Health and climate change: policy responses to protect public health

Effect of a nutritional intervention based on an energy-reduced Mediterranean diet on environmental impact

OBJECTIVE

To estimate the environmental impact of a dietary intervention based on an energy-reduced Mediterranean diet (MedDiet) after one year of follow-up.

METHODS

Baseline and 1-year follow-up data were used for 5800 participants aged 55-75 years with metabolic syndrome in the PREDIMED-Plus study. Food intake was estimated through a validated semiquantitative food consumption frequency questionnaire, and adherence to the MedDiet was estimated through the Diet Score. Using the EAT-Lancet Commission tables we assessed the influence of dietary intake on environmental impact (through five indicators: greenhouse gas emissions (GHG), land use, energy used, acidification and potential eutrophication). Using multivariable linear regression models, the association between the intervention and changes in each of the environmental factors was assessed. Mediation analyses were carried out to estimate to what extent changes in each of 2 components of the intervention, namely adherence to the MedDiet and caloric reduction, were responsible for the observed reductions in environmental impact.

RESULTS

We observed a significant reduction in the intervention group compared to the control group in acidification levels (-13.3 vs. -9.9 g SO2-eq), eutrophication (-5.4 vs. -4.0 g PO4-eq) and land use (-2.7 vs. -1.8 m2). Adherence to the MedDiet partially mediated the association between intervention and reduction of acidification by 15 %, eutrophication by 10 % and land use by 10 %. Caloric reduction partially mediated the association with the same factors by 55 %, 51 % and 38 % respectively. In addition, adherence to the MedDiet fully mediated the association between intervention and reduction in GHG emissions by 56 % and energy use by 53 %.

CONCLUSIONS

A nutritional intervention based on consumption of an energy-reduced MedDiet for one year was associated with an improvement in different environmental quality parameters.

Air pollution and climate change as grand challenges to sustainability

There is a cross-disciplinary link between air pollution, climate crisis, and sustainable lifestyle as they are the most complex struggles of the present century. This review takes an in-depth look at this relationship, considering carbon dioxide emissions primarily from the burning of fossil fuels as the main contributor to global warming and focusing on primary SLCPs such as methane and ground-level ozone. Such pollutants severely alter the climate through the generation of greenhouse gases. The discussion is extensive and includes best practices from conventional pollution control technologies to hi-tech alternatives, including electric vehicles, the use of renewables, and green decentralized solutions. It also addresses policy matters, such as imposing stricter emissions standards, setting stronger environmental regulations, and rethinking some economic measures. Besides that, new developments such as congestion charges, air ionization, solar-assisted cleaning systems, and photocatalytic materials are among the products discussed. These strategies differ in relation to the local conditions and therefore exhibit a varying effectiveness level, but they remain evident as a tool of pollution deterrence. This stresses the importance of holistic and inclusive approach in terms of engineering, policies, stakeholders, and ecological spheres to tackle.

Pediatric Resident and Program Director Views on Climate Change and Health Curricula: A Multi-Institution Study

PURPOSE

The American Academy of Pediatrics emphasized in a 2007 policy statement the importance of educating trainees on the impacts of climate change on children's health, yet few studies have evaluated trainee knowledge and attitudes about climate change-related health effects in children. This multi-institution study assessed pediatric resident and program director (1) knowledge/attitudes on climate change and health, (2) perspectives on the importance of incorporating climate and health content into pediatric graduate medical education, and (3) preferred topics/activities to include in climate and health curricula.

METHOD

This mixed-methods study employed an anonymous cross-sectional survey of pediatric residents and residency program directors from Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN)-affiliated programs. Multivariable regression models and factor analyses were used to examine associations among resident demographics and resident knowledge, attitudes, and interest in a climate change curriculum. A conventional content analysis was conducted for the open-ended responses.

RESULTS

Eighteen programs participated in the study with all program directors (100% response rate) and 663 residents (average response rate per program, 53%; overall response rate, 42%) completing respective surveys. Of the program directors, only 3 (17%) felt very or moderately knowledgeable about the association between climate change and health impacts. The majority of residents (n=423, 64%) agreed/strongly agreed that physicians should discuss global warming/climate change and its health effects with patients/families, while only 138 residents (21%) agreed/strongly agreed that they were comfortable talking with patients and families about these issues. Most residents (n=498, 76%) and program directors (n=15, 83%) agreed/strongly agreed that a climate change curriculum should be incorporated into their pediatrics training program.

CONCLUSIONS

Pediatric residents and program directors support curricula that prepare future pediatricians to address the impact of climate change on children's health; however, few programs currently offer specific training, despite identified needs.

Modelling & Spatial Mapping of Residential-Sector Emissions for Sub-National & Urban Areas

The residential sector accounts for 33% of energy-related Greenhouse Gas (GHG) emissions globally and must undergo rapid emissions reductions in order to support broader society-wide sustainability and net-zero transitions. Additionally, urban areas account for approximately 70% of global GHG emissions. To provide a baseline for urban climate action plans and mitigation strategies, sub-national municipalities must quantify their sectoral baseline emissions in detail and develop strategies for reducing emissions relative to these baselines. Therefore, it is important to establish clear methodologies for computing these baselines in accordance with the best available science. This paper establishes a novel methodology for developing a residential sector emissions model using a data-driven and spatial mapping approach. This would form an important component of future multi-sectoral baseline emissions inventories. •The residential sector emissions model combines publicly available census and building energy performance datasets in order to model and visualize the distribution of energy demand and resultant emissions across an urban study domain in Ireland.•The methodology presented was developed in line with the approaches and requirements of the Global Covenant of Mayors and the Intergovernmental Panel on Climate Change.•It is envisioned that this residential sector emissions model methodology could be applied in any urban area worldwide.

The Climate Change Burden on Immune Health: Are Persons Living with HIV More at Risk?

Climate change poses one of the most significant modern threats to overall human health,especially for vulnerable populations including persons living with HIV (PLWH). In this perspective, we specifically explore the concept of immune resilience in human health and how climate change phenomena - including extreme weather events, food insecurity, pollution, and emerging diseases - may exacerbate immune dysfunction and comorbidities faced by PLWH and hinder access to HIV treatment and prevention services. Multidisciplinary, collaborative efforts are urgently needed to quantify these impacts, develop mitigation strategies, and strengthen policies and funding to bolster immune resilience for PLWH in the face of accelerating climate change.

Impact of climate change on the global circulation of West Nile virus and adaptation responses: a scoping review

BACKGROUND

West Nile virus (WNV), the most widely distributed flavivirus causing encephalitis globally, is a vector-borne pathogen of global importance. The changing climate is poised to reshape the landscape of various infectious diseases, particularly vector-borne ones like WNV. Understanding the anticipated geographical and range shifts in disease transmission due to climate change, alongside effective adaptation strategies, is critical for mitigating future public health impacts. This scoping review aims to consolidate evidence on the impact of climate change on WNV and to identify a spectrum of applicable adaptation strategies.

MAIN BODY

We systematically analyzed research articles from PubMed, Web of Science, Scopus, and EBSCOhost. Our criteria included English-language research articles published between 2007 and 2023, focusing on the impacts of climate change on WNV and related adaptation strategies. We extracted data concerning study objectives, populations, geographical focus, and specific findings. Literature was categorized into two primary themes: 1) climate-WNV associations, and 2) climate change impacts on WNV transmission, providing a clear understanding. Out of 2168 articles reviewed, 120 met our criteria. Most evidence originated from North America (59.2%) and Europe (28.3%), with a primary focus on human cases (31.7%). Studies on climate-WNV correlations (n = 83) highlighted temperature (67.5%) as a pivotal climate factor. In the analysis of climate change impacts on WNV (n = 37), most evidence suggested that climate change may affect the transmission and distribution of WNV, with the extent of the impact depending on local and regional conditions. Although few studies directly addressed the implementation of adaptation strategies for climate-induced disease transmission, the proposed strategies (n = 49) fell into six categories: 1) surveillance and monitoring (38.8%), 2) predictive modeling (18.4%), 3) cross-disciplinary collaboration (16.3%), 4) environmental management (12.2%), 5) public education (8.2%), and 6) health system readiness (6.1%). Additionally, we developed an accessible online platform to summarize the evidence on climate change impacts on WNV transmission ( https://2xzl2o-neaop.shinyapps.io/WNVScopingReview/ ).

CONCLUSIONS

This review reveals that climate change may affect the transmission and distribution of WNV, but the literature reflects only a small share of the global WNV dynamics. There is an urgent need for adaptive responses to anticipate and respond to the climate-driven spread of WNV. Nevertheless, studies focusing on these adaptation responses are sparse compared to those examining the impacts of climate change. Further research on the impacts of climate change and adaptation strategies for vector-borne diseases, along with more comprehensive evidence synthesis, is needed to inform effective policy responses tailored to local contexts.

The role of planetary health in urologic oncology

INTRODUCTION

Climate change and global warming are an omnipresent topic in our daily lives. Planetary health and oncology represent two critical domains within the broader spectrum of healthcare, each addressing distinct yet interconnected aspects of human well-being. We are encouraged to do our part in saving our planet. This should include the decisions we make in our professional life, especially in uro-oncology, as the healthcare sector significantly contributes to environmental pollution.

AREAS COVERED

There are many aspects that can be addressed in the healthcare sector in general, as there are structural problems in terms of energy consumption, water waste, therapeutic techniques, transportation and drug manufacturing, as well as in uro-oncology specific areas. For example, the use of different surgical techniques, forms of anesthesia and the use of disposable or reusable instruments, each has a different impact on our environment. The literature search was carried out using PubMed, a medical database.

EXPERT OPINION

We are used to making decisions based on the best outcome for patients without considering the impact that each decision can have on the environment. In the present article, we outline options and choices for a more climate-friendly approach in urologic oncology.

Resilience: conceptualisations and challenges for effective heatwave public health planning

OBJECTIVES

This article examines diverse perspectives on heatwave resilience in public health planning, interviewing stakeholders from various sectors. It identifies challenges, including operational, political, economic, and cultural aspects, hindering effective strategies. The study advocates for a holistic approach to heatwave resilience, emphasising interdisciplinary research and collaboration for targeted interventions. Enhancing resilience is crucial to mitigating adverse health impacts and safeguarding vulnerable populations during heatwaves. Conceptualisations of resilience related to heatwave public health planning and heatwave resilience vary significantly. There is a need to unveil the multifaceted nature of resilience in the context of heatwaves and identify key challenges that hinder effective public health planning efforts.

STUDY DESIGN

Qualitative study to explore key stakeholders' conceptualisations of resilience and highlight challenges and opportunities needed for greater heatwave resilience and public health planning.

METHODS

Interviews were conducted with a diverse group of key stakeholders involved in local, regional, and national heatwave planning, academics, civil sector and private sector representatives.

RESULTS

The findings of this study highlight diverse conceptualisations of resilience. Conceptualisations of resilience mainly differ on the following: 'whom'; 'what'; 'how'; 'when'; and 'why'. This analysis shows that the concept of resilience is well understood but has different functions. The analysis of challenges revealed several key problems, such as operational and technical; political and governance; organisational and institutional; economic; linguistic; cultural, social, and behavioural; and communication, information, and awareness. These significantly hinder effective heatwave public health planning strategies.

CONCLUSIONS

The study emphasises the need for a holistic and integrated approach to heatwave resilience. Addressing these challenges is crucial for enhancing heatwave public health planning. This study provides valuable insights into the complexities of heatwave resilience, offering guidance for different sectors of society to develop targeted interventions and strategies. The development of new resilience interdisciplinary and intersectoral research, practice, and governance will prove crucial to ongoing efforts to strengthen national heatwave resilience public health planning. By fostering resilience, societies can mitigate the adverse impacts of heatwaves and safeguard the health and well-being of vulnerable populations.

Reducing the carbon footprint of cataract surgery: co-creating solutions with a departmental Delphi process

BACKGROUND

Climate change is arguably the greatest threat to global health of the 21st century. Although cataract surgery is a major contributor to global greenhouse gas emissions, recent literature review identified a paucity of evidence-based strategies for improving the environmental impact of cataract services. Our study aimed to assess the effectiveness of a departmental Delphi process for improving cataract services' environmental sustainability.

METHODS

All members of ophthalmology theatre teams in a UK teaching hospital were invited to participate in a three-stage Delphi process. Team members were surveyed for suggestions for reducing the department's environmental impact. Suggested interventions were refined during a plenary face-to-face discussion and ranked. The highest ranked interventions were combined into a mutually agreed action plan. Data on the economic and environmental cost of cataract services was collected prior to and six months after the Delphi process using the Eyefficiency mobile application.

RESULTS

Twenty-three interventions were suggested by a range of staff cadres. Interventions were ranked by 24 team members. The 2nd, 4th, 5th, 8th and 11th ranked interventions were combined into an "Eco-packs" project in collaboration with suppliers (Bausch + Lomb), saving 675 kg of waste and 350 kg of CO2 equivalent annually.

CONCLUSIONS

The Delphi process is an effective method for provoking departmental engagement with the sustainability agenda that we would encourage all ophthalmology departments to consider utilising. The baseline per case CO2 equivalent measured in our department was reproducible and could serve as a maximum benchmark to be improved upon.

Global warming impact of fluorinated gases in ophthalmic surgeries at a tertiary eye center in India

PURPOSE

Global warming is one of the greatest health threats of the 21 st century. The ophthalmic sector contributes to the emission of greenhouse gases, thus altering the natural environment. There is currently no data on global emissions of fluorinated gases in ophthalmic surgery. This retrospective study from 2017 to 2021 aims to report the carbon dioxide (CO 2 ) equivalence of sulfur hexafluoride (SF 6 ), hexafluoroethane (C 2 F 6 ), and octafluoropropane (C 3 F 8 ) at a tertiary eye center.

METHODS

Data collected from 1842 surgical procedures that used injections of fluorinated gases were analyzed. Environmental impact (global warming potential over 100 years) was calculated by converting milliliters to grams by using modified ideal gas law at standard temperature and pressure for the canisters and then to their CO 2 equivalence.

RESULTS

Though 70% of surgeries used C 3 F 8 , the least greenhouse effect causing fluorinated gas, the total carbon emission was 1.4 metric tons. The most common indication was macular hole surgery (36.86%).

CONCLUSION

This study paves a step toward analyzing the problem statement, thus awakening us to contemplate options to make ophthalmic surgeries greener.

The interplay between climate change and ageing: A systematic review of health indicators

Climate change and rapid population ageing pose challenges for communities and public policies. This systematic review aims to gather data from studies that present health indicators establishing the connection between climate change and the physical and mental health of the older population (≥ 65 years), who experience a heightened vulnerability to the impacts of climate change when compared to other age cohorts. This review was conducted according to the PICO strategy and following Cochrane and PRISMA guidelines. Three databases (PubMed, Scopus and Greenfile) were searched for articles from 2015 to 2022. After applying inclusion and exclusion criteria,nineteen studies were included. The findings indicated that various climate change phenomena are associated with an elevated risk of mortality and morbidity outcomes in older adults. These included cardiovascular, respiratory, renal, and mental diseases, along with physical injuries. Notably, the impact of climate change was influenced by gender, socioeconomic status, education level, and age-vulnerability factors. Climate change directly affected the health of older adults through ambient temperature variability, extreme and abnormal temperatures, strong winds, sea temperature variability, extreme El Niño-southern Oscillation (ENSO) conditions and droughts, and indirectly by air pollution resulting from wildfires. This review presents further evidence confirming that climate change significantly impacts the health and well-being of older adults. It highlights the urgency for implementing effective strategies to facilitate adaptation and mitigation, enhancing the overall quality of life for all individuals.

Health care utilisation of asylum seekers and refugees in the South-West of Germany

BACKGROUND

Limited evidence on utilisation of health care by recently arrived asylum seekers and refugees in high-income countries is available. This study aims to describe the implementation of an integrated care facility (ICF) in an initial reception centre and measure the utilisation of care and the influence of operational parameters.

METHODS

In a retrospective cohort study design, using medical records, we followed inhabitants of a reception centre in Germany between 11.10.2015 and 30.05.2018. We assessed frequency of visits and revisits to a newly established integrated care facility (ICF), and the effects of the ICF on visits to the local emergency department (LED) in the regional tertiary hospital using survival analysis and time series regression. We also explore the influence of operational parameters on the different implementation phases; phase 1: provisional clinic with 1-2 hours of physician presence daily, phase 2: implementation of ICF with 2-4 hours of care by a team of doctors and nurses daily, phase 3: routine running of ICF with daily operational hours of 10am-2pm with care provided by an interdisciplinary team of doctors and nurses.

RESULTS

14,419 total medical visits were recorded from 1,883 persons seeking health care in the ICF. The absolute number of visits per day remained similar over the study period (19·9/day), yet the relative number of visits changed from 2·2 to 15 per 100 inhabitants from phase 2 to 3, respectively. Most visits were due to respiratory infections (612/3080, 20%), and trauma and musculoskeletal conditions (441/3080, 14%). The rate of revisits to ICF was 2·9 per person per month (95%CI 2·9-3), more for those older, female, from North Africa and those with a translator present. The ratio of visits to the LED changed from 0·3/100 inhabitants per day to 0·14/100 inhabitants after implementation of the ICF and back to 0·3/100 inhabitants during the routine running.

CONCLUSIONS

Though seasonal variation and referral practices must be considered, a high rate of revisits to the ICF were recorded. While visits to the LED decreased after the implementation of the ICF, visits returned to the pre-ICF levels during the routine running of the ICF. The results show that AS&R require reliable access to health care, yet the needs of specific groups of migrants may be different, especially those with language barriers, minority groups or those from certain regions. As such, care should be migrant sensitive and adapt to the changing needs of the population. Though more research is required to better understand the differing needs of migrants, this study may help to inform guidelines surrounding migrant sensitive standards of care in Germany.

Intravitreal Injections: Improving Sustainability by Reducing Clinical Waste

BACKGROUND

Intravitreal injections are one of the most commonly performed ophthalmic procedures. It is estimated that over 1 million intravitreal injections are performed in Germany annually. The aim of this study was to quantify the waste and carbon footprint associated with single-use injection sets, and to establish a waste reduction strategy.

MATERIAL AND METHODS

The clinical waste and associated carbon footprint from standard disposable injection sets used by tertiary referral centres in Germany (n = 6) and the United Kingdom (n = 2) were assessed. The safety of performing intravitreal injections with a minimalistic material-sparing approach was evaluated.

RESULTS

The average weight of an injection set (and hence the waste generated from each injection) was 165 g. On average, each injection set comprised 145 g (88%) of plastic, 2.1 g (1.3%) of metal, 4.3 g (2.6%) of paper, and 12.9 g (7.8%) of gauze/swabs. The production of such injection sets was extrapolated to a CO2 equivalent of 752.6 tonnes (t), and the incineration of the resulting waste to a CO2 equivalent of 301.7 t. For 1 million injections, this equates to 145.2 t of plastic, 2.1 t of metal, 4.3 t of paper, and 12.9 t of gauze/swabs. A material-sparing approach can reduce injection set-associated waste by 99% without necessarily compromising patient safety.

CONCLUSION

A resource-saving approach to intravitreal injections can minimise the generation of clinical waste and its associated carbon footprint, thereby supporting sustainability.

Life expectancy and emission trading scheme: a case study in China

Life expectancy can reflect both health benefit and implementation cost of climate policy. Nevertheless, little research has quantified the relation between life expectancy and climate policy in literature. In this paper, we attempt to narrow the research gap by studying how life expectancy is related to the Chinese nationwide emission trading scheme (CNETS). To achieve this research target, a Computable General Equilibrium (CGE) model is employed to simulate the operation of the economic system and the policy shock from emission abatement. The CGE model results show that life expectancy is prolonged by GDP but shortened by emissions, and the GDP impact on life expectancy is larger than the emission impact. Climate policy has dual effects on life expectancy because it relieves both negative emission impacts and positive GDP impacts on lifespan; its net effect on life expectancy is positive. Life expectancy positively impacts GDP, and this impact is moderated by climate policy; specifically, climate policy reinforces the positive impact of life expectancy on GDP. Life expectancy minimally affects carbon emissions during climate policy implementation; in other words, it has minimal impacts on emission abatement. These findings imply that climate policy and life expectancy complement each other; the government could implement climate policy to increase lifespan or prolong life expectancy to facilitate policy implementation.

Knowledge of surgeons and practical stances of healthcare institutions in the Ile-de-France region toward sustainable development: A cross-sectional study

PURPOSE OF THE STUDY

Climate change represents one of the gravest threats to health. Surgical activities mobilize a large number of resources which contribute to increased emission of CO2 and anesthetic gases in the environment. The objective of this study was to assess the level of knowledge of surgeons and the practical stances of healthcare establishments toward sustainable development.

METHODS

This was a descriptive cross-sectional study, lasting 2 months. From 1 May 2021 to 30 June 2021, surgeons were asked via an online questionnaire to participate.

RESULTS

A total of 131 out of the 457 contacted surgeons responded. A majority practiced in the private sector, 48.9% knew little about the rules of sustainable development in operating theaters, and 43.5% had an average level. The sustainable development charter was available in only 23% of establishments, while 19% had a sustainable development committee, and specific sustainable development actions were carried out in 27%.

CONCLUSION

The level of knowledge of surgeons in Île-de-France on sustainable development was low. In general, surgical units were not complying with the rules of good practice on CO2 reduction. It is necessary to find strategies to reduce the impact of operating theaters on the environment.

The Role of Climatic, Environmental and Socioeconomic Factors in the Natural Movement of Urban Populations in Kazakhstan, 2012-2020: An Analysis from a Middle-Income Country in Central Asia

BACKGROUND

This study addresses the importance of identifying key characteristics influencing demographic indicators for urban populations, emphasizing the need to consider regional climatic features and ecological factors. The research utilized data from ten main regional cities across the Republic of Kazakhstan.

METHODS

This study involved a retrospective analysis based on secondary data from official sources spanning 2012-2020. We employed correlation analysis and multidimensional regression models.

RESULTS

Noteworthy predictors for crude birth rate included the influence of effective temperature (β = 0.842, p < 0.0001), marriage rate (β = 0.780, p < 0.0001), Gini coefficient (β = -27.342, p = 0.020) and divorce rate (β = -2.060, p < 0.0001), with overall strong model performance (R2 = 0.940). The degree of atmospheric pollution (β = -0.949, p = 0.044), effective temperature (β = -0.294, p < 0.0001) and Gini coefficient (β = 19.923, p = 0.015) were the predictors for crude mortality rate, with a high model fit (R2 = 0.796).

CONCLUSIONS

The study unveils significant relationships between demographic indicators (crude birth rate, mortality rate) and variables like effective temperature, marriage rate, divorce rate, Gini coefficient, physician density and others. This analysis of climatic, environmental, and socioeconomic factors influencing demographic indicators may help in promoting specific measures to address public health issues in Kazakhstan.

Assessing the impact of climatic variability on acute respiratory diseases across diverse climatic zones in South Africa

Acute respiratory diseases are a significant public health concern in South Africa, with climatic variables such as temperature and rainfall being key influencers. This study investigates the associations between these variables and the prevalence of acute respiratory diseases in Johannesburg, Cape Town, and Gqeberha (Port Elizabeth), representing distinct climatic zones. Spearman's correlation analyses showed negative correlations in Johannesburg for respiratory disease claims with maximum temperature (r = -0.12, p < 0.0001) and mean temperature (r = -0.13, p < 0.0001), and a negative correlation with daily rainfall (r = -0.12, p < 0.0001). Cape Town demonstrated a negative correlation with maximum temperature (r = -0.18, p < 0.0001) and a positive correlation with rainfall (r = 0.08, p < 0.0001). Utilizing Distributed Lag Non-linear Models (DLNM), the study revealed that in Johannesburg, the relative risk (RR) of respiratory claims increases notably at temperatures below 12 °C, and again at a Tmax between 16 and 23 °C. The risk escalates further at >30 °C, although with a considerable error margin. For Cape Town, a stable level of moderate RR is seen from Tmax 15-24 °C, with a significant increase in RR and error margin above 30 °C. In Gqeberha, the DLNM results are less definitive, reflecting the city's moderate climate and year-round rainfall. The RR of acute respiratory diseases did not show clear patterns with temperature changes, with increasing error margins outside the 22 °C threshold. These findings emphasize the imperative for region-specific public health strategies that account for the complex, non-linear influences of climate on respiratory health. This detailed understanding of the climate-health nexus provides a robust basis for enhancing public health interventions and future research directed at reducing the impacts of climate factors.

Health risks from extreme heat in China: Evidence from health insurance

Global warming has accentuated the effects of extreme heat on health. Health insurance, functioning as a risk management tool, has the potential to alleviate these impacts. Consequently, this paper investigates the correlation between extreme heat events and the demand for health insurance in China. Using data from the China Health and Nutrition Survey, we have observed a substantial increase in the likelihood of residents purchasing health insurance during extreme heat events. To be specific, for every extra day of extreme heat events annually, there is a 0.3% increase in the probability of purchasing health insurance. This effect is not uniform across different demographic groups. It is particularly pronounced among middle-aged and elderly individuals, rural residents, those with lower educational levels, higher income brackets, and individuals residing in underprivileged areas with limited access to green spaces and healthcare facilities. Furthermore, our study indicates that the increased frequency of extreme heat events not only impacts individuals' physical health but also triggers negative emotions, which in turn drive risk-averse behavior related to health insurance purchases. These findings carry substantial policy implications for mitigating the economic consequences of climate change.

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

PURPOSE OF REVIEW

Climate change poses a serious threat to human health and well-being. Australia is not immune to the public health impacts and continues to be underprepared, putting the population health at risk. However, there is a dearth in knowledge about how the Australian public health system will address the impacts of climate change.

RECENT FINDINGS

This integrative review synthesises tools, frameworks, and guidance material suitable for climate change adaptation from a preventive public health perspective. The literature search was conducted in electronic databases MEDLINE, PubMed, CINAHL, and Web of Science. Of 4507 articles identified, 19 articles met the inclusion criteria that focused on operational methods in public health and excluded the clinical context and reactive disaster response approaches. This review revealed that Australia is ill-prepared to manage climate change adverse health impacts due to ineffective adaptation strategies. The review highlights that Australia urgently requires effective adaptation strategies such as undertaking a National Adaptation Plan process and an improved understanding in managing complex health risks. Taking this action will strengthen the public health system and build health resilience especially for vulnerable populations. These findings will help understand and develop of the necessary adaptive strategies in Australia.

Occupation in the Anthropocene and Ethical Relationality

Purpose. Occupations have "implications for individuals, societies, and the earth". This article focusses on implications of occupation in relation to the earth and examines the potential to expand occupational justice beyond anthropocentric viewpoints to honour interspecies justice. Approach. A 'theory as method' approach is used to explore the literature. Transgressive decolonial hermeneutics informs analysis. Key issues. The discussion advances understandings about human occupation in relation to more-than-humans, intersections with human occupations and animals, and ethical relationality. Implications. Occupational justice includes honouring interdependence of species, engaging in occupations in ways that are sustainable, considering future generations, and refraining from occupations that have a destructive or detrimental impact on the earth and more-than-humans. The profession has a collective responsibility to honour Indigenous worldviews and Indigenous sovereignty, recognising and welcoming the potential for Western conceptualisations of occupation to be transformed.

Instrument and Supply Variability: An Opportunity to Reduce the Carbon Footprint of the Operating Room

INTRODUCTION

Reducing costs and carbon footprints are important, parallel priorities for the US health-care system. Within surgery, reducing the number of instruments that are sterilized and disposable supplies that are used for each operation may help achieve both goals. We wanted to measure the existing variability in surgical instrument and supply choices and assess whether standardization could have a meaningful cost and environmental impact.

METHODS

We analyzed surgeon preference cards for common general surgery operations at our hospital to measure the number of sterilizable instrument trays and supplies used by each surgeon for each operation. From this data, we calculated supply costs, carbon footprint, and median operative time and studied the variability in each of these metrics.

RESULTS

Among the ten operations studied, variability in sterilizable instrument trays requested on surgeon preference cards ranged from one to eight. Variability in disposable supplies requested ranged from 17 to 45. Variability in open supply costs ranged from $104 to $4184. Variability in carbon footprint ranged from 17 to 708 kg CO2e. If the highest-cost surgeon for each operation switched their preference card to that of the median-cost surgeon, $245,343 in open supply costs and 41,708 kg CO2e could be saved.

CONCLUSIONS

There is significant variability in the instrument and supply choices of surgeons performing common general surgery operations. Standardizing this variability may lead to meaningful cost savings and carbon footprint reduction, especially if scaled across the entire health system.

Unwarranted variation and the goal of net zero for the NHS in England: exploring the link between efficiency working, patient outcomes and carbon footprint

In 2020 the NHS in England set a target of reaching net zero carbon emissions by 2040. Progress has already been made towards this goal, with substantial reductions in the use of environmentally harmful anaesthetic gases, such as desflurane, in recent years. Where an effective replacement already exists, changing practice to use low carbon alternatives is relatively easy to achieve, but much greater challenges lie ahead. The Getting It Right First Time (GIRFT) programme is a clinically-led, data-driven clinical improvement initiative with a focus on reducing unwarranted variation in clinical practice and patient outcomes. Reducing unwarranted variation can improve patient care and service efficiency, and can also support the drive to net zero. In this article we set out what the GIRFT programme is doing to support sustainable healthcare in England, why it is uniquely positioned to support this goal and what the future challenges, barriers, enablers and opportunities are likely to be in the drive to net zero.

Nursing action towards the sustainable development goals: Barriers and opportunities

BACKGROUND

Climate change, poverty, hunger and complex diseases are just some of the many wicked problems impacting human health. The Sustainable Development Goals aim to alleviate these and many other global issues. Although the nursing profession is paramount to successfully achieving the goals, nurses require increased education to maximise their contributions.

OBJECTIVES

The aim of this study was to determine the impact of education on graduate nurses' action towards the Sustainable Development Goals.

DESIGN

This study applied a qualitative case study methodology.

SETTING

The study took place within an Australian Higher Education institution. Graduate nurses working in clinical settings were invited to reflect on the Sustainable Development Goals.

PARTICIPANTS

Participants included thirteen graduate nurses (n = 13) working in a variety of clinical settings that had completed the final year capstone subject.

METHODS

Individual semi-structured interviews were undertaken with graduate nurses who undertook education on the Sustainable Development Goals in an undergraduate Bachelor of Nursing capstone subject. The interviews were transcribed and thematically analysed.

FINDINGS

Data was analysed through two lens focusing on the barriers and opportunities for action towards the Sustainable Development Goals. Three core barriers were identified as 'Drowning'; 'Powerless'; and 'Invisible'. Three key opportunities were designated as 'War on Waste'; 'Front and Centre'; and 'Revolutionary Leadership'.

CONCLUSIONS

Educating undergraduate nurses on the Sustainable Development Goals had limited impact on specific graduate nurses' action towards the goals due to significant barriers within the healthcare system. However, graduate nurses recognised the importance of contributing to the goals and identified opportunities for future action. Education providers and the healthcare industry should work in partnership to create a more sustainable future for healthcare.

UK national survey on surgical gowning for tonsillectomy

OBJECTIVE

Tonsillectomy is a common procedure performed nationally. The personal protective equipment and surgical gowning practices used during this procedure vary widely. We compiled a survey of ENT specialists to gain a national opinion about gowning in tonsillectomy with the aim of determining whether we could make it more environmentally friendly whilst maintaining the highest safety standards.

METHOD

We developed a nine-question survey that was piloted prior to final implementation. The questionnaire was sent to senior registrars and consultant otolaryngologists in the UK.

RESULTS

The survey was completed by a total of 63 ENT specialists. It was found that 82.54 per cent of clinicians would consider wearing a reusable gown that would be sterilised between each procedure.

CONCLUSION

Our survey suggests most ENT clinicians would consider using a more environmentally friendly surgical gown and some may even consider wearing no gown at all, although many are understandably concerned about the transmission of infection or blood splatter.

Published research on the human health implications of climate change between 2012 and 2021: cross sectional study

Objective

To better understand the state of research on the effects of climate change on human health, including exposures, health conditions, populations, areas of the world studied, funding sources, and publication characteristics, with a focus on topics that are relevant for populations at risk.

Design

Cross sectional study.

Data sources

The National Institute of Environmental Health Sciences climate change and human health literature portal, a curated bibliographical database of global peer reviewed research and grey literature was searched. The database combines searches of multiple search engines including PubMed, Web of Science, and Google Scholar, and includes added-value expert tagging of climate change exposures and health impacts.

Eligibility criteria

Inclusion criteria were peer reviewed, original research articles that investigated the health effects of climate change and were published in English from 2012 to 2021. After identification, a 10% random sample was selected to manually perform a detailed characterisation of research topics and publication information.

Results

10 325 original research articles were published between 2012 and 2021, and the number of articles increased by 23% annually. In a random sample of 1014 articles, several gaps were found in research topics that are particularly relevant to populations at risk, such as those in the global south (134 countries established through the United Nations Office for South-South Cooperation) (n=444; 43.8%), adults aged 65 years or older (n=195; 19.2%), and on topics related to human conflict and migration (n=25; 2.5%) and food and water quality and security (n=148; 14.6%). Additionally, fewer first authors were from the global south (n=349; 34.4%), which may partly explain why research focusing on these countries is disproportionally less.

Conclusions

Although the body of research on the health effects of climate change has grown substantially over the past decade, including those with a focus on the global south, a disproportionate focus continues to be on countries in the global north and less at risk populations. Governments are the largest source of funding for such research, and governments, particularly in the global north, need to re-orient their climate and health research funding to support researchers in the global south and to be more inclusive of issues that are relevant to the global south.

Ecology & computer audition: Applications of audio technology to monitor organisms and environment

Among the 17 Sustainable Development Goals (SDGs) proposed within the 2030 Agenda and adopted by all the United Nations member states, the 13th SDG is a call for action to combat climate change. Moreover, SDGs 14 and 15 claim the protection and conservation of life below water and life on land, respectively. In this work, we provide a literature-founded overview of application areas, in which computer audition - a powerful but in this context so far hardly considered technology, combining audio signal processing and machine intelligence - is employed to monitor our ecosystem with the potential to identify ecologically critical processes or states. We distinguish between applications related to organisms, such as species richness analysis and plant health monitoring, and applications related to the environment, such as melting ice monitoring or wildfire detection. This work positions computer audition in relation to alternative approaches by discussing methodological strengths and limitations, as well as ethical aspects. We conclude with an urgent call to action to the research community for a greater involvement of audio intelligence methodology in future ecosystem monitoring approaches.

Climate warming is expanding dengue burden in the Americas and Asia

Climate change poses significant threats to public health, with dengue representing a growing concern due to its high existing burden and sensitivity to climatic conditions. Yet, the quantitative impacts of temperature warming on dengue, both in the past and in the future, remain poorly understood. In this study, we quantify how dengue responds to climatic fluctuations, and use this inferred temperature response to estimate the impacts of historical warming and forecast trends under future climate change scenarios. To estimate the causal impact of temperature on the spread of dengue in the Americas and Asia, we assembled a dataset encompassing nearly 1.5 million dengue incidence records from 21 countries. Our analysis revealed a nonlinear relationship between temperature and dengue incidence with the largest marginal effects at lower temperatures (around 15°C), peak incidence at 27.8°C (95% CI: 27.3 - 28.2°C), and subsequent declines at higher temperatures. Our findings indicate that historical climate change has already increased dengue incidence 18% (12 - 25%) in the study region, and projections suggest a potential increase of 40% (17 - 76) to 57% (33 - 107%) by mid-century depending on the climate scenario, with some areas seeing up to 200% increases. Notably, our models suggest that lower emissions scenarios would substantially reduce the warming-driven increase in dengue burden. Together, these insights contribute to the broader understanding of how long-term climate patterns influence dengue, providing a valuable foundation for public health planning and the development of strategies to mitigate future risks due to climate change.

The influence of humid heat on morbidity of megacity Shanghai in China

BACKGROUND

Increased attention has been paid to humid-heat extremes as they are projected to increase in both frequency and intensity. However, it remains unclear how compound extremes of heat and humidity affects morbidity when the climate is projected to continue warming in the future, in particular for a megacity with a large population.

METHODS

We chose the Wet-Bulb Globe Temperature (WBGT) index as the metric to characterize the humid-heat exposure. The historical associations between daily outpatient visits and daily mean WBGT was established using a Distributed Lag Non-linear Model (DLNM) during the warm season (June to September) from 2013 to 2015 in Shanghai, a prominent megacity of China. Future morbidity burden related to the combined effect of high temperature and humidity were projected under four greenhouse gases (GHGs) emission scenarios (SSP126, SSP245, SSP370 and SSP585).

RESULTS

The humid-heat weather was significantly associated with a higher risk of outpatient visits in Shanghai than the high-temperature conditions. Relative to the baseline period (2010-2019), the morbidity burden due to humid-heat weather was projected to increase 4.4 % (95 % confidence interval (CI): 1.1 %-10.1 %) even under the strict emission control scenario (SSP126) by 2100. Under the high-GHGs emission scenario (SSP585), this burden was projected to be 25.4 % (95 % CI: 15.8 %-38.4 %), which is 10.1 % (95 % CI: 6.5 %-15.8 %) more than that due to high-temperature weather. Our results also indicate that humid-hot nights could cause large morbidity risks under high-GHGs emission scenarios particularly in heat-sensible diseases such as the respiratory and cardiovascular disease by the end of this century.

CONCLUSIONS

Humid heat exposures significantly increased the all-cause morbidity risk in the megacity Shanghai, especially in humid-hot nights. Our findings suggest that the combined effect of elevated temperature and humidity is projected to have more substantial impact on health compared to high temperature alone in a warming climate.

Drawing the Linkage Between Women's Reproductive Health, Climate Change, Natural Disaster, and Climate-driven Migration: Focusing on Low- and Middle-income Countries - A Systematic Overview

Background

One of the most important aspects of women's well-being and welfare is RSH (reproductive and sexual health). Reproductive health is not an exception to the threat that CCC (climate change and climate crisis) poses to numerous facets of public health. Firstly, the present review seeks to identify the influence of climatic changes, natural disasters, and climate-driven migration on RSH. Secondly, to identify knowledge gaps regarding the same.

Material and Methods

Two databases (Scopus and PubMed) were scanned using Boolean operation. The literature search aimed to find records pertaining to topics of RSH and climate change. Using the PRISMA-ScR method, records were screened and shortlisted based on established inclusion criteria. This literature search was carried out in November 2022. In the shortlisted records, preference for the comprehensive review articles was given.

Results

The present review is based on 38 records that collectively revealed that climate crisis and natural disasters have many negative impacts on female reproductive health. These effects are observed in different phases of life, ranging from teenage to menopause. The unique strength of the present review is that it draws a relationship between female reproductive health and the direct as well as indirect effects of the CCC. The available literature about LMICs is predominantly confined to drought, flood, and earthquake. Disasters like tsunamis, cyclones, and avalanches remain unexplored.

Conclusion

From the available literature, it is quite evident that CCC has an adverse effect on a woman's reproductive life as well as a bearing on future generations' health. Filling these knowledge gaps is pivotal for designing more effective disaster and health policies. Policymakers should take into consideration these detrimental effects while designing health schemes and policies for females.

Associations between climate change-related factors and sexual health: A scoping review

There is growing attention to the ways in which climate change may affect sexual health, yet key knowledge gaps remain across global contexts and climate issues. In response, we conducted a scoping review to examine the literature on associations between climate change and sexual health. We searched five databases (May 2021, September 2022). We reviewed 3,183 non-duplicate records for inclusion; n = 83 articles met inclusion criteria. Of these articles, n = 30 focused on HIV and other STIs, n = 52 focused on sexual and gender-based violence (GBV), and n = 1 focused on comprehensive sexuality education. Thematic analysis revealed that hurricanes, drought, temperature variation, flooding, and storms may influence HIV outcomes among people with HIV by constraining access to antiretroviral treatment and worsening mental health. Climate change was associated with HIV/STI testing barriers and worsened economic conditions that elevated HIV exposure (e.g. transactional sex). Findings varied regarding associations between GBV with storms and drought, yet most studies examining flooding, extreme temperatures, and bushfires reported positive associations with GBV. Future climate change research can examine understudied sexual health domains and a range of climate-related issues (e.g. heat waves, deforestation) for their relevance to sexual health. Climate-resilient sexual health approaches can integrate extreme weather events into programming.

Consumers' Preferences and Attitudes towards Plant-Based Milk

Plant-based milk (PBM) has become increasingly popular due to its environmental sustainability, health benefits, ingredient abundance, and unique taste. This study aims to identify the main factors that affect consumer preferences and attitudes towards PBM, and to examine the effect of consumer attitudes including environmental awareness, health consciousness, and food neophobia on WTP. We use the double-bounded dichotomy choice (DBDC) method to calculate consumers' willingness to pay (WTP) for PBM. We find that the appearance, taste, nutritional value, and environmental benefits of PBM significantly increase consumers' WTP for it. Consumers with high environmental awareness are more likely to perceive PBM as environmentally friendly and are willing to pay a higher price for it. Consumers with high health consciousness tend to value the environmental benefits of PBM and prioritize purchase convenience, as it aligns with their health-conscious lifestyle, leading to a higher WTP for PBM. The results of our study can help design effective strategies to market plant-based milk and develop sustainable and healthy food systems.

The trends of disease burden due to high temperature in Mainland China from 1990 to 2019 and its prediction to 2030

The risk of high-temperature-related diseases is increasing owing to global warming. This study aimed to assess the trend of disease burden caused by high temperatures in Mainland China from 1990 to 2019 and to predict the trend of disease burden over the next 10 years. The latest data were downloaded from the Global Burden of Disease Database (GBD) for analysis, and the disease burden related to high temperature was described by mortality and disability-adjusted life-years (DALYs) and stratified by etiology, sex, and age. Statistical analyses were performed using the R software. In 2019, there were 13,907 deaths attributed to high temperatures in Mainland China, and this was 29.55% higher than the 10,735 deaths in 1990. Overall, the age-standardized mortality and DALYs attributed to high temperatures showed a downward trend from 1990 to 2019. We observed an etiological shift in high-temperature-related diseases. The age-standardized DALYs contribution attributed to high temperatures in 1990 was mainly from communicable, maternal, neonatal, and nutritional diseases (CMNND) (21.81/100,000), followed by injury (18.30/100,000) and non-communicable diseases (10.40/100,000). In 2019, the largest contribution shifted to non-communicable diseases (10.07/100,000), followed by injuries (5.21/100,000), and CMNND (2.30/100,000). The disease burden attributed to high temperatures was higher in males than in females and increased with age. In 2030, the mortality rate and DALYs due to high temperatures are predicted to decrease further, and the largest contribution will come from chronic non-communicable diseases, the occurrence of which will remain at a high level over the next 10 years. The burden of disease due to high temperatures in Mainland China is still heavy, mainly due to population aging and an increase in non-communicable diseases.

Pharmacy students' perceptions on environmental sustainability in pharmacy education and practice

Background

Given the negative environmental impacts of pharmaceuticals, including their contribution to healthcare's carbon footprint, pharmacists have a role in responding to the climate and biodiversity crises. Knowledge and education are required to support transitions to environmentally sustainable pharmacy practice (ESPP). The aim of this study was to explore Australian undergraduate pharmacy students' knowledge and attitudes towards environmental sustainability and ESPP curriculum content.

Methods

Participants were surveyed using an anonymous online questionnaire deployed using Qualtrics. The questionnaire comprised of two main sections: the 15-item New Ecological Paradigm (NEP) scale to determine participants' environmental attitude score, and section on students' perceptions and curricular experience of environmentally sustainable practice which was adapted from previously published surveys. The invitation with survey link was disseminated via social media, Australian pharmacy student organisations, and direct approach. Quantitative data were reported descriptively. Qualitative data from responses to open-ended questions were analysed thematically using a reflexive, recursive approach. Incomplete survey responses were excluded from the analysis.

Results

Of the 164 complete responses, 99% had previously received information on environmental sustainability. However, only 10% were knowledgeable about ESPP and only 8.5% were aware of ESPP content in their pharmacy school curriculum. Importantly, 70% of respondents saw ESPP as relevant to their future pharmacy practice, and 94% believed the pharmacy profession has a responsibility to undertake sustainability initiatives in the delivery of pharmaceutical care.

Conclusions

Australian pharmacy students lacked knowledge of ESPP and few reported having curricular exposure to ESPP content in their pharmacy degrees. Therefore, ESPP content is an important area for development in pharmacy curricula.

Climate change mitigation: Qualitative analysis of environmental impact-reducing strategies in German primary care

BACKGROUND

The German healthcare system is responsible for 5,2% of the national emissions of greenhouse gases. Therefore, mitigation actions to reduce the carbon footprint are crucial. However, there have been few approaches to achieve this in German primary care.

OBJECTIVES

This study aimed to identify environmental impact-reducing strategies of German primary care practices.

METHODS

During the summer of 2021, a qualitative study was conducted using interviews and focus groups with experts in primary care across Germany, such as physicians, medical assistants, health scientists and experts on the health system level. Verbatim transcribed data were analyzed using Thematic Analysis.

RESULTS

The sample comprised 26 individual interviews and two focus groups with a total of N = 40 participants. Findings provide a first overview of pursued mitigation strategies and contextual factors influencing their implementation. Strategies referred to the use of water and energy, recycling and waste management, supply chains and procurement, digitisation, mobility, patient care, behavioural changes and system level. Implementing sustainable actions in daily care was considered expensive and often unfeasible due to lack of staff, time and restrictive hygiene regulations. Participants called for more instruction on implementing mitigating actions, for example, through websites, podcasts, guidelines or quality indicators.

CONCLUSION

This study's findings can support the development of future environmental impact-reducing strategies in primary care. Potential options for guidance and support should be considered to facilitate sustainability.

Sustainability in Obstetrics and Gynecology

Current practices in the U.S. health care industry drive climate change. This review summarizes the vast research on the negative health effects of the climate crisis on patients as relevant to obstetrics and gynecology. We further propose solutions to decarbonize operating rooms, labor and delivery units, and nurseries and neonatal intensive care units through evidence-based reduction in our single-use supply, energy, and water, as well as anesthetic gases and appropriate waste sorting.

Harnessing the power on our plates: sustainable dietary patterns for public and planetary health

Globally, diet quality is poor, with populations failing to achieve national dietary guidelines. Such failure has been consistently linked with malnutrition and poorer health outcomes. In addition to the impact of diet on health outcomes, it is now accepted that what we eat, and the resulting food system, has significant environmental or planetary health impacts. Changes are required to our food systems to reduce these impacts and mitigate the impact of climate change on our food supply. Given the complexity of the interactions between climate change, food and health, and the different actors and drivers that influence these, a systems-thinking approach to capture such complexity is essential. Such an approach will help address the challenges set by the UN 2030 Agenda for sustainable development in the form of the sustainable development goals (SDG). Progress against SDG has been challenging, with an ultimate target of 2030. While the scientific uncertainties regarding diet and public and planetary health need to be addressed, equal attention needs to be paid to the structures and systems, as there is a need for multi-level, coherent and sustained structural interventions and policies across the full food system/supply chain to effect behaviour change. Such systems-level change must always keep nutritional status, including impact on micronutrient status, in mind. However, benefits to both population and environmental health could be expected from achieving dietary behaviour change towards more sustainable diets.

Projections of Temperature-Related Suicide under Climate Change Scenarios in Japan

BACKGROUND

The impact of climate change on mental health largely remains to be evaluated. Although growing evidence has reported a short-term association between suicide and temperature, future projections of temperature-attributable suicide have not been thoroughly examined.

OBJECTIVES

We aimed to project the excess temperature-related suicide mortality in Japan under three climate change scenarios until the 2090s.

METHODS

Daily time series of mean temperature and the number of suicide deaths in 1973-2015 were collected for 47 prefectures in Japan. A two-stage time-stratified case-crossover analysis was used to estimate the temperature-suicide association. We obtained the modeled daily temperature series using five general circulation models under three climate change scenarios from the latest Coupled Model Intercomparison Project Phase 6 (CMIP6) Shared Socioeconomic Pathways scenarios (SSPs): SSP1-2.6, SSP2-4.5, and SSP5-8.5. We projected the excess temperature-related suicide mortality until 2099 for each scenario and evaluated the net relative changes compared with the 2010s.

RESULTS

During 1973-2015, there was a total of 1,049,592 suicides in Japan. Net increases in temperature-related excess suicide mortality were estimated under all scenarios. The net change in 2090-2099 compared with 2010-2019 was 1.3% [95% empirical confidence interval (eCI): 0.6, 2.4] for the intermediate-emission scenario (SSP2-4.5), 0.6% (95% eCI: 0.1, 1.6) for a low-emission scenario (SSP1-2.6), and 2.4% (95% eCI: 0.7, 3.9) for the extreme scenario (SSP5-8.5). The increases were greater the more extreme the scenarios were, with the highest increase under the most extreme scenario (SSP5-8.5).

DISCUSSION

This study indicates that Japan may experience a net increase in excess temperature-related suicide mortality, especially under the intermediate and extreme scenarios. The findings underscore the importance of mitigation policies. Further investigations of the future impacts of climate change on mental health including suicide are warranted. https://doi.org/10.1289/EHP11246.

Impacts of net zero policies on air quality in a metropolitan area of the United Kingdom: Towards world health organization air quality guidelines

Climate change and air pollution are closely interlinked since carbon dioxide and air pollutants are co-emitted from fossil fuel combustion. Net Zero (NZ) policies aiming to reduce carbon emissions will likely bring co-benefits in air quality and associated health. However, it is unknown whether regional NZ policies alone will be sufficient to reduce air pollutant levels to meet the latest 2021 World Health Organisation (WHO) guidelines. Here, we carried out high resolution air quality modelling for in the West Midlands region, a typical metropolitan area in the UK, to quantify the effects of different NZ policies on air quality. Results show that NZ policies will significantly improve air quality in the West Midlands, with up to 6 μg m-3 (21%) reduction in annual mean NO2 (mostly through the electrification of vehicle fleet, EV) and up to 1.4 μg m-3 (12%) reduction in annual mean PM2.5 projected for 2030 relative to levels under a "business as usual" (BAU) scenario. Under BAU, 2030 PM2.5 concentrations in most wards would be below 10 μg m-3 whilst under the Net Zero scenario, those in all wards would be below 10 μg m-3. This means that the ward averages in the West Midlands would meet the UK PM2.5 of 10 μg m-3target a decade early under the Net Zero scenario. However, no ward-level-averaged annual mean PM2.concentrations meet the 2021 WHO Air Quality guideline level of 5 μg m-3 under any scenario. Similarly for NO2 only 18 wards (8% of the region's population) are predicted to have NO2 concentrations below the 2021 WHO guideline level (10 μg m-3). Decarbonisation policies linked to Net Zero deliver substantial regional air quality benefits, but are not in isolation sufficient to deliver clean air with air pollutant levels low enough to meet the 2021 WHO guidelines.

Heat wave exposure and semen quality in sperm donation volunteers: A retrospective longitudinal study in south China

BACKGROUND

Previous studies have suggested an association between non-optimum ambient temperature and decreased semen quality. However, the effect of exposure to heat waves on semen quality remains unclear.

METHODS

Volunteers who intended to donate sperm in Guangdong provincial human sperm bank enrolled. Heat waves were defined by temperature threshold and duration, with a total of 9 definitions were employed, specifying daily mean temperature exceeding the 85th, 90th, or 95th percentile for at least 2, 3, or 4 consecutive days. Residential exposure to heat waves during 0-90 days before ejaculation was evaluated using a validated gridded dataset on ambient temperature. Association and potential windows of susceptibility were evaluated and identified using linear mixed models and distributed lag non-linear models.

RESULTS

A total of 2183 sperm donation volunteers underwent 8632 semen analyses from 2018 to 2019. Exposure to heat wave defined as daily mean temperature exceeding the 95th percentile for at least 4 consecutive days (P95-D4) was significantly associated with a 0.11 (95% confidence interval [CI]: 0.03, 0.18) ml, 3.36 (1.35, 5.38) × 106/ml, 16.93 (7.95, 25.91) × 106, and 2.11% (1.4%, 2.83%) reduction in semen volume, sperm concentration, total sperm number, and normal forms, respectively; whereas exposure to heat wave defined as P90-D4 was significantly associated with a 1.98% (1.47%, 2.48%) and 2.08% (1.57%, 2.58%) reduction in total motility and progressive motility, respectively. Sperm count and morphology were susceptible to heat wave exposure during the early stage of spermatogenesis, while sperm motility was susceptible to exposure during the late stage.

CONCLUSION

Heat wave exposure was significantly associated with a reduction in semen quality. The windows of susceptibility during 0-90 days before ejaculation varied across sperm count, motility, and morphology. Our findings suggest that reducing heat wave exposure before ejaculation may benefit sperm donation volunteers and those attempting to conceive.

A dynamic game modeling on air pollution mitigation with regional cooperation and noncooperation

Mitigating regional air pollution involves multifaceted trade-offs, including long-term versus short-term development versus emission-reduction among different regions. Considering the heterogeneity of levels of regional economic development and capacity for environmental governance as well as the spatial spillover effect of pollution, the game theory method can explore each region's dynamic emission-reduction path. In this article, the dynamic game mechanism (Regional Environment Economy Game Modeling model) is incorporated into the environment economy system to solve the Nash equilibrium under dynamic conditions and explore the game strategies of each region. Taking air pollution mitigation in North China as an example, this article compares the emission-reduction effect and social welfare under regional cooperative and noncooperative game scenarios and clarifies the abatement-sharing mechanism between provinces. The results show that a noncooperative policy is strictly inferior to a cooperative policy for achieving given emission-reduction goals and maximizing social welfare. Our findings offer evidence for strengthening regional cooperation in reducing carbon emissions and provide policy recommendations for synergistic pollution abatement and joint regional pollution mitigation. Integr Environ Assess Manag 2023;19:1555-1569. © 2023 SETAC.

Protecting pregnant women from climate disasters: Strategies in the aftermath of Pakistan's devastating flood

Sudden‐onset climate events can have a significant impact on maternal health care systems, particularly in low‐ and middle‐income countries where resources are limited. We outline strategic policies that can help anticipate and plan for such disasters and help minimize negative maternal outcomes.

Reducing the carbon footprint in carpal tunnel surgery inside the operating room with a lean and green model: a comparative study

The primary aim of our study was to assess the environmental impact of moving from a standard to a lean and green model for a carpal tunnel decompression. We objectively measured the clinical waste generated, the number of single use items and the number of sterile instruments required for a standard procedure, and then moved to smaller instrument trays, smaller drapes and fewer disposables. These two models were compared for waste generation, financial costs and carbon footprint. Information prospectively collected on seven patients in the standard model and 103 patients in the lean and green model in two hospitals over a 15-month period, demonstrated a reduction in CO2 emissions of 80%, clinical waste reduction of 65%, and an average aggregate cost saving of 66%. The lean and green model can deliver a safe, efficient, cost-effective and sustainable service for patients undergoing carpal tunnel decompression.Level of evidence: III.

Natural and socio-environmental factors contribute to the transmissibility of COVID-19: evidence from an improved SEIR model

COVID-19 has ravaged Brazil, and its spread showed spatial heterogeneity. Changes in the environment have been implicated as potential factors involved in COVID-19 transmission. However, considerable research efforts have not elucidated the risk of environmental factors on COVID-19 transmission from the perspective of infectious disease dynamics. The aim of this study is to model the influence of the environment on COVID-19 transmission and to analyze how the socio-ecological factors affecting the probability of virus transmission in 10 states dramatically shifted during the early stages of the epidemic in Brazil. First, this study used a Pearson correlation to analyze the interconnection between COVID-19 morbidity and socio-ecological factors and identified factors with significant correlations as the dominant factors affecting COVID-19 transmission. Then, the time-lag effect of dominant factors on the morbidity of COVID-19 was investigated by constructing a distributed lag nonlinear model and standard two-stage meta-analytic model, and the results were considered in the improved SEIR model. Lastly, a machine learning method was introduced to explore the nonlinear relationship between the environmental propagation probability and socio-ecological factors. By analyzing the impact of environmental factors on virus transmission, it can be found that population mobility directly caused by human activities had a greater impact on virus transmission than temperature and humidity. The heterogeneity of meteorological factors can be accounted for by the diverse climate patterns in Brazil. The improved SEIR model was adopted to explore the interconnection of COVID-19 transmission and the environment, which revealed a new strategy to probe the causal links between them.

Global issues, local action: exploring local governments use of research in "tackling climate change and its impacts on health" in Victoria, Australia

BACKGROUND

Local government plays an important role in addressing complex public health challenges. While the use of research in this work is important, it is often poorly understood. This study aimed to build knowledge about how research is used by investigating its use by local government authorities (LGAs) in Victoria, Australia in responding to a new legislative requirement to prioritise climate and health in public health planning. The role of collaboration was also explored.

METHODS

Informed by Normalization Process Theory (NPT), this study adopted multiple research methods, combining data from an online survey and face-to-face interviews. Quantitative data were analysed using descriptive statistics; thematic analysis was used to analyse qualitative data.

RESULTS

Participants comprised 15 interviewees, and 46 survey respondents from 40 different LGAs. Research was most commonly accessed via evidence synthesis, and largely used to inform understanding about climate and health. When and how research was used was shaped by contextual factors including legislation, community values and practical limitations of how research needed to be communicated to decision-makers. Collaboration was more commonly associated with research access than use.

CONCLUSIONS

Greater investment in the production and dissemination of localised research, that identifies local issues (e.g. climate risk factors) and is tailored to the communication needs of local audiences is needed to foster more impactful research use in local public health policy.

Ambient temperatures associated with reduced cognitive function in older adults in China

The cognitive function status of older adults determines the social function and living quality of older adults, which is related to the healthy development and stability of the society. However, the impact of high or low ambient temperature on cognitive function in older adults remains unclear. Based on data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we comprehensively assessed the impact of ambient temperature on the cognitive function of older adults in this study. The findings exhibited that for each 1 °C ascent in monthly temperature of high temperature, the examination score of global cognitive function of older adults decreased by 0.48 (95% CI 0.21-0.74), which was greater than that of 0.14 (95% CI 0.06-0.25) for each 1 °C reduction in low temperature. Overall, the detrimental effect of high temperature on cognitive function in older adults was more significant than that of low temperature, including on the five sub-cognitive functions involved. Our research provides vital technical guidance and reference for the health protection and prevention of cognitive function of older adults in specific external environmental conditions under the current climatic variation and temperature rise.