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

Abstract 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

Poverty and Reductions in Fitness Levels in Children and Adolescents in Upper Middle-income Countries

ncreasingly it is recognised that what happens in childhood has a significant impact on health in adulthood. As we and others have shown—social, emotional, cognitive and physical development in childhood and adolescence tracks through to later life.1 2 The paper by Tomkinson and colleagues3 examined trends in cardiorespiratory fitness (CRF) levels in childhood and adolescence. It is an important piece of work because poor fitness levels in adolescence are significantly linked with higher all-cause mortality rates later in life4 and because, as the authors illustrate in their comprehensive study, CRF fitness levels in children and adolescents in high-income and high-middle-income countries have significantly declined since the 1980s

Healthy Eating in primary schools: an educational perspective from a socially deprived area

The issue of access to cheap and healthy food for those living in poverty is now part of the social and health agenda in the United Kingdom. The pilot study described in this paper is investigating access to healthy food in a deprived area of London. The study has three interrelated elements: the local community, the school as part of the community and geographical mapping. The paper focuses on the work that has been undertaken with primary schools in the study area, identifying the strategies being used to collect data and outlining some preliminary findings