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

Development and evaluation of a personalized normative feedback intervention for Hispanic youth at high risk of smoking

Despite reductions in overall smoking rates, data show that adolescents continue to smoke at higher rates than adults and that adolescents living in the Texas–Mexico border area are more likely than their counterparts living elsewhere in Texas to smoke. While adult smoking in the Paso del Norte Region has decreased significantly over the past decade, area youth smoking rates exceed both state and national averages. Recent estimates report cigarette smoking among El Paso youth in the past month to be slightly more than 28% as compared with 21% among Texas youth participating in the 2009 statewide Youth Risk Behavior Survey and 19% among U.S. youth in the same survey. Sociodemographic factors such as income, low community educational attainment, ethnicity, and social context have been shown to contribute to smoking initiation and prevalence among adolescents. In addition to prioritizing groups that may be at high risk of smoking, the CDC\u27s Best Practices for Tobacco Control Programs (2007) suggests several strategies to help eliminate tobacco-related health disparities nationwide. These include identifying populations with disparities related to smoking, partnering to enhance intervention reach and resources, and developing and implementing culturally relevant approaches to smoking prevention and cessation. Accordingly, the purpose of this research project was to develop and evaluate an innovative intervention for youth who may be at high risk of smoking because of sociodemographic factors. Specifically, the research examined whether existing behavioral technology that has been used successfully to reduce alcohol consumption in youth and adults, Personalized Normative Feedback (PNF), can be adapted to similarly affect smoking behavior. PNF refers to a brief intervention process that includes assessment of individual use patterns and direct comparisons of such behaviors to normative data. In the current project, PNF techniques were featured in a brief intervention program that prioritized smoking and non-smoking youth who may be at high risk for continued or future smoking. The primary hypotheses were that participants receiving the PNF intervention would report decreased susceptibility to smoking, lowered estimates of descriptive norms favoring smoking (social norms), and increased negative attitudes towards smoking relative to baseline and in comparison with participants exposed to a nutrition program similar in format and duration but that did not address smoking in any way. Results indicated that although intervention participants reported decreased susceptibility and lowered social norms relative to controls, these changes were not statistically reliable. Regarding changes in attitudes, participants in both groups reported increases in negative attitudes towards smoking which were statistically reliable, and were highest among youth who reported current smoking. Significant differences in smoking prevalence, norms, attitudes, and susceptibility were found by study site and by smoking status, suggesting the need for tailored prevention intervention approaches at the community level. Implications for future research and prevention intervention programs are discussed, as are limitations and strengths of the use of PNF to reduce smoking susceptibility among youth who may be at high risk of smoking because of contextual and sociodemographic factors

Depression and Co-Occurring Health Determinants of Hispanic Men With HIV Infection in the U.S.-Mexico Border Region: A Pilot Study

HIV infection among Hispanic men is a public health concern. Certain factors have been identified that may contribute to the high rates of HIV infection among Hispanic men such as migration, acculturation, poverty, and depression. These men are at risk for additional co-occurring health issues. Given limited research, few studies have focused specifically on Hispanic men with HIV infection residing in a U.S.-Mexico border community. This pilot study surveyed participants (n = 39) to better understand co-occurrence of health determinants, especially depression among Hispanic men with HIV infections. The study's findings indicate that clinicians need to be aware that certain factors may influence depression among people with Hispanic men with HIV infection. Clinicians also need awareness of the impact of depression on adherence to HIV care and treatment among Hispanic men with HIV infection. More research is needed to explore the relationship of HIV-related stigma, HIV disclosure, social support, and depression among Hispanic men with HIV infections

Health Risk and Protective Factors Among Hispanic Women Living in the U.S.-Mexico Border Region

As the Hispanic population continues to flourish in areas such the U.S.-Mexico border region, more attention needs to be focused on health factors among Hispanics. The purpose of this study was (1) to determine what specific health protective and health risk factors exist among Mexican/Mexican American women residing along the U.S.-Mexico border and (2) to determine the relationship between the protective and risk factors among these women. A sample of Mexican/Mexican American women (N = 98) participated in a structured interview that collected data on familism, Hispanic stress, depression, violence, and sexual risk and demographic variables. Religious factors had the largest influence on the health risk behaviors of alcohol intoxication and drug intoxication (p < .05), while familism influenced only condom use (p = .002) and a lifetime history of intimate partner violence (p = .039). Health care access also influenced the health risks of alcohol intoxication (p = .013), drug intoxication (p = .012), and condom use (p = .019). The study's results provide implications for clinical care and directions for future research