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The article presents the author's insights on the primary research needs in aquatic activity. In terms of organs these include researches that involve the heart, respiratory system, and musculoskeletal system. It notes the roles of aquatic activity in diabetes, asthma, arthritis, parkinsonism, and osteoporosis. Studies on how aquatic activity helps develop balance, strength, endurance, coordination as well as improve mood, emotion, cognition and cognitive functioning are also presented.

Objectives: global warming poses a serious threat to human health, yet healthcare organisations and staff have been relatively slow to engage with sustainable healthcare practices. This review of the literature seeks to frame what is already known about nurses and their views on global warming and sustainable health care. Design: 11 primary research articles were sourced from a search of five mainstream databases. These articles were subject to a basic thematic analysis. Results: six themes were identified: sustainability, endemic blindness to global issues, environmental numbness, social norms, priority assigned to sustainability, and psychology of responsibility and blame. Conclusion: from the literature reviewed, there are a number of social, cultural and psychological barriers that have led to widespread inaction. This article recommends further research to understand the psychological barriers in more depth as this is a poorly understood area. [ABSTRACT FROM AUTHOR]

Healthcare is a significant contributor to environmental impact but this has received little attention. The typical laboratory uses far more energy and water per unit area than the typical office building. There is a need to sensitise laboratories to the importance of adopting good environmental practices. Since this comes at an initial cost, it is vital to obtain senior management support. Convincing management of the various tangible and intangible benefits that can accrue in the long run should help achieve this support. Many good environmental practices do not have a cost but will require a change in the culture and mind-set of the organisation. Continuing education and training are important keys to successful implementation of good practices. There is a need to undertake a rigorous cost-benefit analysis of every change that is introduced in going green. The adoption of good practices can eventually lead to ISO certification if this is desired. This paper provides suggestions that will allow a laboratory to start going green. It will allow the industry to enhance its corporate citizenship whilst improving its competitive advantage for long-term. [ABSTRACT FROM AUTHOR]

The U.S. health care sector is highly interconnected with industrial activities that emit much of the nation’s pollution to air, water, and soils. We estimate emissions directly and indirectly attributable to the health care sector, and potential harmful effects on public health. Negative environmental and public health outcomes were estimated through economic input-output life cycle assessment (EIOLCA) modeling using National Health Expenditures (NHE) for the decade 2003–2013 and compared to national totals. In 2013, the health care sector was also responsible for significant fractions of national air pollution emissions and impacts, including acid rain (12%), greenhouse gas emissions (10%), smog formation (10%) criteria air pollutants (9%), stratospheric ozone depletion (1%), and carcinogenic and non-carcinogenic air toxics (1–2%). The largest contributors to impacts are discussed from both the supply side (EIOLCA economic sectors) and demand side (NHE categories), as are trends over the study period. Health damages from these pollutants are estimated at 470,000 DALYs lost from pollution-related disease, or 405,000 DALYs when adjusted for recent shifts in power generation sector emissions. These indirect health burdens are commensurate with the 44,000–98,000 people who die in hospitals each year in the U.S. as a result of preventable medical errors, but are currently not attributed to our health system. Concerted efforts to improve environmental performance of health care could reduce expenditures directly through waste reduction and energy savings, and indirectly through reducing pollution burden on public health, and ought to be included in efforts to improve health care quality and safety. [ABSTRACT FROM AUTHOR]

Background: Human health is fundamentally determined by the health of ecosystems. Guidance is lacking about how to address the topic of ecosystems within medical education. Aims: To determine the nature of discussions around ecosystems in the educational, medical and medical education literature. To identify learning needs of tomorrow’s doctors. Methods: A narrative synthesis approach was used. Systematic searches were completed in 14 databases. Two independent reviewers screened results. Preliminary synthesis included textual descriptions and quality appraisal. Data were analysed using the Education for Sustainable Healthcare framework and thematic analysis. Relationships between studies were explored. Best evidence synthesis, contacting authors of primary studies and critical reflection reinforced robustness. Results: Six thousand seven hundred and fifty-three abstracts and 123 full texts were screened. Twenty-seven studies were included. Many studies lacked clear reporting. Medical students and doctors displayed knowledge about ecosystems, but lacked confidence to enact sustainable practices. Education about causes and consequences of environmental change is required. Few studies proposed specific learning objectives. Conclusions: To prepare for roles as health care workers and leaders, medical students must learn about relationships between ecosystems, health and health care. The Education for Sustainable Healthcare framework outlines essential knowledge and attitudes but requires addition of practical competencies. Further research should explore the framework’s relevance in different contexts, in order to structure training accordingly. [ABSTRACT FROM AUTHOR]

Objectives. To quantify the increased disease burden caused by US health care sector life cycle greenhouse gas (GHG) emissions of 614 million metric tons of carbon dioxide equivalents in 2013. Methods. We screened for health damage factors that linked GHG emissions to disease burdens. We selected 5 factors, based on appropriate temporal modeling scales, which reflect a range of possible GHG emissions scenarios. We applied these factors to health care sector emissions. Results. We projected that annual GHG emissions associated with health care in the United States would cause 123 000 to 381 000 disability-adjusted life-years in future health damages, with malnutrition being the largest damage category. Conclusions. Through their contribution to global climate change, GHG emissions will negatively affect public health because of an increased prevalence of extreme weather, flooding, vector-borne disease, and other effects. As the stewards of global health, it is important for health care professionals to recognize the magnitude of GHG emissions associated with health care itself, and the severity of associated health damages. [ABSTRACT FROM AUTHOR]

This study sheds new light on why healthcare organisations are having difficulty responding to the growing pressure from stakeholders to proactively address their responsibility to deliver high-quality services without harming the environment. Basing our work on past research on stakeholder pressure and environmental barriers, we conceptualise and empirically test the effect of the interplay between stakeholder pressure and internal barriers on healthcare organisations' adoption of proactive environmental strategies (PESs). To test the proposed hypotheses, a survey was carried out among medical directors of Italian healthcare organisations in 2012. Our results show that the lack of commitment to environmental issues within the organisation represents the main barrier to healthcare organisations' implementing PESs. Furthermore, the difficulties in evaluating the impacts of advanced environmental practices negatively moderate the influence of stakeholders on developing PESs. Our findings contribute to extending previous knowledge on PESs in two ways: (i) focusing on the healthcare sector, our study investigates the phenomenon in a research context that has been largely overlooked in the sustainability literature; and (ii) cross-cutting previous research on stakeholder pressure and internal barriers, the study conceptualises and tests a more complete framework for understanding the adoption of PESs. [ABSTRACT FROM AUTHOR]

The article focuses on the role of health professionals during climate related health dangers. Topics discussed are need for inclusion of courses in climate and health for medical students, list of resources on climate change and health which includes published reports, websites and published books, and efforts of institutes such as Center for Climate Change & Health, California, U.S. Climate & Health Alliance, and Health Care Without Harm (HCWH) founded by Gary Cohen in Virginia.

Background The deleterious effects of climate change mean that environmental sustainability is increasingly becoming a moral and economic necessity. Consequently, clinicians will increasingly be called upon to manage the effects of health care on climate change, and they must therefore do as much as is practically possible to limit the negative effects of their practice on the environment. As medical educators we have the opportunity not only to reduce the environmental impact of our own clinical practice, but also that of those who we teach, through innovation. Such novelty can be explored during student-selected components (SSCs). Context The project, entitled 'Can we introduce sustainability to clinical skills teaching?' was led by two third-year medical students during their SSC periods. New ways to make existing skills more sustainable were explored by surveying existing practice in the workplace, analysing selected skills in a lab-based setting and through discussions with sustainability champions. Innovation Cannulation and intravenous (IV) antibiotic preparation were chosen by the students as prototype skills. These skills were observed by the students in the workplace and adapted by them to appease the 'triple bottom line' of sustainability: environmental, social and economic factors were addressed. The revised skills were taught by the students to their peers in a sustainably conscious fashion. Implications Provided that such innovations in sustainable skills teaching are deemed appropriate by clinical skills directors, such methods could be adopted across medical schools and expanded to cover a wider range of skills. [ABSTRACT FROM AUTHOR]

MEDICAL CARE IS IN CRISIS throughout North America. In the United States, health care is excellent for those who can afford it, or for those who are fortunate enough to […]

Healthcare has been progressively required to improve its environmental performance as have other industries in recent years. In this regard, many new healthcare facilities have been built worldwide adopting sustainability-oriented approaches. However, results have been limited from an ecological and economic perspective, and many projects have rapidly become failures and then been abandoned. A large part of these failures is grounded in the misalignment between the adoption of eco-friendly facilities and greening technologies and the persistence of outdated practices, mindsets and behaviours among healthcare professionals. This study aims at furthering the current debate among leading practitioners and scholars of engineering business management about the combination of organizational and architectural levers for improving the sustainability of healthcare delivery. By taking a socio-technical systems perspective, we developed a literature-grounded framework and relative propositions with respect to the improvement of sustainability-related performances in hospitals through the combination of organizational and architectural levers. Ten levers and their mutual relationships have been identified and described. [ABSTRACT FROM AUTHOR]

Purpose: Pharmaceuticals are an integral part of a dignified life. However, a lack of degradability and threats to the welfare of living beings cause concern due to their emission into the environment. There is also a lack of knowledge about cause and consequence. Therefore, we intend to contribute to the development of educational programmes which should increasingly include the topic 'pharmaceuticals in the environment'. Methods: Considering the current literature, we developed a corresponding series of worksheets (Online Resource) and sample solutions on an introductory level and integrated them into our curriculum. Results: The material compiled for the worksheets was arranged in a logical order and considers several subtopics. The worksheets aim to support the examination of related aspects such as environmental effects, emissions, wastewater treatment plants, degradation, degradation by-products, advanced oxidation processes, hydraulic retention times, half-life times, biosolids, exposition pathways, precautionary principle, classification schemes for pharmaceuticals and, related to the structure-activity relationship, the design for degradability. The students managed to work on the tasks in an appropriate manner and received a good overview of the occurrence and fate of pharmaceuticals in the environment. Conclusions: Tasks that were presented to students regarding the topic 'pharmaceuticals in the environment' contributed to a better understanding of the possible risks of medical care on an introductory level. The tasks have been incorporated into a logic series of worksheets (Online Resource) with sample solutions available. Alternatively, the material would be appropriate for the preparation of a corresponding lecture on this topic. [ABSTRACT FROM AUTHOR]

Background: Anthropogenic climate change presents a major global health threat. However, the very provision of healthcare itself is associated with a significant environmental impact. Carbon footprinting techniques are increasingly used outside of the healthcare sector to assess greenhouse gas emissions and inform strategies to reduce them.Aim: This study represents the first assessment of the carbon footprint of an individual specialty service to include both direct and indirect emissions.Methods: This was a component analysis study. Activity data were collected for building energy use, travel and procurement. Established emissions factors were applied to reconcile this data to carbon dioxide equivalents (CO2eq) per year.Results: The Dorset Renal Service has a carbon footprint of 3006 tonnes CO2eq per annum, of which 381 tonnes CO2eq (13% of overall emissions) result from building energy use, 462 tonnes CO2eq from travel (15%) and 2163 tonnes CO2eq (72%) from procurement. The contributions of the major subsectors within procurement are: pharmaceuticals, 1043 tonnes CO2eq (35% of overall emissions); medical equipment, 753 tonnes CO2eq (25%). The emissions associated with healthcare episodes were estimated at 161 kg CO2eq per bed day for an inpatient admission and 22 kg CO2eq for an outpatient appointment.Conclusions: These results suggest that carbon-reduction strategies focusing upon supply chain emissions are likely to yield the greatest benefits. Sustainable waste management and strategies to reduce emissions associated with building energy use and travel will also be important. A transformation in the way that clinical care is delivered is required, such that lower carbon clinical pathways, treatments and technologies are embraced. The estimations of greenhouse gas emissions associated with outpatient appointments and inpatient stays calculated here may facilitate modelling of the emissions of alternative pathways of care. [ABSTRACT FROM AUTHOR]

Andrew Connor's article provides a simple explanation of climate change and outlines how and why renal medicine has been among the first specialties to begin to pursue the necessary changes in infrastructure and practice to develop more sustainable healthcare. [ABSTRACT FROM AUTHOR]

Objective: Hospital and other health care facilities (HCFs) are known to generate lot of waste for which its management is a matter of considerable public health and environmental concern. The study was undertaken to describe the current practices, gaps and quantify the load of health care solid waste. Methodology: Out of one hundred and fifty health care facilities (HCFs) in Punjab, the largest province of Pakistan, a sample of fifteen (HCFs) was taken from a few selected Districts, to include six large hospitals and nine without indoor facilities. Results: Only 40% of studied institutions had some program to dispose-off the waste. Even these programs were deficient in many areas and could hardly be considered as scientific. One third of institutional personnel interviewed had proper awareness or existence of a training program. Only one institution had some concept of taking safety steps from infectious materials. Conclusion: The process of solid waste collection, storing, transporting and final disposal was highly inefficient in almost all the institutions. No regulatory body or system of waste was in place in any of the hospitals. There was no allocated budget in 27% of the hospitals for covering the cost of waste disposal. An average of 0.3 kg/bed/day of solid unsafe waste demands a systematic program of its disposal, failing which serious environmental hazards would develop for within and surroundings communities. [ABSTRACT FROM AUTHOR]

There has been considerable interest in bridging educational programs in the United States across healthcare, architecture, industrial design, and human computing disciplines to design more effective and safer healthcare environments. New combinations of professionals including those outside the traditional healthcare disciplines are coming together to solve quality and safety problems and to re-envision the physical and social design of healthcare organizations. Little is known about the knowledge and skills essential to integrate these diverse perspectives and pose innovative solutions. A set of seven interprofessional competencies were identified through review of the literature, interviews of faculty and leaders in the field, and experience of the authors teaching interprofessional courses in healthcare design. The relevance and feasibility of these competencies were assessed through expert review by faculty and consultants and implementation in multiple courses. [ABSTRACT FROM AUTHOR]

Detailed information about the composition of the carbon footprint of the NHS in the Grampian health region, and in Scotland generally, is not available at present. Based on the limited information available, our best guess is that travel emissions in Grampian are substantial, perhaps 49,000 tonnes CO2 per year. This is equivalent to 233 million km of car travel per year. A well-established telemedicine network in the Grampian region, which saves over 2000 patient journeys a year from community hospitals, avoids about 260,000 km travel per year, or about 59 tonnes CO2 per year. Therefore using telehealth as it has been used historically (primarily to facilitate hospital-to-hospital interactions) seems unlikely to have a major environmental impact - although of course there may be other good reasons for persevering with conventional telehealth. On the other hand, telehealth might be useful in reducing staff travel and to a lesser extent, visitor travel. It looks particularly promising for reducing outpatient travel, where substantial carbon savings might be made by reconfiguring the way that certain services are provided. [ABSTRACT FROM AUTHOR]

The article focuses on the 2002-2003 survey to determine the prevalence of disability among persons in Los Angeles County, California and assess the effects of environmental barriers to health care on these persons. The survey results suggested that persons with physical or sensory disabilities experienced several environmental barriers.

Focuses on the relationship between the environment and medical practice. How the global environment is declining and will affect human life and health; Attempts of Health Care Without Harm to reduce the amount of waste generated in health care practice; Suggestion that there is a need to balance between environmental concerns and a commitment to patient care.

Copyright of Acta Medica Transilvanica is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Medica Transilvanica is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article focuses on the connection between the healthcare industry and the environment. It stresses that with quality health care means less environmental impact from water usage, transportation, electricity, paper wastes and diagnostic machines. It cites the difference of the healthcare industry in Cuba and in the U.S., in which Cubans accomplish quality health care with few natural resources. The author adds that it is important to design an economy that moves towards environmental sanity.

The article presents an analysis of the efforts made by hospitals to increase recycling and reduce waste. Figures released as part of an audit conducted by the British Medical Association evaluating the amount of "anaesthetic" waste generated at National Health Service hospitals in Great Britain is examined. How clinicians might decrease the amount of waste they produce by reducing and reusing resources is discussed. The challenges facing clinical waste improvement include social attitudes and logistical, institutional, and legal barriers.

The article discusses the efforts of the National Health Service (NHS) in Great Britain to reduce its carbon footprint. It is noted that the launch of the NHS carbon reduction strategy will be headed by chief executive David Nicholson. A report titled the NHS Sustainability Development Unit is assessed. One of the first priorities to be addressed is the reduction of the huge carbon costs of drug procurement and medical equipment. It is stressed that the NHS must cut consumption and examine how to make drug manufacture less carbon intensive. INSET: MEDICAL INSTRUMENTS.

The article reflects the opinion of the author on the significance of public health ethics in the prevention of diseases that were brought about by environment changes. According to the author, public health must be redefined ecologically in a way that life-support environment significant for human survival is shielded. He noted that sufficient health services must be equally distributed to the people yet must not be maximized but only be brought up to a level sufficient for good life.

Byline: Yao-Yang Shieh, Chang-tseh Hsieh Physicians need two kinds of support in their decision-making activities, namely information itself and information analysis processing. The first kind of support is the raw data itself. The second kind of support is to process the data by means of formal analytical methods as specified by the physician. In this study, the roles of DSS (decision support systems) for improving the efficiency and effectiveness of decision making by the physician are examined, and the foundation for developing such a DSS is studied. Some major benefits of deploying the proposed DSS on the internet are addressed. The proposed system attempted to incorporate an adaptive pattern recognition system into the framework of the model base. Such a model highlights functions and decision making requirements at each stage of medical practice The strategy and mechanism by which decision support can be provided to the physician, the targeted decision maker, was also explored.

The article focuses on environment-wide association studies (EWAS). Topics discussed include the challenges of analyzing big environmental data, the need to develop a new model that would determine the environmental exposures associated with a disease while mitigating the possibilities of selective reporting, and how the EWAS model can ben extended and improved to capture time dependence.

The author reflects on the importance and benefits of sustainable medicine in Great Britain. Physicians are now becoming concerned of the carbon costs of care and the impact of climate change on health care. The author points that sustainable medicine is good for the environment as well as for the people. The author further asserts that sustainability measures in medicine is part of a strategy in the society which aims to prevent global warming and reduce greenhouse gas emissions.

This commentary is on the review by Glader et al. on pages 1116–1123 of this issue. [ABSTRACT FROM AUTHOR]

A new design audit tool contains a series of resources for carrying out an assessment of environments used by people with dementia. It is suitable for refurbishment projects or new buildings and can be used across a range of settings, including day centres, hospital wards, care homes and GP surgeries. [ABSTRACT FROM AUTHOR]

The author discusses issues related to environmental waste in the health care system and how it must be reduced for carbon reduction strategies to succeed. Particular attention is paid to a linked analysis article research published in this issue of journal titled "Coming round to recycling." Results of an analysis of the carbon footprint of the National Health Service in Great Britain are assessed.

Reports that vinyl softeners used in medical devices and children's toys were deemed safe by the American Council on Science and Health. The plasticizers, Di-2ethythexyl-phthalate (DEHP) and di-isononyl phthalate (DINP); Opinion of Health Care Without Harm, which commissioned a comprehensive review of scientific literature on the subject.