The Imperative for Climate Action to Protect Health

The Climate-Asthma Connection: Examining the Influence of Climate Change Anxiety on Asthma Control and Quality of Life: A Multi-National Study

AIMS

This study aims to identify the impact of climate change anxiety and asthma control on asthmatics' quality of life and examine the moderating role of climate change anxiety in this linkage.

METHOD

A multi-national cross-sectional study was conducted in four Arabian countries on 1266 asthmatics selected by convenience sampling. Data were collected from November 2023 to February 2024 using a climate anxiety scale, mini-asthma quality of life questionnaire, and an asthma control questionnaire.

RESULTS

Climate anxiety was higher among middle-aged participants, as well as those with longer disease durations and previous hospitalisations. Climate anxiety showed strong negative correlations with asthma control (r = -0.704, p ≤ 0.05) and asthma quality of life (r = - 0.638, p ≤ 0.05). Climate anxiety and asthma control are powerful predictors of quality of life among asthmatics. Climate anxiety moderates the relationship between asthma control and quality of life, making it less positive (B = -0.094, p > 0.001). Covariates such as gender, age, comorbidities, employment status, disease duration, and previous hospitalisation showed significant associations with asthma quality of life.

IMPLICATIONS FOR NURSING PRACTICE

Assessment and mitigation of climate anxiety among asthmatics is a key strategy for controlling asthma and improving the quality of life. So, nurses must incorporate climate anxiety assessment into the care plan for asthmatics.

IMPACT

Climate change is a global concern, and insights into how climate-related psychological stressors exacerbate asthma symptoms and overall health outcomes are necessary. The findings provide actionable data for healthcare professionals to underscore the need for integrated healthcare approaches considering environmental and psychological factors.

REPORTING METHOD

This study adheres to strengthening the reporting of observational studies in epidemiology (STROBE) statement.

PATIENT OR PUBLIC CONTRIBUTION

Clients with asthma across multiple nationalities actively contributed to our paper.

Epithelial barrier dysfunction and associated diseases in companion animals: Differences and similarities between humans and animals and research needs

Since the 1960s, more than 350,000 new chemicals have been introduced into the lives of humans and domestic animals. Many of them have become part of modern life and some are affecting nature as pollutants. Yet, our comprehension of their potential health risks for both humans and animals remains partial. The "epithelial barrier theory" suggests that genetic predisposition and exposure to diverse factors damaging the epithelial barriers contribute to the emergence of allergic and autoimmune conditions. Impaired epithelial barriers, microbial dysbiosis, and tissue inflammation have been observed in a high number of mucosal inflammatory, autoimmune and neuropsychiatric diseases, many of which showed increased prevalence in the last decades. Pets, especially cats and dogs, share living spaces with humans and are exposed to household cleaners, personal care products, air pollutants, and microplastics. The utilisation of cosmetic products and food additives for pets is on the rise, unfortunately, accompanied by less rigorous safety regulations than those governing human products. In this review, we explore the implications of disruptions in epithelial barriers on the well-being of companion animals, drawing comparisons with humans, and endeavour to elucidate the spectrum of diseases that afflict them. In addition, future research areas with the interconnectedness of human, animal, and environmental well-being are highlighted in line with the "One Health" concept.

Strengthening crisis resilience in German primary care by using quality indicators: findings of a process evaluation in the RESILARE project

BACKGROUND

In recent years, health systems worldwide have been confronted with several crises such as natural disasters or the COVID-19 pandemic, that affected lives and health of many people. In light of waves of infections and heat, climate change is considered to be the biggest health threat of the 21st century. Strengthening individual and organizational crisis resilience in healthcare settings thus becomes a crucial factor in maintaining care quality and protecting vulnerable patients during such crises. The RESILARE project therefore aimed to develop and evaluate quality indicators that support primary care practices in preparing for and adapting to crisis-related challenges.

METHODS

In a three-phased process, indicator development was based on systematic literature research and qualitative data, a two-stage expert panel process, and pilot testing in a maximum of n = 35 ambulatory practices during an outreach visit. Practice-individual indicator-related status and benchmarking information were provided via feedback reports to complete the audit and feedback program. A mixed-methods process evaluation used semistructured interviews with participating General practitioners and nonphysician health professionals to explore support and challenges for the implementation of the derived set of quality indicators. Two online surveys were conducted to evaluate all indicators and the two-part feedback report. Qualitative data were analyzed inductively using a thematic analysis approach. Survey data were analyzed descriptively.

RESULTS

A total of n = 32 indicators covered four domains: (1) individual resilience, (2) crisis prevention, (3) organizational resilience, and (4) climate resilience. N = 34 practices participated in the piloting and the process evaluation. Participants generally attributed a high relevance to the domains, and considered the indicator set suitable for implementation into existing quality management systems. Planning and implementation of measures that strengthen crisis resilience in practices were triggered or intensified by piloting the indicators and by the two-part feedback report. The identified challenges involved the volume of indicators and practice-individual implementation of renewable energy sources on rented premises. Participants expressed their desire for peer exchange regarding proven concepts for crisis resilience.

Climate change and environmental sustainability in otolaryngology: A state-of-the-art review

BACKGROUND

Climate change has been identified by the World Health Organization (WHO) as the greatest existing threat to human health. Given the direct exposure of the upper aerodigestive system to pollutants, patients in otolaryngology are at high risk for increased disease burden in the setting of climate change and worsening air quality. Given this and the environmental impact of surgical care, it is essential for surgeons to understand their role in addressing climate health through quality-driven clinical initiatives, education, advocacy, and research.

METHODS

A state-of-the-art review was performed of the existing literature on the otolaryngologic health impacts of climate change and environmental sustainability efforts in surgery with specific attention to studies in otolaryngology - head and neck surgery.

FINDINGS

Climate variables including heat and air pollution are associated with increased incidence of allergic rhinitis, chronic rhinosinusitis and head and neck cancer. A number of studies have shown that sustainability initiatives in otolaryngology are safe and provide direct cost benefit.

CONCLUSION

Surgeons have the opportunity to lead on climate health and sustainability to address the public health burden of climate change.

Environmental sustainability in gynecologic oncology

Climate change is a complex, global issue that is impacting human health in various ways, with healthcare being a significant contributor to carbon emissions in the United States. This review discusses the environmental impact of important aspects of gynecologic oncology care, including surgery, anesthesia care, radiology, chemotherapy, and radiation oncology. Operating room energy and material use is highlighted, with a focus on the environmental impact of robotic surgery. The contribution of certain anesthetic gases in increasing greenhouse gas emissions is addressed. Additionally, the environmental impacts of radiologic imaging, chemotherapy, and radiation oncology are also discussed. Despite the complexity of climate change, there are multiple strategies on the individual and institutional level that can help mitigate the environmental impact of gynecologic oncology care. Individual efforts include practicing red bag stewardship, limiting single use-supplies, decreasing the use of potentially deleterious anesthetics, and supporting research into alternative dosing for chemotherapy and radiation which requires less patient travel. Institutional strategies include investing in efficient HVAC systems, utilizing reusable and reprocessed materials and devices, and purchasing renewable energy sources. Both individuals and institutions can advocate with industry and government at all levels for practices and policies that support lower carbon emissions. By recognizing our role in reducing carbon emissions, we can work towards improving the well-being of our patients and the larger community.

[Medical education in ecology and environmental health: A sustainable tool for action]

Global warming and the disruption in ecosystems have been identified as the greatest threats to human health in the 21st century. Today, the French healthcare system accounts for 6.6% to 10% of overall greenhouse gas emissions in France. This system is currently not resilient and totally dependent on fossil fuels. Therefore, a transformation of the current system is needed in order to reduce the deterioration of populations' health. Medical education and pedagogy have been identified as a major solution for the ecological transformation of the healthcare system. The introduction of early education on ecology and environmental health in the first and second cycles of medical studies is a major lever for action. From the third cycle of medical studies, and more specifically in pathology, it is essential to teach this topic to residents and experienced pathologists, whether in "theoretical teaching" or "applied to the medical specialty". The aim of this review is to identify the educational programs and training currently available in the medical courses and at the post-graduate level, regarding ecology/environmental health and the consequences on human health. Then, we will detail more specifically the pedagogical perspectives and training opportunities for pathology residents and pathologists.

e-Health and environmental sustainability in vascular surgery

e-Health technology holds great promise for improving the management of patients with vascular diseases and offers a unique opportunity to mitigate the environmental impact of vascular care, which remains an under-investigated field. The innovative potential of e-Health operates in a complex environment with finite resources. As the expansion of digital health will increase demand for devices, contributing to the environmental burden of electronics and energy use, the sustainability of e-Health technology is of crucial importance, especially in the context of increasing prevalence of cardiovascular diseases. This review discusses the environmental impact of care related to vascular surgery and e-Health innovation, the potential of e-Health technology to mitigate greenhouse gas emissions generated by the health care sector, and to provide leads to research promoting e-Heath technology sustainability. A multifaceted approach, including ethical design, validated eco-audits methodology and reporting standards, technological refinement, electronic and medical devices reuse and recycling, and effective policies is required to provide a sustainable and optimal level of care to vascular patients.

Exploring the contribution of inter-individual factors to the development of physiological heat strain in older adults exposed to simulated indoor overheating

Older adults are at elevated risk of heat-related mortality due to age-associated declines in thermoregulatory and cardiovascular function. However, the inter-individual factors that exacerbate physiological heat strain during heat exposure remain unclear, making it challenging to identify more heat-vulnerable subgroups. We therefore explored factors contributing to inter-individual variability in physiological responses of older adults exposed to simulated hot weather. Thirty-seven older adults (61-80 years, 16 females) rested for 8 h in 31 and 36 °C (45% relative humidity). Core (rectal) temperature, heart rate (HR), HR variability, mean arterial pressure (MAP), and cardiac autonomic responses to standing were measured at baseline and end-exposure. Bootstrapped least absolute shrinkage and selection operator regression was used to evaluate whether variation in these responses was related to type 2 diabetes (T2D, n = 10), hypertension (n = 18), age, sex, body morphology, habitual physical activity levels, and/or heat-acclimatization. T2D was identified as a predictor of end-exposure HR (with vs. without: 13 beats/min (bootstrap 95% confidence interval: 6, 23)), seated MAP (-7 mmHg (-18, 1)), and the systolic pressure response to standing (20 mmHg (4, 36)). HR was also influenced by sex (female vs. male: 8 beats/min (1, 16)). No other predictors were identified. The inter-individual factors explored did not meaningfully contribute to the variation in body temperature responses in older adults exposed to simulated indoor overheating. By contrast, cardiovascular responses were exacerbated in females and individuals with T2D. These findings improve understanding of how inter-individual differences contribute to heat-induced physiological strain in older persons.

Climate change and cardiovascular health: Recent updates and actions for healthcare

Climate change is a public health crisis predominantly due to fossil fuel combustion, that challenges planetary and human health. Considerable evidence exists to demonstrate the impact climate change has on cardiovascular disease primarily through air pollution, and non-optimal temperature. Conversely, healthcare systems themselves contribute substantially to climate change. Many clinicians personally report a sense of responsibility to reduce the detrimental impact of parts of our healthcare system on the environment. Roadmaps exist to guide decarbonization and reduce pollution in the healthcare sector. The first step in minimizing the climate impact of the provision of cardiovascular care is to determine the carbon footprint of highly resource dependent sectors such as critical care cardiology as well as the cardiac catheterization and electrophysiology laboratories. This should be followed by sustainable changes to address healthcare waste and energy use. Engagement from healthcare leadership, governmental organizations and major cardiac societies will be necessary to impact meaningful change.

California dreaming: Why environmental justice is integral to the success of climate change policy

In the realm of climate policy, issues of environmental justice (EJ) are often treated as second-order affairs compared to overarching sustainability goals. We argue that EJ is in fact critical to successfully addressing our national and global climate challenges; indeed, centering equity amplifies the voices of the diverse constituencies most impacted by climate change and that are needed to build successful coalitions that shape and advance climate change policy. We illustrate this perspective by highlighting the experience of California and the contentious processes by which EJ became integrated into the state's climate action efforts. We examine the achievements and shortcomings of California's commitment to climate justice and discuss how lessons from the Golden State are influencing the evolution of current federal climate change policy.

Climate Change

As human-induced climate change warms the planet, its health impacts will affect all populations, but certain groups will be more vulnerable to its impacts. Given its role as a health care safety net, emergency medicine will play a crucial role in addressing these health conditions. Additionally, with its expertise in disaster medicine, interdisciplinary collaboration, and health care systems knowledge, emergency medicine has the potential to lead the health care sector's response to climate change.

Adipose Tissue Dysfunction Related to Climate Change and Air Pollution: Understanding the Metabolic Consequences

Obesity, a global pandemic, poses a major threat to healthcare systems worldwide. Adipose tissue, the energy-storing organ during excessive energy intake, functions as a thermoregulator, interacting with other tissues to regulate systemic metabolism. Specifically, brown adipose tissue (BAT) is positively associated with an increased resistance to obesity, due to its thermogenic function in the presence of uncoupled protein 1 (UCP1). Recently, studies on climate change and the influence of environmental pollutants on energy homeostasis and obesity have drawn increasing attention. The reciprocal relationship between increasing adiposity and increasing temperatures results in reduced adaptive thermogenesis, decreased physical activity, and increased carbon footprint production. In addition, the impact of climate change makes obese individuals more prone to developing type 2 diabetes mellitus (T2DM). An impaired response to heat stress, compromised vasodilation, and sweating increase the risk of diabetes-related comorbidities. This comprehensive review provides information about the effects of climate change on obesity and adipose tissue, the risk of T2DM development, and insights into the environmental pollutants causing adipose tissue dysfunction and obesity. The effects of altered dietary patterns on adiposity and adaptation strategies to mitigate the detrimental effects of climate change are also discussed.

Real-time forecast of temperature-related excess mortality at small-area level: towards an operational framework

The development of innovative tools for real-time monitoring and forecasting of environmental health impacts is central to effective public health interventions and resource allocation strategies. Though a need for such generic tools has been previously echoed by public health planners and regional authorities responsible for issuing anticipatory alerts, a comprehensive, robust and scalable real-time system for predicting temperature-related excess deaths at a local scale has not been developed yet. Filling this gap, we propose a flexible operational framework for coupling publicly available weather forecasts with temperature-mortality risk functions specific to small census-based zones, the latter derived using state-of-the-art environmental epidemiological models. Utilising high-resolution temperature data forecast by a leading European meteorological centre, we demonstrate a real-time application to forecast the excess mortality during the July 2022 heatwave over England and Wales. The output, consisting of expected temperature-related excess deaths at small geographic areas on different lead times, can be automated to generate maps at various spatio-temporal scales, thus facilitating preventive action and allocation of public health resources in advance. While the real-case example discussed here demonstrates an application for predicting (expected) heat-related excess deaths, the framework can also be adapted to other weather-related health risks and to different geographical areas, provided data on both meteorological exposure and the underlying health outcomes are available to calibrate the associated risk functions. The proposed framework addresses an urgent need for predicting the short-term environmental health burden on public health systems globally, especially in low- and middle-income regions, where rapid response to mitigate adverse exposures and impacts to extreme temperatures are often constrained by available resources.

Maternal preconceptional and prenatal exposure to El Niño Southern Oscillation levels and child mortality: a multi-country study

El Niño Southern Oscillation (ENSO) has been shown to relate to the epidemiology of childhood infectious diseases, but evidence for whether they increase child deaths is limited. Here, we investigate the impact of mothers' ENSO exposure during and prior to delivery on child mortality by constructing a retrospective cohort study in 38 low- and middle-income countries. We find that high levels of ENSO indices cumulated over 0-12 lagged months before delivery are associated with significant increases in risks of under-five mortality; with the hazard ratio ranging from 1.33 (95% confidence interval [CI], 1.26, 1.40) to 1.89 (95% CI, 1.78, 2.00). Child mortality risks are particularly related to maternal exposure to El Niño-like conditions in the 0th-1st and 6th-12th lagged months. The El Niño effects are larger in rural populations and those with unsafe sources of drinking water and less education. Thus, preventive interventions are particularly warranted for the socio-economically disadvantaged.

Single-use synthetic plastic and natural fibre anaesthetic drug trays: a comparative life cycle assessment of environmental impacts

BACKGROUND

Single-use anaesthetic drug trays are used widely in Australia, but their environmental impact is unclear.

METHODS

A life cycle assessment was completed for 10 different types of single-use anaesthetic drug trays made of four materials: the synthetic plastics polypropylene and polystyrene, and the natural fibres bagasse (sugarcane pulp) and cellulose pulp.

RESULTS

Carbon emissions per tray from total life cycle with landfill disposal were 33-454 g CO2-eq, which equates to 152-2066 tonnes CO2-eq annually. Recycling mitigates this impact, reducing emissions per tray to 16-294 g CO2-eq. The tray with the least emissions for landfill and recycling was the small polystyrene injection tray. There was a significant linear relationship between the mass of a tray and its carbon emissions. For landfill, recycling, and incineration disposal, Pearson's r value was 0.98, 0.99, and 0.95, respectively. Composting natural fibres can give a carbon benefit over some synthetic plastics under specific disposal scenarios, but this benefit was not seen under all circumstances. There was a strong positive correlation between the increasing mass of a tray and its increasing environmental impacts for water consumption, particulate matter formation, and mineral depletion.

CONCLUSIONS

Single-use trays with the lowest mass should be preferentially chosen. Recycling and composting will reduce environmental impacts. Natural fibre does not automatically confer any environmental benefit over plastic and sustainability claims should be carefully examined for accuracy. The practice of using a single-use drug tray for every procedure should be reconsidered.

Compatibility of pulse protein in the formulation of plant based yogurt: a review of nutri-functional properties and processing impact

With the increased environmental concerns and health awareness among consumers, there has been a notable interest in plant-based dairy alternatives. The plant-based yogurt market has experienced rapid expansion in recent years. Due to challenges related to cultivation, higher cost of production and lower protein content researchers have explored the viability of pulse-based yogurt which has arisen as an economically and nutritionally abundant solution. This review aims to examine the feasibility of utilizing pulse protein for yogurt production. The nutritional, antinutritional, and functional characteristics of various pulses were discussed in detail, alongside the modifications in these properties during the various stages of yogurt manufacturing. The review also sheds light on pivotal findings from existing literature and outlines challenges associated with the production of pulse-based yogurt. Pulses have emerged as promising base materials for yogurt manufacturing due to their favorable nutritional and functional characteristics. Further, the fermentation process can effectively reduce antinutritional components and enhance digestibility. Nonetheless, variations in sensorial and rheological properties were noted when different types of pulses were employed. This issue can be addressed by employing suitable combinations to achieve the desired properties in pulse-based yogurt.

The carbon footprint of health care delivery in Western Australia's public health system

Background

Health systems have a dual imperative to take action on climate change. First, they must develop climate resilient health services in response to the direct and indirect impacts of climate change on health. Second, they must reduce their own carbon footprint since health systems are a significant contributor to global greenhouse gas emissions.

Methods

An environmentally-extended multi-region input-output analysis was carried out, incorporating National Accounts data for Australia and annual expenditure data from WA Health for financial year 2019-20. Expenditure data were categorised to one of 344 economic sectors and by location of the provider of goods or services purchased.

Findings

WA Health contributes 8% of WA's total carbon footprint, driven by expenditure on chemicals (23.8% of total), transport (20.2% of total), and electricity supply (19.7% of total). These 3 sectors represent 63.7% of WA Health's carbon footprint, but only 10.8% of its total expenditure.

Interpretation

Reducing emissions related to health service provision in WA will require a holistic approach that leverages carbon footprinting insights and integrates them into organisational decision-making across all health programs. The high carbon-intensity of the transport and chemicals sectors supports previous research calling for a reduction in unnecessary pathology testing and the transition to delivery of non-urgent health care via sustainable models of telehealth. The impact of WA's size and location presents challenges, with a predominantly non-renewable energy supply and reliance on transport and supply chains from other states adding significantly to emissions.

Funding

The study received funding from the Australian Research Council, The University of Sydney, and the WA Department of Health. The full list of funding information can be found in Acknowledgements.

Ambient heat exposure patterns and emergency department visits and hospitalizations among medicare beneficiaries 2008-2019

OBJECTIVE

To assess the association between ambient heat and all-cause and cause-specific emergency department (ED) visits and acute hospitalizations among Medicare beneficiaries in the conterminous United States.

DESIGN

Retrospective cohort study.

SETTING

Conterminous US from 2008 and 2019.

PARTICIPANTS

2% random sample of all Medicare fee-for-service beneficiaries eligible for Parts A, B, and D.

MAIN OUTCOME MEASURES

All-cause and cause-specific (cardiovascular, renal, and heat-related) ED visits and unplanned hospitalizations were identified using primary ICD-9 or ICD-10 diagnosis codes. We measured the association between ambient temperature - defined as daily mean temperature percentile of summer (June through September) - and the outcomes. Hazard ratios and their associated 95% confidence intervals were estimated using multivariable Cox proportional hazards regression, adjusting for individual level demographics, comorbidities, healthcare utilization factors and zip-code level social factors.

RESULTS

Among 809,636 Medicare beneficiaries (58% female, 81% non-Hispanic White, 24% <65), older beneficiaries (aged ≥65) exposed to >95th percentile temperature had a 64% elevated adjusted risk of heat-related ED visits (HR [95% CI], 1.64 [1.46,1.85]) and a 4% higher risk of all-cause acute hospitalization (1.04 [1.01,1.06]) relative to <25th temperature percentile. Younger beneficiaries (aged <65) showed increased risk of heat-related ED visits (2.69 [2.23,3.23]) and all-cause ED visits (1.03 [1.01,1.05]). The associations with heat related events were stronger in males and individuals dually eligible for Medicare and Medicaid. No significant differences were observed by climatic region. We observed no significant relationship between temperature percentile and risk of CV-related ED visits or renal-related ED visits.

CONCLUSIONS

Among Medicare beneficiaries from 2008 to 2019, exposure to daily mean temperature ≥ 95th percentile was associated with increased risk of heat-related ED visits, with stronger associations seen among beneficiaries <65, males, and patients with low socioeconomic position. Further longitudinal studies are needed to understand the impact of heat duration, intensity, and frequency on cause-specific hospitalization outcomes.

Climate-sensitive health counselling in Germany: a cross-sectional study about previous participation and preferences in the general public

BACKGROUND

In response to climate change (CC), medicine needs to consider new aspects in health counselling of patients. Such climate-sensitive health counselling (CSHC) may include counselling patients on preventing and coping with climate-sensitive diseases or on leading healthy and climate-friendly lifestyles. This study aimed to identify previous participation in and preferences for CSHC as well as associated sociodemographic and attitudinal factors among the general public in Germany.

METHODS

We conducted a cross-sectional study in a population-based online panel in five German federal states (04-06/2022). We performed descriptive statistics and multivariable regression analysis to assess prior participation in CSHC and content preferences regarding CSHC, as well as associations between sociodemographic variables and general preference for CSHC.

RESULTS

Among 1491 participants (response rate 47.1%), 8.7% explicitly reported having participated in CSHC, while 39.9% had discussed at least one CSHC-related topic with physicians. In the studied sample, 46.7% of participants would like CSHC to be part of the consultation with their physician, while 33.9% rejected this idea. Participants aged 21 to 40 years (versus 51 to 60), individuals alarmed about CC (versus concerned/cautious/disengaged/doubtful/dismissive), and those politically oriented to the left (vs. centre or right) showed greater preference for CSHC in the multivariable regression model. Most participants wanted to talk about links to their personal health (65.1%) as opposed to links to the health of all people (33.2%).

CONCLUSIONS

Almost half of the participants in this sample would like to receive CSHC, especially those who are younger, more alarmed about CC and more politically oriented to the left. More research and training on patient-centred implementation of CSHC is needed.

Indoor overheating: A review of vulnerabilities, causes, and strategies to prevent adverse human health outcomes during extreme heat events

The likelihood of exposure to overheated indoor environments is increasing as climate change is exacerbating the frequency and severity of hot weather and extreme heat events (EHE). Consequently, vulnerable populations will face serious health risks from indoor overheating. While the relationship between EHE and human health has been assessed in relation to outdoor temperature, indoor temperature patterns can vary markedly from those measured outside. This is because the built environment and building characteristics can act as an important modifier of indoor temperatures. In this narrative review, we examine the physiological and behavioral determinants that influence a person's susceptibility to indoor overheating. Further, we explore how the built environment, neighborhood-level factors, and building characteristics can impact exposure to excess heat and we overview how strategies to mitigate building overheating can help reduce heat-related mortality in heat-vulnerable occupants. Finally, we discuss the effectiveness of commonly recommended personal cooling strategies that aim to mitigate dangerous increases in physiological strain during exposure to high indoor temperatures during hot weather or an EHE. As global temperatures continue to rise, the need for a research agenda specifically directed at reducing the likelihood and impact of indoor overheating on human health is paramount. This includes conducting EHE simulation studies to support the development of consensus-based heat mitigation solutions and public health messaging that provides equitable protection to heat-vulnerable people exposed to high indoor temperatures.

Impact of climate change on atopic dermatitis: A review by the International Eczema Council

Atopic dermatitis (AD), the most burdensome skin condition worldwide, is influenced by climatic factors and air pollution; however, the impact of increasing climatic hazards on AD remains poorly characterized. Leveraging an existing framework for 10 climatic hazards related to greenhouse gas emissions, we identified 18 studies with evidence for an impact on AD through a systematic search. Most climatic hazards had evidence for aggravation of AD the impact ranged from direct effects like particulate matter-induced AD exacerbations from wildfires to the potential for indirect effects like drought-induced food insecurity and migration. We then created maps comparing the past, present, and future projected burden of climatic hazards to global AD prevalence data. Data are lacking, especially from those regions most likely to experience more climatic hazards. We highlight gaps important for future research: understanding the synergistic impacts of climatic hazards on AD, long-term disease activity, the differential impact on vulnerable populations, and how basic mechanisms explain population-level trends.

"HOW TO" ……. Incorporating education for sustainable development within a radiography curriculum: A narrative review

OBJECTIVES

This narrative review aims to describe opportunities to embed sustainability as a core concept in radiography education by exploring teaching strategies to increase awareness about sustainability and its importance in radiography; encourage a culture of personal responsibility and investigate effective teaching methods to engage students in exploring sustainable radiography practices. Climate change can adversely affect the health of populations worldwide. Medical imaging and radiotherapy services are recognised as substantial contributors to the ecological impact of the healthcare industry. There is a need to address the inclusion of sustainability in radiography education due to its increasing relevance to complex cultural and environmental problems.

KEY FINDINGS

Literature searches were conducted using CINAHL and Google Scholar, focusing on keywords such as "Sustainability," "Healthcare," and "Radiography Curriculum." A variety of teaching strategies are available to facilitate the instruction of sustainable healthcare practices. Many pedagogical methods promote emancipation and transformative learning, such as problem-based learning, case-study learning, debate, and participatory action research, contributing to a student-centred learning experience. Traditional lecturing and interprofessional teaching also enhance the learner experience by stimulating new ways of thinking.

CONCLUSION

Communicating about climate change is important. The radiography curriculum should include education on sustainability for meaningful global health literacy, encourage active research involvement, and ensure that sustainable healthcare principles are incorporated into daily practice.

IMPLICATIONS TO PRACTICE

Radiographers possess the ability to assess the various elements influencing a patient's health status and identify which aspects might affect their capacity for behaviour change. This empowers patients to effectively control their conditions within the framework of personalised care. Radiographers have the potential to motivate actions, shape policies, and drive transformation as advocates for environmental and health messengers.

Contribution of hospital pharmacists to sustainable healthcare: a systematic review

BACKGROUND

With a global annual carbon footprint of the healthcare sector of 2 gigatons of CO2e, healthcare systems must contribute to the fight against climate change. Hospital pharmacists could be key players in ecological transition due to their role in managing healthcare products. The aim of this study was to summarise the evidence on interventions implemented in healthcare facilities involving pharmacists to improve the environmental footprint of healthcare.

METHODS

This systematic review was conducted following PRISMA 2020 guidelines. The Medline, Web of Science and ScienceDirect databases were searched for studies published between 2013 and 2023. To be eligible for inclusion, studies had to include hospital pharmacists and present contributions aimed at reducing the environmental footprint of healthcare in healthcare facilities. Outcomes were the description of the contribution, the methods used and the stages of healthcare product lifecycle analysed. A Mixed Methods Appraisal Tool was used to assess the risk of bias for each study.

RESULTS

Seventeen studies were included. Pharmacists played a leading role in 15 (88%) and had a supporting role in the others. The healthcare products targeted were medicines (59%), medical devices (12%) or both (29%). The stages of the healthcare product cycle addressed by the contributions were elimination (71%), dispensing (35%), procurement and supply (35%), production (29%), and prescription (24%). Only two studies used life cycle assessment and only one assessed all three pillars of sustainability. Two studies had good methodological quality while the rest had at least one element of uncertainty.

CONCLUSION

This review confirms the central role of the pharmacist and the importance of a multidisciplinary approach in implementing eco-responsible actions. It could be useful to hospitals and other teams wanting to improve sustainable actions and it emphasises the importance of collaborating with pharmacists when planning sustainable initiatives. Future eco-responsible initiatives must use robust reproducible methods.

TRIAL REGISTRATION

PROSPERO #CRD42023406835.

Physicians' duty to climate protection as an expression of their professional identity: a defence from Korsgaard's neo-Kantian moral framework

The medical profession is observing a rising number of calls to action considering the threat that climate change poses to global human health. Theory-led bioethical analyses of the scope and weight of physicians' normative duty towards climate protection and its conflict with individual patient care are currently scarce. This article offers an analysis of the normative issues at stake by using Korsgaard's neo-Kantian moral account of practical identities. We begin by showing the case of physicians' duty to climate protection, before we succinctly introduce Korsgaard's account. We subsequently show how the duty to climate protection can follow from physicians' identity of being a healthcare professional. We structure conflicts between individual patient care and climate protection, and show how a transformation in physicians' professional ethos is possible and what mechanisms could be used for doing so. An important limit of our analysis is that we mainly address the level of individual physicians and their practical identities, leaving out important measures to respond to climate change at the mesolevels and macrolevels of healthcare institutions and systems, respectively.

[Integrating environmental health into our nursing practices]

The healthcare sector accounts for 8% of the national carbon footprint in France. It is imperative to integrate climate and environmental issues into modern healthcare management. Many health professionals are advocating for more eco-responsible care. Each caregiver can reduce the environmental and health impact of their activity, while evolving in a healthy environment. Nurses have a particular responsibility to contribute to sustainable development.

Climate change and its impact on asthma

ABSTRACT

Earth's climate is changing at an unprecedented pace, primarily due to anthropogenic causes including greenhouse gas emissions. Evidence shows a strong link between climate change and its effects on asthma. Healthcare professionals must be educated to advocate for and lead effective strategies to reduce the health risks of climate change.

Transitioning to sustainable, climate-resilient healthcare: insights from a health service staff survey in Australia

BACKGROUND

More than 80 countries, including Australia, have made commitments to deliver climate-resilient and low carbon healthcare. Understanding how healthcare workers view their own and their organization's efforts to achieve sustainable and climate-resilient healthcare practice is vital to inform strategies to accelerate that transition.

METHODS

We conducted an online staff survey in a large state government hospital-and-health-service organisation in Queensland, Australia, to ascertain attitudes and practices towards environmentally sustainable, climate-resilient healthcare, and views about the organizational support necessary to achieve these goals in their workplace.

RESULTS

From 301 participants showed staff strongly support implementing sustainable and climate-resilient healthcare but require significantly more organizational support. Participants identified three categories of organizational support as necessary for the transition to environmentally sustainable and climate-resilient health services and systems: (1) practical support to make sustainability easier in the workplace (e.g. waste, energy, water, procurement, food, transport etc.); (2) training and education to equip them for 21st century planetary health challenges; and (3) embedding sustainability as 'business as usual' in healthcare culture and systems.

CONCLUSIONS

The research provides new insight into health workforce views on how organizations should support them to realize climate and sustainability goals. This research has implications for those planning, managing, implementing, and educating for, the transition to environmentally sustainable and climate-resilient health services and systems in Queensland, Australia, and in similar health systems internationally.

How social background and interest in science are linked to junior high school students' perceptions of the ecological transition

Junior high school students are tomorrow's key protagonists in the ecological transition. They need enlightened education to face the uncertainty and challenges of climate change. The development of climate change education programs requires a clear understanding of how young people perceive the issue. This study deals with social representations. Its aim was to understand how social background and interest in science are linked to the way young people perceive the concept of the ecological transition. Four hundred twenty-nine junior high school students took part in this study. Data were collected and subjected to prototypical analysis and factorial correspondence analysis. Three main findings emerged from the analysis: (1) the participants had significant knowledge of the ecological transition, (2) their awareness of the social aspects of climate change was limited, and (3) their representations of the ecological transition were linked to their interest in science and their parents' social background. To conclude, these results underline the importance of educating all social classes about effective solutions for the ecological transition. Our findings also highlight the need to consider existing representations and prior knowledge when designing educational programs on climate change issues.

A toxicological perspective on climate change and the exposome

Climate change is accompanied by changes in the exposome, including increased heat, ground-level ozone, and other air pollutants, infectious agents, pollens, and psychosocial stress. These exposures alter the internal component of the exposome and account for some of the health effects of climate change. The adverse outcome pathways describe biological events leading to an unfavorable health outcome. In this perspective study, I propose to use this toxicological framework to better describe the biological steps linking a stressor associated with climate change to an adverse outcome. Such a framework also allows for better identification of possible interactions between stressors related to climate change and others, such as chemical pollution. More generally, I call for the incorporation of climate change as part of the exposome and for improved identification of the biological pathways involved in its health effects.

The utility of heart rate and heart rate variability to identify limits of tolerance to moderate-intensity work in the heat: a secondary analysis

We investigated the utility of heart rate (HR) and heart rate variability (HRV) for identifying individuals who may terminate work early due to excessive heat strain. Forty-eight men and women (median = 36 years; Q1 = 20 years; Q3 = 54 years) attempted 180 min of moderate-intensity work at a fixed metabolic rate (∼200 W/m2; ∼3.5 METs) in a hot environment (wet-bulb globe temperature: 32 °C). Receiver operating characteristics (ROC) curves were used to identify the ability of indices of HR (absolute HR, percentage of maximum HR, percentage of HR reserve) and HRV (root-mean-square of successive differences (RMSSD), high-frequency power, and detrended fluctuation analysis component alpha 1 (DFA α1)) to discriminate between participants who completed the 180 min work bout or terminated prematurely. Participants who terminated work prematurely (n = 26) exhibited higher HR and percentage of HR measures, as well as reduced RMSSD and DFA α1 after the first hour of work compared to participants who completed the bout. The discriminative utility of HR and HRV indices was strongest within the first hour of work, with percentage of HR reserve demonstrating excellent discriminative power (ROC area under curve (AUC) of 0.8). Stratifying participants by age and sex improved ROC AUC point estimates for most indices, particularly in female participants. The study provides preliminary evidence supporting the use of noninvasive cardiac monitoring for predicting work tolerance in healthy individuals exposed to occupational heat stress. HR and percentage of HR reserve were suggested to discriminate work termination most effectively. Further investigations are warranted to explore the influence of individual factors and refine the discriminative thresholds for early identification of excessive occupational heat strain.

Impact of extreme weather events on healthcare utilization and mortality in the United States

Climate change is intensifying extreme weather events. Yet a systematic analysis of post-disaster healthcare utilization and outcomes for severe weather and climate disasters, as tracked by the US government, is lacking. Following exposure to 42 US billion-dollar weather disasters (severe storm, flood, flood/severe storm, tropical cyclone and winter storm) between 2011 and 2016, we used a difference-in-differences (DID) approach to quantify changes in the rates of emergency department (ED) visits, nonelective hospitalizations and mortality between fee-for-service Medicare beneficiaries in affected compared to matched control counties in post-disaster weeks 1, 1-2 and 3-6. Overall, disasters were associated with higher rates of ED utilization in affected counties in post-disaster week 1 (DID of 1.22% (95% CI, 0.20% to 2.25%; P < 0.020)) through week 2. Nonelective hospitalizations were unchanged. Mortality was higher in affected counties in week 1 (DID of 1.40% (95% CI, 0.08% to 2.74%; P = 0.037)) and persisted for 6 weeks. Counties with the greatest loss and damage experienced greater increases in ED and mortality rates compared to all affected counties. Thus, billion-dollar weather disasters are associated with excess ED visits and mortality in Medicare beneficiaries. Tracking these outcomes is important for adaptation that protects patients and communities, health system resilience and policy.

The Impact of Climate Change, Pollution, and Biodiversity Loss on Digestive Health and Disease

The environment is changing rapidly under pressure from 3 related drivers: climate change, pollution, and biodiversity loss. These environmental changes are affecting digestive health and disease in multiple ways. Heat extremes can cause intestinal and hepatic dysfunction. Access to adequate amounts of food of high nutritional content and to clean water is under threat. Extreme weather is associated with flooding and enteric infections and affects the delivery of care through infrastructure loss. Air, water, and soil pollution from chemicals and plastics are emerging as risk factors for a variety of intestinal diseases including eosinophilic esophagitis, metabolic dysfunction associated fatty liver disease, digestive tract cancers, inflammatory bowel disease, and functional bowel disease. Migration of populations to cities and between countries poses a special challenge to the delivery of digestive care. The response to the threat of environmental change is well underway in the global digestive health community, especially with regard to understanding and reducing the environmental impact of endoscopy. Individuals, and peer societies, are becoming more engaged, and have an important role to play in meeting the challenge.

Building climate resilience: awareness of climate change adaptation in German outpatient medical practices

BACKGROUND

Climate change is seen as the biggest health threat of the twenty-first century. Making outpatient medical practices resilient is therefore crucial to protect vulnerable groups and maintain quality of care. Awareness is a precondition for action. This study aims to explore awareness (knowledge, experience and attention) of climate change adaptation among stakeholders of outpatient medical practices.

METHODS

Semi-structured interviews and focus groups with stakeholders of outpatient medical practices were conducted. The qualitative data were analysed in a two-step Thematic Analysis process.

RESULTS

In total, n = 40 stakeholders participated in two focus groups and 26 interviews. The findings show a mixed degree of awareness in outpatient medical practices. The spectrum ranged from a passive role with curative acting only, handing over responsibility to others and a low perceived self-efficacy to a proactive and responsible implementation of adaptation strategies. Participants who saw the need and responsibility of climate change adaptation in medical practices perceived low additional workload. In general, implementation of climate change adaptation measures and general awareness of climate change adaptation appeared to be depending on a certain tension for change and a higher self-efficacy.

CONCLUSION

Medical practices, and specifically primary care, plays a crucial role in climate change adaptation, and awareness needs to be increased further in order to cope with consequences of climate change. To facilitate this, there should be a strong emphasis on climate change adaptation strategies being part of outpatient care provider roles rather than being perceived as an "add-on" to already high workloads.

Environmental Impact of Adult Tonsillectomy: Life Cycle Assessment and Cost Comparison of Techniques

OBJECTIVES

To quantify and compare the cost and environmental impact of different techniques for adult tonsillectomy surgery, and to identify target areas for impact reduction.

METHODS

Fifteen consecutive adult tonsillectomy surgeries were prospectively randomized to one of three tonsillectomy techniques: cold, monopolar electrocautery, or low-temperature radiofrequency ablation (Coblation). Life cycle assessment was used to comprehensively evaluate the environmental impact of study surgeries. Outcomes assessed included multiple measures of environmental impact, including greenhouse gas (GHG) emissions, and cost. Environmental impact measures were analyzed to identify highest-yield areas for improvement, and outcomes were compared between surgical techniques using statistical analysis.

RESULTS

GHG emissions for cold, monopolar electrocautery, and Coblation techniques were 157.6, 184.5, and 204.7 kilograms of carbon dioxide equivalents (kgCO2 -eq) per surgery, respectively, with costs totaling $472.51, $619.10, and $715.53 per surgery, respectively. Regardless of surgery technique, anesthesia medications and disposable equipment contributed most to environmental harm. Cold technique demonstrated reduced environmental impact related to disposable surgical equipment in the categories of greenhouse gas emissions, acidification of soil and water, eutrophication of air, ozone depletion, release of carcinogenic, and non-carcinogenic toxic substances, and respiratory pollutant production (p < 0.05 for all comparisons with other techniques).

CONCLUSION

Within the boundaries of operating room processes, cold technique minimizes cost and environmental impact of adult tonsillectomy surgery, with statistical significance noted in the impact of disposable surgical equipment. Areas of highest potential for improvement identified include reducing use of disposable equipment and collaboration with the Anesthesiology care team to streamline medication use.

LEVEL OF EVIDENCE

2, randomized trial Laryngoscope, 134:622-628, 2024.

The Impact of Climate Change on Global Oncology

Climate change is the greatest threat to human health of our time, with significant implications for global cancer control efforts. The changing frequency and behavior of climate-driven extreme weather events results in more frequent and increasingly unanticipated disruptions in access to cancer care. Given the significant threat that climate change poses to cancer control efforts, oncology professionals should champion initiatives that help protect the health and safety of patients with cancer, such as enhancing emergency preparedness and response efforts and reducing emissions from our own professional activities, which has health cobenefits for the entire population.

Health-Damaging Climate Events Highlight the Need for Interdisciplinary, Engaged Research

In 2023 human populations experienced multiple record-breaking climate events, with widespread impacts on human health and well-being. These events include extreme heat domes, drought, severe storms, flooding, and wildfires. Due to inherent lags in the climate system, we can expect such extremes to continue for multiple decades after reaching net zero carbon emissions. Unfortunately, despite these significant current and future impacts, funding for research in climate and health has lagged behind that for other geoscience and biomedical research. While some initial efforts from funding agencies are evident, there is still a significant need to increase the resources available for multidisciplinary research in the face of this issue. As a group of experts at this important intersection, we call for a more concerted effort to encourage interdisciplinary and policy-relevant investigations into the detrimental health effects of continued climate change.

Technical and Administrative Advances to Promote Sustainable Radiology

Climate change mandates that we take steps to understand and mitigate the negative environmental consequences of the practice of health care, so that health care advances sustainably. In this article, the authors review and discuss a sample of technical and administrative advances required to align the practice of radiology with principles of environmental sustainability.

The CHANGE (Climate Health ANalysis Grading Evaluation) tool for weight of evidence reviews on climate change and health research

BACKGROUND

Climate change has been identified as one of the biggest threats to human health. Despite this claim, there are no standardized tools that assess the rigor of published literature for use in weight of evidence (WOE) reviews. Standardized assessment tools are essential for creating clear and comparable WOE reviews. As such, we developed a standardized tool for evaluating the quality of climate change and health studies focused on evaluating studies that quantify exposure-response relationships and studies that implement and/or evaluate adaptation interventions.

METHODS

The authors explored systematic-review methodology to enhance transparency and increase efficiency in summarizing and synthesizing findings from studies on climate change and health research. The authors adapted and extended existing WOE methods to develop the CHANGE (Climate Health ANalysis Grading Evaluation) tool. The resulting assessment tool has been refined through application and subsequent team input.

RESULTS

The CHANGE tool is a two-step standardized tool for systematic review of climate change and health studies of exposure-response relationships and adaptation intervention studies. Step one of the CHANGE tool aims to classify studies included in weight-of-evidence reviews and step two assesses the quality and presence of bias in the climate change and health studies.

CONCLUSION

The application of the CHANGE tool in WOE reviews of climate change and health will lead to increased comparability, objectivity, and transparency within this research area.

Climate-Informed Patient Care as a Social Determinant of Health

This JAMA Forum discusses the implications for patient care by recognizing climate change as a social determinant of health.

Effects of cold and hot temperatures on the renal function of people with chronic disease

OBJECTIVES

This study investigated the effects of hot and cold temperature on the renal function of people with chronic diseases, such as diabetes, hypertension, and chronic kidney disease, using large-scale clinical data.

METHODS

We used retrospective cohort data from the Clinical Data Warehouse of the Seoul St Mary's Hospital, which contains clinical, diagnostic, laboratory, and other information about all patients who have visited the hospital since 1997. We obtained climate data from the Automated Synoptic Observing System of the Korea Meteorological Administration. The heat index was used as a measuring tool to evaluate heat exposure by indexing the actual heat that individuals feel according to temperature and humidity. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. To investigate changes in renal function trends with heat index, this study used generalized additive mixed models.

RESULTS

Renal function decreased linearly with increasing heat index after approximately 25°C, which was considered the flexion point of temperature. A linear decrease in the eGFR was observed with the effects of 0 to 5 lag days. Although there was a correlation observed between the decrease in eGFR and temperatures below -10°C, the results did not indicate statistical significance.

CONCLUSIONS

The results of our study provide scientific evidence that high temperatures affect the renal function of people with chronic diseases. These results can help prevent heat-related morbidity by identifying those who are more likely to develop renal disease and experience worsening renal function.

Experimental research in environmentally induced hyperthermic older persons: A systematic quantitative literature review mapping the available evidence

The heat-related health burden is expected to persist and worsen in the coming years due to an aging global population and climate change. Defining the breadth and depth of our understanding of age-related changes in thermoregulation can identify underlying causes and strategies to protect vulnerable individuals from heat. We conducted the first systematic quantitative literature review to provide context to the historical experimental research of healthy older adults - compared to younger adults or unhealthy age matched cases - during exogenous heat strain, focusing on factors that influence thermoregulatory function (e.g. co-morbidities). We identified 4,455 articles, with 147 meeting eligibility criteria. Most studies were conducted in the US (39%), Canada (29%), or Japan (12%), with 71% of the 3,411 participants being male. About 71% of the studies compared younger and older adults, while 34% compared two groups of older adults with and without factors influencing thermoregulation. Key factors included age combined with another factor (23%), underlying biological mechanisms (18%), age independently (15%), influencing health conditions (15%), adaptation potential (12%), environmental conditions (9%), and therapeutic/pharmacological interventions (7%). Our results suggest that controlled experimental research should focus on the age-related changes in thermoregulation in the very old, females, those with overlooked chronic heat-sensitive health conditions (e.g. pulmonary, renal, mental disorders), the impact of multimorbidity, prolonged and cumulative effects of extreme heat, evidence-based policy of control measures (e.g. personal cooling strategies), pharmaceutical interactions, and interventions stimulating protective physiological adaptation. These controlled studies will inform the directions and use of limited resources in ecologically valid fieldwork studies.

Towards a more integrated research framework for heat-related health risks and adaptation

Advances in research on current and projected heat-related risks from climate change and the associated responses have rapidly developed over the past decade. Modelling architectures of climate impacts and heat-related health risks have become increasingly sophisticated alongside a growing number of experiments and socioeconomic studies, and possible options for heat-related health adaptation are increasingly being catalogued and assessed. However, despite this progress, these efforts often remain isolated streams of research, substantially hampering our ability to contribute to evidence-informed decision making on responding to heat-related health risks. We argue that the integration of scientific efforts towards more holistic research is urgently needed to tackle fragmented evidence and identify crucial knowledge gaps, so that health research can better anticipate and respond to heat-related health risks in the context of a changing climate. In this Personal View, we outline six building blocks, each constituting a research stream, but each needed as part of a more integrated research framework-namely, projected heat-related health risks; adaptation options; the feasibility and effectiveness of adaptation; synergies, trade-offs, and co-benefits of adaptation; adaptation limits and residual risks; and adaptation pathways. We outline their respective importance and discuss their benefits for health-related research and policy.

Planetary health: an imperative for pediatric radiology

The global temperature has been increasing resulting in climate change. This negatively impacts planetary health that disproportionately affects the most vulnerable among us, especially children. Extreme weather events, such as hurricanes, tornadoes, wildfires, flooding, and heatwaves, are becoming more frequent and severe, posing a significant threat to our patients' health, safety, and security. Concurrently, shifts in environmental exposures, including air pollution, allergens, pathogenic vectors, and microplastics, further exacerbate the risks faced by children. In this paper, we provide an overview of pediatric illnesses that are becoming more prevalent and severe because of extreme weather events, global temperature increases, and shifts in environmental exposures. As members of pediatric health care teams, it is crucial for pediatric radiologists to be knowledgeable about the impacts of climate change on our patients, and continue to advocate for safe, healthier environments for our patients.