Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Configuring political relationships to navigate host-country institutional complexity: Insights from Anglophone sub-Saharan Africa

YesWe examine how ties with multiple host-country political institutions contribute to MNE subsidiary performance in countries with weak formal institutions. We suggest that forging relationships between subsidiaries and host-country government actors, local chieftains, and religious leaders generates regulative, normative, and cultural-cognitive political resources. We integrate institutional and configuration theories to argue that similarity to an ideal configuration of the three political resources contributes to MNE subsidiary performance, and that the more dysfunctional host country institutions, the greater the impact on performance. We test our hypotheses using primary and archival data from 604 MNE subsidiaries in 23 Anglophone sub-Saharan African countries and find support for our hypotheses. In our conclusion we discuss the wider theoretical, managerial, and public policy implications of our findings.The full-text of this article will be released for public view at the end of the publisher embargo - 12 months after publication

Configuring political relationships to navigate host-country institutional complexity: insights from Anglophone sub-Saharan Africa

We examine how ties with multiple host-country political institutions contribute to MNE subsidiary performance in countries with weak formal institutions. We suggest that forging relationships between subsidiaries and host-country government actors, local chieftains, and religious leaders generates regulative, normative, and cultural-cognitive political resources. We integrate institutional and configuration theories to argue that similarity to an ideal configuration of the three political resources contributes to MNE subsidiary performance, and that the more dysfunctional host country institutions, the greater the impact on performance. We test our hypotheses using primary and archival data from 604 MNE subsidiaries in 23 Anglophone sub-Saharan African countries and find support for our hypotheses. In our conclusion we discuss the wider theoretical, managerial, and public policy implications of our findings

Health of urban Ghanaian women as identified by the Women's Health Study of Accra

The purpose of the Women’s Health Study of Accra was to provide an assessment of the prevalence of communicable and non-communicable illnesses.MethodThis was a prospective, community-based study that included an interview for medical illnesses, a comprehensive physical examination, and laboratory testing. A total of 1328 women were examined at Korle Bu Teaching Hospital, University of Ghana.ResultsPrevalent conditions included poor vision (66.8%), malaria (48.7%), pain (42.8%), poor dentition (41.6%), hypertension (40.2%), obesity (34.7%), arthritis (27.1%), chronic back pain (19.4%), abnormal rectal (16.0%) and pelvic examinations (12.7%), HIV in women age 24–29 (8.3%), and hypercholesterolemia (22.7%). Increasing age, lack of formal education, and low-income adversely affected health conditions.ConclusionThe high prevalence of preventable illnesses in this expanding urban population indicates that the health care services are obligated to develop and provide screening, preventive strategies and treatment for both general health and gynecologic health conditions