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

Parental affective personality and children's self-reported internalising and externalising behaviour

Past research has demonstrated associations between parental personality traits and children's behaviour. However, fathers have been largely excluded from this research, and mothers often rate both their own personality and their child's behaviour, contributing to shared method variance. This study contributes to the literature by examining associations between parental biologically based affective personality traits, analysed separately for mothers and fathers, and seven- and eight-year-old children's self-reported internalising and externalising behaviours. Data were analysed for 272 mother-child dyads and 208 father-child dyads. A series of multiple linear regressions was utilised to test associations between mothers' and fathers' traits of ANGER, SADNESS, FEAR, PLAY, SEEKING and CARE, assessed using the Affective Neuroscience Personality Scales (ANPS), and children's self-reported internalising and externalising behaviours, assessed using the Berkeley Puppet Interview. Results revealed that higher ANPS ANGER scores amongst mothers were associated with more externalising behaviours in boys. Mothers with higher scores on SEEKING had sons with lower scores on externalising behaviours, while mothers with higher PLAY scores had sons with lower scores on internalising behaviours. Fathers with higher ANPS SADNESS scores had children with greater internalising behaviours, while fathers with greater FEAR traits had children with lower internalising behaviours. Indirect associations through harsh or positive parenting were not significant. Findings demonstrated that ANPS traits of ANGER, PLAY and SEEKING for mothers and FEAR and SADNESS for fathers are associated with children's self-reported externalising and internalising behaviours. This study adds to the literature on biologically based parental affective personality and children's internalising and externalising behaviours