed knowledge about the effect of climate change on kidney health or the environmental effect of kidney care. Only 14% were involved in climate change and kidney health initiatives (membership, knowledge/awareness, research, and advocacy), 22% in sustainable kidney care initiatives (education/advocacy, preventative nephrology, sustainable dialysis, promoting transplant/home therapies, and research), and 26% reported organizational initiatives in sustainable kidney care (sustainable general or dialysis practices, preventative/lean nephrology, and focused committees). Participants from lower-income countries generally reported higher knowledge and variable level of concern. Engagement in sustainable kidney care did not vary by income level. Guidance/toolkit (79%), continuing education (75%), and opportunities (74%) were the top choices to increase engagement. National initiatives (47%), preventative measures (35%), and research endeavors (31%) were the top avenues for organizational engagement. These varied by income level, suggesting that the vision and priorities vary by baseline resource setting.
Conclusions
We have identified knowledge and practice gaps among health care professionals on the bidirectional relationship between kidney disease and climate change in a multinational context and several avenues to increase their engagement.
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Affiliation(s)
- Shaifali Sandal
- Divisions of Nephrology and Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- MEDIC, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Isabelle Ethier
- Division of Nephrology, Department of Medicine, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Health Innovation and Evaluation hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Ugochi Onu
- Department of Medicine, University of Nigeria Teaching Hospital Enugu, Ituku-Ozalla, Nigeria
| | - Winston Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Divya Bajpai
- Department of Nephrology, Seth G.S.M.C. and K.E.M. Hospital, Mumbai, India
| | | | - Peace Bagasha
- Directorate of Internal Medicine, Department of Internal Medicine, Mulago National Referral Hospital l and College of Health Sciences, Makerere University, Kampala, Uganda
| | - Letizia De Chiara
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Ehab Hafiz
- Theodor Bilharz Research Institute, Giza, Egypt
| | - Brendan Smyth
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Dearbhla Kelly
- Oxford Critical Care, John Radcliffe Hospital, Oxford, United Kingdom
| | - Maria Pippias
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Renal Unit, North Bristol NHS Trust, Bristol, United Kingdom
| | - Vivekanand Jha
- The George Institute for Global Health, UNSW, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- Faculty of Medicine, Imperial College London, London, United Kingdom
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Guihenneuc J, Cambien G, Blanc-Petitjean P, Papin E, Bernard N, Jourdain B, Barcos I, Saez C, Dupuis A, Ayraud-Thevenot S, Migeot V. Knowledge, behaviours, practices, and expectations regarding climate change and environmental sustainability among health workers in France: a multicentre, cross-sectional study. Lancet Planet Health 2024; 8:e353-e364. [PMID: 38849178 DOI: 10.1016/s2542-5196(24)00099-8] [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: 12/23/2023] [Revised: 03/25/2024] [Accepted: 04/26/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Faced with climate change, hospitals are confronted with a dual challenge. On one hand, they need to embark on a far-reaching ecological transformation to reduce their contribution to greenhouse gas emissions and other environmental impacts; on the other hand, they need to limit the effects of climate change on their activities. We aimed to evaluate the knowledge, behaviours, practices, and expectations of health workers in French hospitals regarding climate change and environmental sustainability. METHODS This multicentre, cross-sectional study was carried out in six French hospitals from June 1, 2021 to Dec 31, 2022. All health workers at the hospitals were eligible to participate and were recruited through internal publicity. We designed a structured questionnaire consisting of five parts: participant characteristics, knowledge and perceptions of climate change, pro-environmental behaviours, practices concerning environmental sustainability actions, and expectations. A multilevel logistic regression model was used to evaluate associations between the knowledge, behaviours, and practices of health workers and the characteristics of the health workers and hospitals. FINDINGS Of 57 034 health workers across the six hospitals, 4552 (8·0%) participated in the study. Of those for whom gender data were available, 3518 (78·2%) participants were women and 979 (21·8%) were men. Participants considered energy consumption (71·0%) and waste and discharges related to medical activities (55·6%) and non-medical activities (50·2%) to be the three activities with the greatest environmental impact. On a scale of 1 (not a priority) to 10 (high priority), the median rating attributed by the participants to the commitment of their hospitals to ecological transformation was 5·0 (IQR 3·0-6·0). 1079 (23·7%) of 4552 participants had already initiated at least one environmental sustainability action in their hospital. Barriers reported by participants to the implementation of environmental sustainability-related projects were the lack of dedicated time (40·4%), hierarchical support (32·5%), methodological support (28·9%), and access to training (23·7%). The presence of a sustainable development steering committee, especially one with more than 5 years of activity, was positively associated with health workers feeling better informed about the ecological transformation of their hospital (adjusted odds ratio 1·78 [95% CI 1·29-2·45]), having better knowledge of the environmental impacts of their hospital (1·83 [1·32-2·53]), and initiating a larger number of environmental sustainability actions (1·74 [1·33-2·29]). INTERPRETATION We showed that health workers in French hospitals seem to be committed to the ecological transformation of their workplaces, and identified some drivers and barriers to further support these essential transformations. There is an urgent need to bolster training for all health workers, enhance structural frameworks within hospitals, and encourage future interdisciplinary research on the vulnerability of health-care facilities to climate change. FUNDING The University Hospital of Poitiers.
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Affiliation(s)
- Jérémy Guihenneuc
- Université de Poitiers, CNRS, EBI, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'Investigation Clinique CIC1402, Axe Santé Environnementale, Poitiers, France; Pôle BIOSPHARM, CHU de Poitiers, Poitiers, France.
| | - Guillaume Cambien
- Université de Poitiers, CNRS, EBI, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'Investigation Clinique CIC1402, Axe Santé Environnementale, Poitiers, France; Pôle BIOSPHARM, CHU de Poitiers, Poitiers, France
| | - Pauline Blanc-Petitjean
- Epidemiology and Public Health Department, CHU Rennes, Rennes, France; CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Rennes, France
| | - Emeline Papin
- Université de Poitiers, CHU de Poitiers, INSERM, Centre d'Investigation Clinique CIC1402, Axe Santé Environnementale, Poitiers, France
| | - Noëlle Bernard
- Department of Internal Medicine and Infectious Diseases, University Hospital of Bordeaux, Hôpital Saint André, Bordeaux, France
| | - Bernard Jourdain
- Sustainable Development Department, Hospital of Niort, Niort, France
| | - Isabelle Barcos
- Methodological Support and Innovation in Prevention Department, University Hospital of Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Cécile Saez
- Sustainable Development Department, University Hospital of Bordeaux, Talence, France
| | - Antoine Dupuis
- Université de Poitiers, CNRS, EBI, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'Investigation Clinique CIC1402, Axe Santé Environnementale, Poitiers, France; Pôle BIOSPHARM, CHU de Poitiers, Poitiers, France
| | - Sarah Ayraud-Thevenot
- Université de Poitiers, CNRS, EBI, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'Investigation Clinique CIC1402, Axe Santé Environnementale, Poitiers, France; Pôle BIOSPHARM, CHU de Poitiers, Poitiers, France
| | - Virginie Migeot
- Epidemiology and Public Health Department, CHU Rennes, Rennes, France; CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Rennes, France
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Teichgräber U, Ingwersen M, Sturm MJ, Giesecke J, Allwang M, Herzog I, von Gierke F, Schellong P, Kolleg M, Lange K, Wünsch D, Gugel K, Wünsch A, Zöllkau J, Petruschke I, Häseler-Ouart K, Besteher B, Philipp S, Mille U, Ouart D, Jünger J. Objective structured clinical examination to teach competency in planetary health care and management - a prospective observational study. BMC MEDICAL EDUCATION 2024; 24:308. [PMID: 38504289 PMCID: PMC10953132 DOI: 10.1186/s12909-024-05274-9] [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] [Received: 11/16/2023] [Accepted: 03/07/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Health professionals are increasingly called upon and willing to engage in planetary health care and management. However, so far, this topic is rarely covered in medical curricula. As the need for professional communication is particularly high in this subject area, this study aimed to evaluate whether the objective structured clinical examination (OSCE) could be used as an accompanying teaching tool. METHODS During the winter semester 2022/2023, 20 third- and fifth-year medical students voluntarily participated in a self-directed online course, three workshops, and a formal eight-station OSCE on planetary health care and management. Each examinee was also charged alternatingly as a shadower with the role of providing feedback. Experienced examiners rated students' performance using a scoring system supported by tablet computers. Examiners and shadowers provided timely feedback on candidates` performance in the OSCE. Immediately after the OSCE, students were asked about their experience using a nine-point Likert-scale survey and a videotaped group interview. Quantitative analysis included the presentation of the proportional distribution of student responses to the survey and of box plots showing percentages of maximum scores for the OSCE performance. The student group interview was analyzed qualitatively. RESULTS Depending on the sub-theme, 60% -100% of students rated the subject of planetary health as likely to be useful in their professional lives. Similar proportions (57%-100%) were in favour of integrating planetary health into required courses. Students perceived learning success from OSCE experience and feedback as higher compared to that from online courses and workshops. Even shadowers learned from observation and feedback discussions. Examiners assessed students' OSCE performance at a median of 80% (interquartile range: 83%-77%) of the maximum score. CONCLUSIONS OSCE can be used as an accompanying teaching tool for advanced students on the topic of planetary health care and management. It supports learning outcomes, particularly in terms of communication skills to sensitise and empower dialogue partners, and to initiate adaptation steps at the level of individual patients and local communities.
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Affiliation(s)
- Ulf Teichgräber
- Office of the Dean, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.
- Department of Radiology, Department of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Maja Ingwersen
- Department of Radiology, Department of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Max-Johann Sturm
- Student Representatives, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Jan Giesecke
- Student Representatives, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Manuel Allwang
- Student Representatives, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Ida Herzog
- Student Representatives, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | | | - Paul Schellong
- Institute of Infection Medicine and Hospital Hygiene, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matthias Kolleg
- Department of Internal Medicine IV, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Kathleen Lange
- Department of Internal Medicine IV, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Daniel Wünsch
- Clinic of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Katrin Gugel
- Clinic of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Anne Wünsch
- Department of Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Janine Zöllkau
- Department of Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Inga Petruschke
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Kristin Häseler-Ouart
- Department of Internal Medicine II, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Bianca Besteher
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Swetlana Philipp
- Department of Psychosocial Medicine, Psychotherapy, and Psychooncology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Urte Mille
- SkillsLab Jena, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Dominique Ouart
- Office of the Dean, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Jana Jünger
- Institute for Communication and Assessment Research, Heidelberg, Germany
- Program of Master of Medical Education (MME), Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
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Born KB, Levinson W, Vaux E. Choosing Wisely and the climate crisis: a role for clinicians. BMJ Qual Saf 2024; 33:200-204. [PMID: 37268407 DOI: 10.1136/bmjqs-2023-015928] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/14/2023] [Indexed: 06/04/2023]
Affiliation(s)
- Karen B Born
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Wendy Levinson
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Emma Vaux
- Department of Renal Medicine, Royal Berkshire Hospital NHS Foundation Trust, Reading, UK
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Gasciauskaite G, Lunkiewicz J, Tucci M, Von Deschwanden C, Nöthiger CB, Spahn DR, Tscholl DW. Environmental and economic impact of sustainable anaesthesia interventions: a single-centre retrospective observational study. Br J Anaesth 2024:S0007-0912(23)00692-X. [PMID: 38177005 DOI: 10.1016/j.bja.2023.11.049] [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: 08/22/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Anaesthesia contributes substantially to the environmental impact of healthcare. To reduce the ecological footprint of anaesthesia, a set of sustainability interventions was implemented in the University Hospital Zurich, Switzerland. This study evaluates the environmental and economic implications of these interventions. METHODS This was a single-centre retrospective observational study. We analysed the environmental impact and financial implications of changes in sevoflurane, desflurane, propofol, and plastic consumption over 2 yr (April 2021 to March 2023). The study included pre-implementation, implementation, and post-implementation phases. RESULTS After implementation of sustainability measures, desflurane use was eliminated, there was a decrease in the consumption of sevoflurane from a median (inter-quartile range) of 25 (14-39) ml per case to 11 (6-22) ml per case (P<0.0001). Propofol consumption increased from 250 (150-721) mg per case to 743 (370-1284) mg per case (P<0.0001). Use of plastics changed: in the first quarter analysed, two or more infusion syringes were used in 62% of cases, compared with 74% of cases in the last quarter (P<0.0001). Two or more infusion lines were used in 58% of cases in the first quarter analysed, compared with 68% of cases in the last quarter (P<0.0001). This resulted in an 81% reduction in overall environmental impact from 3 (0-7) to 1 (0-3) CO2 equivalents in kg per case (P<0.0001). The costs during the final study phase were 11% lower compared with those in the initial phase: from 25 (13-41) to 21 (14-31) CHF (Swiss francs) per case (P<0.0001). CONCLUSIONS Implementing sustainable anaesthesia interventions can significantly reduce the environmental impact and cost of anaesthesia.
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Affiliation(s)
- Greta Gasciauskaite
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland.
| | - Justyna Lunkiewicz
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Tucci
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Donat R Spahn
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - David W Tscholl
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
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Gasciauskaite G, Lunkiewicz J, Spahn DR, Von Deschwanden C, Nöthiger CB, Tscholl DW. Environmental sustainability from anesthesia providers' perspective: a qualitative study. BMC Anesthesiol 2023; 23:377. [PMID: 37978425 PMCID: PMC10655271 DOI: 10.1186/s12871-023-02344-1] [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: 07/07/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The world faces a significant global health threat - climate change, which makes creating more environmentally sustainable healthcare systems necessary. As a resource-intensive specialty, anesthesiology contributes to a substantial fraction of healthcare's environmental impact. This alarming situation invites us to reconsider the ecological health determinants and calls us to action. METHODS We conducted a single-center qualitative study involving an online survey to explore the environmental sustainability from anesthesia providers' perspectives in a center implementing internal environmentally-sustainable anesthesia guidelines. We asked care providers how they perceive the importance of environmental issues in their work; the adverse effects they see on ecological sustainability in anesthesia practice; what measures they take to make anesthesia more environmentally friendly; what barriers they face in trying to do so; and why they are unable to adopt ecologically friendly practices in some instances. Using a thematic analysis approach, we identified dominating themes in participants' responses. RESULTS A total of 62 anesthesia providers completed the online survey. 89% of the participants stated that environmental sustainability is essential in their work, and 95% reported that they implement measures to make their practice greener. A conscious choice of anesthetics was identified as the most common step the respondents take to reduce the environmental impact of anesthesia. Waste production and improper waste management was the most frequently mentioned anesthesia-associated threat to the environment. Lacking knowledge/teaching in sustainability themes was recognized as a crucial barrier to achieving ecology goals. CONCLUSIONS Sustainable anesthesia initiatives have the potential to both encourage engagement among anesthesia providers and raise awareness of this global issue. These findings inspire opportunities for action in sustainable anesthesia and broaden the capacity to decrease the climate impact of health care.
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Affiliation(s)
- Greta Gasciauskaite
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland.
| | - Justyna Lunkiewicz
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Donat R Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Corinna Von Deschwanden
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Christoph B Nöthiger
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - David W Tscholl
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
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Quitmann C, Griesel S, Nayna Schwerdtle P, Danquah I, Herrmann A. Climate-sensitive health counselling: a scoping review and conceptual framework. Lancet Planet Health 2023; 7:e600-e610. [PMID: 37438001 DOI: 10.1016/s2542-5196(23)00107-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 07/14/2023]
Abstract
Health professional societies and researchers call for the integration of climate change into health counselling. However, the scientific evidence and conceptual grounding of such climate-sensitive health counselling (CSHC) remains unclear. We conducted a scoping review identifying scientific articles on the integration of climate change into communication between health professionals and patients in health-care settings. Scientific databases (Web of Science, PubMed, and Google Scholar) were searched from inception until Nov 30, 2022. 97 articles were included, of which 33 represented empirical research, and only two evaluated the effects of CSHC. More than half of the articles originated from the USA and addressed physicians. We introduce a conceptual framework for CSHC, which elaborates on aims, content areas, and communication strategies, and establishes the guiding principle of integrating CSHC into routine activities of health care. This framework supports health professionals in implementing CSHC and enables researchers to conceptualise intervention studies investigating how CSHC can contribute to the health of patients and the planet.
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Affiliation(s)
- Claudia Quitmann
- Institute of Global Health, University Hospital Heidelberg, Medical Faculty University Heidelberg, Heidelberg, Germany
| | - Silvan Griesel
- Institute of Global Health, University Hospital Heidelberg, Medical Faculty University Heidelberg, Heidelberg, Germany
| | - Patricia Nayna Schwerdtle
- Institute of Global Health, University Hospital Heidelberg, Medical Faculty University Heidelberg, Heidelberg, Germany; Interdisciplinary Centre for Scientific Computing (IWR)-Climate Change and Health AI Lab, University of Heidelberg, Heidelberg, Germany; School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Ina Danquah
- Institute of Global Health, University Hospital Heidelberg, Medical Faculty University Heidelberg, Heidelberg, Germany
| | - Alina Herrmann
- Institute of Global Health, University Hospital Heidelberg, Medical Faculty University Heidelberg, Heidelberg, Germany; Institute of General Medicine, University Hospital Cologne, Medical Faculty University of Cologne, Cologne, Germany.
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Nazir A, Ma X, Vervoort D. Environmentally sustainable surgical health systems: an analysis of policies, tools, and guidelines. Lancet Planet Health 2023; 7:e538-e539. [PMID: 37437993 DOI: 10.1016/s2542-5196(23)00124-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/26/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Anisa Nazir
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
| | - Xiya Ma
- Division of Plastic Surgery, Université de Montréal, Montréal, QC, Canada
| | - Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, Toronto, ON M5S 1A8, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A8, Canada
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