On the nature of eco-anxiety: How constructive or unconstructive is habitual worry about global warming?

Three studies investigated habitual worry about global warming as an example of 'eco-anxiety'. The key question was whether such worrying is constructive (a motivated pro-environmental response) or unconstructive (a symptom of pathological worry). Pathological worry and worry about global warming were assessed together with two other worry sources, that is, personal issues and the world economy (Study 1) and personal issues and the corona virus (Study 2). In both studies a statistically significant correlation was found between pathological worry and global warming worry. However, this relationship was nonsignificant when controlled for the other two worry sources. Comparisons between Studies 1 and 2 conducted one month before and during the COVID-19 crisis, respectively, as well as between order conditions within Study 2 suggested that global warming worry was unaffected by the COVID-19 context. Study 3 demonstrated that global warming worry was associated with the perception of a proximal and distal threat, and correlated positively with determinants of pro-environmental behaviour, that is, a pro-ecological worldview, pro-environmental values, past pro-environmental behaviour and a 'green' identity. Global warming worry also correlated positively with emotion clusters signifying determination, anxiety, and anger, respectively. The three studies together suggest that while habitual global warming worry may be unconstructive and part of intrapersonal dysfunction for some individuals, for many others it is a constructive adaptive pro-environmental response

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)