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

Helmintos parasitos do pirarucu, Arapaima gigas (Schinz, 1822) (Osteoglossiformes: Arapaimidae), no rio Araguaia, estado de Mato Grosso, Brasil Helminth parasites of pirarucu, Arapaima gigas (Schinz, 1822) (Osteoglossiformes: Arapaimidae) from Araguaia River, State of Mato Grosso, Brazil

Foram examinados 65 exemplares de pirarucu em agosto de 2004, provenientes do rio Araguaia, Estado de Mato Grosso, Brasil para o estudo dos seus helmintos parasitos. Cinco espécies foram registradas parasitando Arapaima gigas: Dawestrema cycloancistrium (Monogenea) nas brânquias, Nilonema senticosum e Goezia spinulosa (Nematoda) na vesícula gasosa e no estômago respectivamente; Caballerotrema brasiliense (Digenea) e Polyacanthorhynchus rhopalorhynchus (Acanthocephala) no intestino. Os valores mais altos de prevalência foram observados para D. cycloancistrium (100%) and P. rhopalorhynchus (96,9%). Os maiores valores de intensidade e abundância média foram calculados para C. brasiliense e N. senticosum (61 e 46,9, respectivamente). Todas estas espécies são registradas pela primeira vez na Bacia do Rio Araguaia.<br>Sixty-five specimens of pirarucu collected in August 2004 from Araguaia River, State of Mato Grosso, Brazil, were examined to study their helminth parasites. Five species were recorded parasitic Arapaima gigas: Dawestrema cycloancistrium (Monogenea) in gills, Nilonema senticosum and Goezia spinulosa (Nematoda) in the swimbladder and stomach, respectively; Caballerotrema brasiliense (Digenea) and Polyacanthorhynchus rhopalorhynchus (Acanthocephala) in the intestine. Highest prevalence values were detected for D. cycloancistrium (100%) and P. rhopalorhynchus (96.9%). Highest values of mean intensity and mean abundance were detected for C. brasiliense and N. senticosum (61 and 46.9, respectively). All these species are recorded by the first time in the Araguaia River basin

Human immunodeficiency virus continuum of care in 11 european union countries at the end of 2016 overall and by key population: Have we made progress?

Background. High uptake of antiretroviral treatment (ART) is essential to reduce human immunodeficiency virus (HIV) transmission and related mortality; however, gaps in care exist. We aimed to construct the continuum of HIV care (CoC) in 2016 in 11 European Union (EU) countries, overall and by key population and sex. To estimate progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target, we compared 2016 to 2013 estimates for the same countries, representing 73% of the population in the region. Methods. A CoC with the following 4 stages was constructed: number of people living with HIV (PLHIV); proportion of PLHIV diagnosed; proportion of those diagnosed who ever initiated ART; and proportion of those ever treated who achieved viral suppression at their last visit. Results. We estimated that 87% of PLHIV were diagnosed; 92% of those diagnosed had ever initiated ART; and 91% of those ever on ART, or 73% of all PLHIV, were virally suppressed. Corresponding figures for men having sex with men were: 86%, 93%, 93%, 74%; for people who inject drugs: 94%, 88%, 85%, 70%; and for heterosexuals: 86%, 92%, 91%, 72%. The proportion suppressed of all PLHIV ranged from 59% to 86% across countries. Conclusions. The EU is close to the 90-90-90 target and achieved the UNAIDS target of 73% of all PLHIV virally suppressed, significant progress since 2013 when 60% of all PLHIV were virally suppressed. Strengthening of testing programs and treatment support, along with prevention interventions, are needed to achieve HIV epidemic control