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Background: Education is urgently needed to equip medical students with knowledge, values and skills to promote planetary health. However, the current literature offers little insight into evidence-based approaches and best practices. In response to this pressing need, a novel serious game was introduced into the medical curriculum at Erasmus Medical Center in 2023. The aim of this study was to evaluate the knowledge and attitudes of medical students after they had played a serious game that addresses climate change and health. Methods: In accordance with a mixed-methods design, quantitative data were collected using pre- and post-intervention surveys. Differences were assessed using the Wilcoxon signed rank test. Focus group discussions were held after the game and thematically analysed. Results: One hundred forty-five students (38.6% of the entire cohort) played the game, of which 59 students completed the pre- and post-intervention surveys. After the game, self-reported knowledge increased. Regarding objective knowledge, an increase in the proportion of students who answered one of the two questions correctly was observed, while the proportion of correct responses decreased for the other question. Student's responses to two out of five attitude questions were significantly more positive. The proportion of students who recognized the importance of climate change education, to inform patients and society about the health impacts of climate change, increased. Moreover, survey results indicated a significant increase in climate worry subsequent to the game. Eleven students participated in the focus group discussions. Thematic analysis highlighted participants' reflections on the roles and responsibilities in climate change and health, along with their realisation of the tools for action that climate and health co-benefits provide. Another significant aspect was the importance participants placed on learning alongside peers with diverse attitudes. Additionally, participants appreciated the tangible overview of climate change and health provided by the serious game. Conclusions: Our novel serious game addressed an important gap in the medical curriculum. The game can enable medical students to cultivate the necessary knowledge and attitudes to promote health in times of a climate crisis. The accompanying climate worry needs attention through the empowerment of students' agency to foster change. [ABSTRACT FROM AUTHOR]

Background: Observing hand hygiene compliance (HHC) among non-sterile healthcare workers (HCW) in the operating theatre (OT) is challenging, since there are no tailored protocols or observation tools.Aim: To develop and test a hand hygiene protocol tailored to non-sterile HCW in the OT.Methods: In this prospective observational study, nine hospitals in the Rotterdam-Rijnmond region provided input on a draft protocol on hand hygiene in the OT, resulting in a new consensus protocol for the region. An observation tool based on the protocol was developed and tested. HHC rates with 95%-confidence intervals (CI) were calculated by type of hospital and type of HCW.Findings: The protocol contains three sections: 1. written general hand hygiene rules, 2. written hand hygiene rules specific for anaesthesia and surgery, and 3. visual representation of the OT, divided into four hand hygiene areas. Hand hygiene should be applied when changing from area. An average HHC of 48.0% (95%-CI:45.2%-61.2%) was observed in OTs across all hospitals. The two specialized hospitals (64.0%, 95%-CI: 30.6%-89.8% and 76.7%, 95%-CI:62.8%-84.5%) scored the highest HHC, while the academic teaching hospital scored the lowest (23.1%, 95%-CI: 0.0%-45.8%). The average HHC of anaesthesiologists was the lowest (31.6%, 95%-CI: 19.2%-62.4%), the OT-assistants scored the highest (57.4%, 95%-CI: 50.1%-78.2%).Conclusion: This uniform way of observing HHC in the OT, enables evaluation of the effectiveness of interventions in the OT and facilitates friendly competition. In the Rotterdam-Rijnmond region, HHC in the OT was below 50% and needs to be addressed in teaching hospitals and among physicians. [ABSTRACT FROM AUTHOR]

Objective To assess injury-related mortality, disability and disability-adjusted life years (DALYs) in six European countries. Methods Epidemiological data (hospital discharge registers, emergency department registers, mortality databases) were obtained for Austria, Denmark, Ireland, Netherlands, Norway, and the United Kingdom (England and Wales). For each country, the burden of injury was estimated in years lost due to premature mortality (YLL), years lived with disability (YLD), and DALYs (per 1000 persons). Findings We observed marked differences in the burden of injury between countries. Austria lost the largest number of DALYs (25 per 1000 persons), followed by Denmark, Norway and Ireland (17-20 per 1000 persons). In the Netherlands and United Kingdom, the total burden due to injuries was relatively low (12 per 1000 persons). The variation between countries was attributable to a high variation in premature mortality (YLL varied from 9-17 per 1000 persons) and disability (YLD varied from 2-8 per 1000 persons). In all countries, males aged 25-44 years represented one third of the total injury burden, mainly due to traffic and intentional injuries. Spinal cord injury and skull-brain injury resulted in the highest burden due to permanent disability. Conclusion The burden of injury varies considerably among the six participating European countries, but males aged 15-24 years are responsible for a disproportionate share of the assessed burden of injury in all countries. Consistent injury control policy is supported by high-quality summary measures of population health. There is an urgent need for standardized data on the incidence and functional consequences of injury. Objectif Evaluer la mortalite, l'incapacite et les annees de vie perdues ajustees sur l'incapacite (DALY) dues aux traumatismes dans six pays europeens. Methodes Les donnees epidemiologiques (registres de sortie d'etablissements hospitaliers, registres des services d'urgence, bases de donnees sur la mortalite) ont ete obtenues pour l'Autriche, le Danemark, l'Irlande, la Norvege, les Pays-Bas et le Royaume-Uni (Angleterre et Pays de Galles). Pour chaque pays, la charge des traumatismes a ete estimee en annees de vie perdues du fait de la mortalite prematuree (YLL), en annees vecues avec une incapacite (YLD) et en DALY pour 1000 personnes. Resultats Des differences marquees ont ete constatees entre les pays concernant la charge des traumatismes. C'est l'Autriche qui a perdu le plus grand nombre de DALY (25 pour 1000 personnes) suivie du Danemark, de la Norvege et de l'Irlande (17 a 20 pour 1000 personnes). Aux Pays-Bas et au Royaume-Uni, la charge totale des traumatismes etait relativement faible (12 pour 1000 personnes). La difference entre les pays etait imputable a une forte variation de la mortalite prematuree (YLL entre 9 et 17 pour 1000 personnes) et de l'incapacite (YLD entre 2 et 8 pour 1000 personnes). Dans tous les pays, les hommes ages de 25 a 44 ans supportaient un tiers de la charge totale des traumatismes--constitues principalement d'accidents de la circulation et de traumatismes intentionnels. Les incapacites permanentes etaient dues avant tout a des lesions de la moelle epiniere et a des traumatismes craniens. Conclusion La charge des traumatismes varie considerablement entre les six pays europeens consideres, mais les hommes ages de 15 a 24 ans supportent une part disproportionnee de la charge evaluee des traumatismes dans tous les pays consideres. Une politique coherente de lutte contre les traumatismes s'appuie sur des indicateurs generaux de qualite de l'etat de sante de la population. Il faut d'urgence obtenir des donnees standardisees sur l'incidence et les consequences fonctionnelles des traumatismes. Objetivo Evaluar la mortalidad, la discapacidad y los anos de vida ajustados en funcion de la discapacidad (AVAD) relacionados con los traumatismos en seis paises europeos. Metodos Se obtuvieron datos epidemiologicos (registros de alta de los hospitales, registros de urgencias y bases de datos sobre la mortalidad) en Austria, Dinamarca, Irlanda, Noruega, los Paises Bajos y el Reino Unido (Inglaterra y Gales). La carga de traumatismos en cada pais se estimo en anos perdidos por muerte prematura, anos vividos con discapacidad y AVAD (por 1000 personas). Resultados La carga de traumatismos presento grandes diferencias entre los paises. La mayor perdida de AVAD correspondio a Austria (25 por 1000), seguida de Dinamarca, Noruega e Irlanda (17-20 por 1000). En los Paises Bajos y el Reino Unido, la carga total de traumatismos fue relativamente baja (12 por 1000). Las variaciones entre los paises fueron atribuibles a una gran variacion de la mortalidad prematura (los anos perdidos por muerte prematura oscilaron entre 9 y 17 por 1000) y de la discapacidad (los anos vividos con discapacidad oscilaron entre 2 y 8 por 1000). En todos los paises estudiados, los varones de 25 a 44 anos sufrieron un tercio de la carga total de traumatismos, debida principalmente a los traumatismos intencionados o causados por el trafico. Los traumatismos craneoencefalicos y medulares fueron la causa de mayor carga de discapacidad permanente. Conclusion La carga de traumatismos presento una variacion considerable entre los seis paises europeos participantes, pero los varones de 15-24 anos son los que soportan la mayor carga en todos los paises. Los indicadores de buena calidad que resumen la salud de la poblacion respaldan una politica coherente de control de los traumatismos. Hay una necesidad urgente de datos normalizados sobre la incidencia y las consecuencias funcionales de los traumatismos. [TEXT NOT REPRODUCIBLE IN ASCII.], Introduction Injuries are a major cause of morbidity and mortality in developing and in industrialized regions. (1,2) Rational choices for injury prevention need to rely on comparable indicators relating the [...]