Healthcare in the era of climate change and the need for environmental sustainability

Sustainable tourism for climate change and environmental sustainability in Tunisia: Evidence from a novel measure, nonlinear modeling, and wavelet coherence

This study examines the asymmetric impact of international tourism on CO2 emissions and environmental sustainability in Tunisia. Using the Nonlinear Autoregressive Distributed Lag (NARDL) model within a Stochastic Impacts by Regression on Population, Affluence, and Technology (STIRPAT) framework, we construct a composite index via Principal Component Analysis (PCA). Robustness checks include Fully Modified Ordinary Least Squares (FMOLS), Bias-corrected Wavelet coherence, and asymmetric causality analysis through Vector Autoregression (VAR). Findings reveal that tourism traffic asymmetrically affects environmental sustainability, except for carbon emissions, even under nonlinear Granger causality analysis. Trade openness also exerts asymmetric effects, supporting the Pollution Haven hypothesis. Policy recommendations highlight the need for smart strategies such as mobile applications and taxation to track tourism-related carbon footprints, foster youth-led tourism businesses, address brain drain, and advance a circular economy. Sustainable tourism, alongside key structural factors, plays a vital role in shaping long-term environmental quality. Strategic agricultural development, improved governance, and the efficient use of renewable energy are crucial. Enhancing energy security, reducing fossil fuel dependence, and promoting green technology investments are necessary steps. This study contributes uniquely by compiling and updating a dataset based on six environmental criteria-air quality, energy management, biodiversity, health, population pressure, and water resources-while employing advanced econometric techniques.

APAGE Position Statements on Green and Sustainability in Gastroenterology, Hepatology, and Gastrointestinal Endoscopy

BACKGROUND AND AIM

The APAGE Position Statements aimed to provide guidance to healthcare practitioners on clinical practices aligned with climate sustainability.

METHODS

A taskforce convened by APAGE proposed provisional statements. Twenty-two gastroenterologists from the Asian Pacific region participated in online voting and consensus was assessed through an anonymized and iterative Delphi process.

RESULTS

There were five sections that addressed the rationale for climate action, the importance of adopting principles of waste management, clinical practice, gastrointestinal endoscopy, and issues related to advocacy and research. Sixteen statements achieved consensus and included the following: 1. APAGE recommends adopting prompt measures to reduce the carbon footprint of clinical practice due to the importance of climate action and its health cobenefits. 5. APAGE recommends adherence to professional clinical guidelines to optimize clinical care delivery in gastroenterology and hepatology to avoid the environmental impact of unnecessary procedures and tests. 8. APAGE recommends an emphasis on health promotion, disease prevention, and appropriate screening and surveillance, when resources are available, to reduce the environmental impact of managing more advanced diseases that require more intensive resources. 12. APAGE recommends that technological advances in endoscopic imaging and artificial intelligence, when available, be used to improve the precision of endoscopic diagnosis to reduce the risk of missed lesions and need for unnecessary biopsies. 13. APAGE recommends against the routine use of single-use endoscopes.

CONCLUSION

The position statements provide guidance to healthcare practitioners on clinical practices in gastroenterology, hepatology, and endoscopy that promote climate sustainability.

Healthcare Professionals' Perceptions of Pre-, Peri-, and Postoperative Virtual Reality Immersion in Elderly Patients

Background/Objectives: There is a lack of research examining healthcare professionals' perspectives regarding the potential of non-pharmacological solutions such as immersive virtual reality (VR). The aim of this study was to investigate opportunities and challenges related to the application of immersive virtual reality (VR) technology in patients aged 65 and older undergoing surgery with regional anesthesia and sedation. Method: A qualitative, multicenter study was conducted in the spring of 2024, involving semi-structured interviews with 17 healthcare professionals. Result: A qualitative content analysis of the interviews identified the main theme "Healthcare professionals' openness to opportunities for this technology for elderly patients", with the subthemes and themes "elderly patients", which included the participants' attitudes towards elderly patients; "virtual reality", which concerned opportunities, barriers, and risks; and "sustainable healthcare", which comprised the participants' thoughts about its impact on sustainable development. Conclusions: The participants suggested potential areas of use for VR during the perioperative period but also identified limitations and risks. They suggested VR was likely to have a positive impact on sustainable healthcare, as well as economic advantages. For its successful implementation, the equipment must be safe. There also needs to be a clear division of responsibilities for it to be functional and suitable for its users. Strategies such as nudging can be used to facilitate its implementation.

Climate Sustainability as a Catalyst for Quality and Excellence in Gastrointestinal Endoscopy: A Narrative Review

The significant contribution of greenhouse gas (GHG) emissions to global warming and the resultant negative impact on health is well established. Within the hospital setting, the endoscopy center has been ranked third-after the operating theater complex and intensive care unit-in terms of the volume of hazardous medical waste generated. Such regulated medical waste cannot be recycled, and the disposal process results in higher costs and a larger carbon footprint. There have been clarion calls to reduce the number of endoscopic procedures as a means of reducing GHG emissions. Previous studies have demonstrated the carbon footprint of inappropriate endoscopic procedures. However, endoscopy is an important diagnostic and therapeutic tool that has been shown to be cost-effective. A focus simply on reduction in procedural case volume alone raises the unintended consequences of inequitable access to endoscopy for those in need. A more nuanced approach that is aligned with the innate sense of healthcare professional aspirations and pride, in terms of seeking quality and clinical excellence, should be considered. An evidence-based approach, with a focus on quality and efficiency, as well as appropriate and timely use of new technology, will serve as a catalyst for positive behavioral change toward quality procedures and excellence. This will improve patient satisfaction, increase professional expertise and pride, and reduce carbon footprint through minimization of inappropriate and avoidable repeat procedures.