Pub Date : 2024-11-01DOI: 10.1016/S2542-5196(24)00283-3
Cahal McQuillan
{"title":"Planetary Health Research Digest","authors":"Cahal McQuillan","doi":"10.1016/S2542-5196(24)00283-3","DOIUrl":"10.1016/S2542-5196(24)00283-3","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 11","pages":"Page e878"},"PeriodicalIF":24.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/S2542-5196(24)00241-9
Jessica F Davies FANZA MSc , Forbes McGain MBBS PhD , Evelyn Sloan DPT , Prof Jill Francis PhD , Stephanie Best PhD
Hospitals use many single-use devices that produce more waste and greenhouse gas emissions than reusable devices; operating theatres alone are responsible for up to a third of hospital waste. We explored barriers and enablers to replacing disposable devices with reusable alternatives in operating theatres by use of interviews, the Theoretical Domains Framework, and theory-informed behaviour change techniques. 19 stakeholders were interviewed at a large tertiary hospital in Melbourne, Australia, and 53 barriers and 44 experience-based or intuition-based enablers were identified. 30 strategies were identified across six topics: external purchasing (two strategies); internal purchasing (seven strategies); incentivisation and standardised environmental decision making (three strategies); successful practical introduction of reusable devices (five strategies); identification of goals and facilitation of leadership (two strategies); and a community of practice and knowledge building (11 strategies). We present these 30 implementation strategies, from the individual to the policy level, which consist of evidence-based behaviour change techniques aimed at addressing the identified barriers to replacing single-use devices with reusable alternatives.
{"title":"A qualitative exploration of barriers, enablers, and implementation strategies to replace disposable medical devices with reusable alternatives","authors":"Jessica F Davies FANZA MSc , Forbes McGain MBBS PhD , Evelyn Sloan DPT , Prof Jill Francis PhD , Stephanie Best PhD","doi":"10.1016/S2542-5196(24)00241-9","DOIUrl":"10.1016/S2542-5196(24)00241-9","url":null,"abstract":"<div><div>Hospitals use many single-use devices that produce more waste and greenhouse gas emissions than reusable devices; operating theatres alone are responsible for up to a third of hospital waste. We explored barriers and enablers to replacing disposable devices with reusable alternatives in operating theatres by use of interviews, the Theoretical Domains Framework, and theory-informed behaviour change techniques. 19 stakeholders were interviewed at a large tertiary hospital in Melbourne, Australia, and 53 barriers and 44 experience-based or intuition-based enablers were identified. 30 strategies were identified across six topics: external purchasing (two strategies); internal purchasing (seven strategies); incentivisation and standardised environmental decision making (three strategies); successful practical introduction of reusable devices (five strategies); identification of goals and facilitation of leadership (two strategies); and a community of practice and knowledge building (11 strategies). We present these 30 implementation strategies, from the individual to the policy level, which consist of evidence-based behaviour change techniques aimed at addressing the identified barriers to replacing single-use devices with reusable alternatives.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 11","pages":"Pages e937-e945"},"PeriodicalIF":24.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/S2542-5196(24)00235-3
John Jamir Benzon R Aruta , Romiane Grace V Gonzales , Gaye Justinia R Delos Santos , Eliza Faye B Lumanog , Alexandra S Chew , Aenghel Marie D Bonoan , Ginger Erin Swa
{"title":"Climate injustice: lessons from the Philippines' jeepney modernisation programme","authors":"John Jamir Benzon R Aruta , Romiane Grace V Gonzales , Gaye Justinia R Delos Santos , Eliza Faye B Lumanog , Alexandra S Chew , Aenghel Marie D Bonoan , Ginger Erin Swa","doi":"10.1016/S2542-5196(24)00235-3","DOIUrl":"10.1016/S2542-5196(24)00235-3","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 11","pages":"Pages e875-e876"},"PeriodicalIF":24.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/S2542-5196(24)00229-8
R Eric Lewandowski PhD , Susan D Clayton PhD , Lukas Olbrich MSc , Joseph W Sakshaug PhD , Britt Wray PhD , Sarah E O Schwartz PhD , Jura Augustinavicius PhD , Peter D Howe PhD , McKenna Parnes PhD , Sacha Wright BSc , Caitlyn Carpenter , Arkadiusz Wiśniowski PhD , Diego Perez Ruiz PhD , Lise Van Susteren MD
<div><h3>Background</h3><div>Climate change has adverse effects on youth mental health and wellbeing, but limited large-scale data exist globally or in the USA. Understanding the patterns and consequences of climate-related distress among US youth can inform necessary responses at the individual, community, and policy level.</div></div><div><h3>Methods</h3><div>A cross-sectional descriptive online survey was done of US youth aged 16–25 years from all 50 states and Washington, DC, between July 20 and Nov 7, 2023, via the Cint digital survey marketplace. The survey assessed: climate-related emotions and thoughts, including indicators of mental health; relational aspects of climate-related emotions; beliefs about who or what has responsibility for causing and responding to climate change; desired and planned actions in response to climate change; and emotions and thoughts about the US Government response to climate change. Respondents were asked whether they had been affected by various severe weather events linked to climate change and for their political party identification. Sample percentages were weighted according to 2022 US census age, sex, and race estimates. To test the effects of political party identification and self-reported exposure to severe weather events on climate-related thoughts and beliefs we used linear and logistic regression models, which included terms for political party identification, the number of self-reported severe weather event types in respondents' area of residence in the past year, and demographic control variables.</div></div><div><h3>Findings</h3><div>We evaluated survey responses from 15 793 individuals (weighted proportions: 80·5% aged 18–25 years and 19·5% aged 16–17 years; 48·8% female and 51·2% male). Overall, 85·0% of respondents endorsed being at least moderately worried, and 57·9% very or extremely worried, about climate change and its impacts on people and the planet. 42·8% indicated an impact of climate change on self-reported mental health, and 38·3% indicated that their feelings about climate change negatively affect their daily life. Respondents reported negative thoughts about the future due to climate change and actions planned in response, including being likely to vote for political candidates who support aggressive climate policy (72·8%). In regression models, self-reported exposure to more types of severe weather events was significantly associated with stronger endorsement of climate-related distress and desire and plans for action. Political party identification as Democrat or as Independent or Other (<em>vs</em> Republican) was also significantly associated with stronger endorsement of distress and desire and plans for action, although a majority of self-identified Republicans reported at least moderate distress. For all survey outcomes assessed in the models, the effect of experiencing more types of severe weather events did not significantly differ by political party identification.</div>
{"title":"Climate emotions, thoughts, and plans among US adolescents and young adults: a cross-sectional descriptive survey and analysis by political party identification and self-reported exposure to severe weather events","authors":"R Eric Lewandowski PhD , Susan D Clayton PhD , Lukas Olbrich MSc , Joseph W Sakshaug PhD , Britt Wray PhD , Sarah E O Schwartz PhD , Jura Augustinavicius PhD , Peter D Howe PhD , McKenna Parnes PhD , Sacha Wright BSc , Caitlyn Carpenter , Arkadiusz Wiśniowski PhD , Diego Perez Ruiz PhD , Lise Van Susteren MD","doi":"10.1016/S2542-5196(24)00229-8","DOIUrl":"10.1016/S2542-5196(24)00229-8","url":null,"abstract":"<div><h3>Background</h3><div>Climate change has adverse effects on youth mental health and wellbeing, but limited large-scale data exist globally or in the USA. Understanding the patterns and consequences of climate-related distress among US youth can inform necessary responses at the individual, community, and policy level.</div></div><div><h3>Methods</h3><div>A cross-sectional descriptive online survey was done of US youth aged 16–25 years from all 50 states and Washington, DC, between July 20 and Nov 7, 2023, via the Cint digital survey marketplace. The survey assessed: climate-related emotions and thoughts, including indicators of mental health; relational aspects of climate-related emotions; beliefs about who or what has responsibility for causing and responding to climate change; desired and planned actions in response to climate change; and emotions and thoughts about the US Government response to climate change. Respondents were asked whether they had been affected by various severe weather events linked to climate change and for their political party identification. Sample percentages were weighted according to 2022 US census age, sex, and race estimates. To test the effects of political party identification and self-reported exposure to severe weather events on climate-related thoughts and beliefs we used linear and logistic regression models, which included terms for political party identification, the number of self-reported severe weather event types in respondents' area of residence in the past year, and demographic control variables.</div></div><div><h3>Findings</h3><div>We evaluated survey responses from 15 793 individuals (weighted proportions: 80·5% aged 18–25 years and 19·5% aged 16–17 years; 48·8% female and 51·2% male). Overall, 85·0% of respondents endorsed being at least moderately worried, and 57·9% very or extremely worried, about climate change and its impacts on people and the planet. 42·8% indicated an impact of climate change on self-reported mental health, and 38·3% indicated that their feelings about climate change negatively affect their daily life. Respondents reported negative thoughts about the future due to climate change and actions planned in response, including being likely to vote for political candidates who support aggressive climate policy (72·8%). In regression models, self-reported exposure to more types of severe weather events was significantly associated with stronger endorsement of climate-related distress and desire and plans for action. Political party identification as Democrat or as Independent or Other (<em>vs</em> Republican) was also significantly associated with stronger endorsement of distress and desire and plans for action, although a majority of self-identified Republicans reported at least moderate distress. For all survey outcomes assessed in the models, the effect of experiencing more types of severe weather events did not significantly differ by political party identification.</div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 11","pages":"Pages e879-e893"},"PeriodicalIF":24.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Should climate and health researchers accept funding from industries that profit from climate-damaging consumption? In this Personal View, we aim to ignite discussions on this key topic and to introduce a guideline to possibly help climate and health researchers grappling with this complex question. Drawing from existing tools focused on other public health issues and the conclusions of the 2023 Lancet Series on commercial determinants of health, we propose a guideline comprising six parts: meeting public health and climate goals; building credibility and trust; avoiding undue dependence on particular sources of funding; not inflating without good reason the public image of industry; embedding processes to ensure transparency and independence; and protecting the freedom to publish. We invite other climate and public health scientists to report their own experiences and provide feedback on this guideline.
{"title":"Public good or climate washing? A guideline for climate and health researchers considering funding from carbon-intensive industries","authors":"Connie Hoe PhD , Aditi Bunker DrScHum , Cristina Arnés-Sanz MPharm , Prof Joacim Rocklöv PhD , Kirsty Wild PhD , Wallis Turner Holmes LLB , Prof Alistair Woodward PhD","doi":"10.1016/S2542-5196(24)00231-6","DOIUrl":"10.1016/S2542-5196(24)00231-6","url":null,"abstract":"<div><div>Should climate and health researchers accept funding from industries that profit from climate-damaging consumption? In this Personal View, we aim to ignite discussions on this key topic and to introduce a guideline to possibly help climate and health researchers grappling with this complex question. Drawing from existing tools focused on other public health issues and the conclusions of the 2023 <em>Lancet</em> Series on commercial determinants of health, we propose a guideline comprising six parts: meeting public health and climate goals; building credibility and trust; avoiding undue dependence on particular sources of funding; not inflating without good reason the public image of industry; embedding processes to ensure transparency and independence; and protecting the freedom to publish. We invite other climate and public health scientists to report their own experiences and provide feedback on this guideline.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 11","pages":"Pages e946-e950"},"PeriodicalIF":24.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/S2542-5196(24)00244-4
Prof Stephen P Luby MD , Jenna E Forsyth PhD , Prof Zafar Fatmi MBBS , Mahbubur Rahman MBBS , Jesmin Sultana MPH , Prof Erica L Plambeck PhD , Prof N Grant Miller PhD , Prof Eran Bendavid MD , Prof Peter J Winch MD , Prof Howard Hu MD , Prof Bruce Lanphear MD , Prof Philip J Landrigan MD
Lead, an element toxic to countless biological processes, occurs naturally in the earth's lithosphere and is geologically sequestered from the biosphere at the earth's surface. When humans remove lead from the lithosphere and distribute it throughout the economy, its toxic effects impact throughout the web of life. Lead mining and manufacturing is a small industry that generates enormous harms. Lead impairs the growth, development, and reproduction of microbes, insects, plants, and animals. The annual human costs of lead exposure include 5·5 million premature adult deaths from cardiovascular disease and US$1·4 trillion in losses to the global economy from lead impairing children's cognitive development. Although the lead industry touts lead as the most recycled metal, most recycling occurs within countries that are incapable of enforcing environmental regulations. Millions of metric tonnes of lead are dispersed into the environment each year, disproportionately in low-income and middle-income countries. Substitutes for lead in the economy are available and we should act in the best interests of the planet and human health by eliminating lead from the global economy by 2035.
{"title":"Removing lead from the global economy","authors":"Prof Stephen P Luby MD , Jenna E Forsyth PhD , Prof Zafar Fatmi MBBS , Mahbubur Rahman MBBS , Jesmin Sultana MPH , Prof Erica L Plambeck PhD , Prof N Grant Miller PhD , Prof Eran Bendavid MD , Prof Peter J Winch MD , Prof Howard Hu MD , Prof Bruce Lanphear MD , Prof Philip J Landrigan MD","doi":"10.1016/S2542-5196(24)00244-4","DOIUrl":"10.1016/S2542-5196(24)00244-4","url":null,"abstract":"<div><div>Lead, an element toxic to countless biological processes, occurs naturally in the earth's lithosphere and is geologically sequestered from the biosphere at the earth's surface. When humans remove lead from the lithosphere and distribute it throughout the economy, its toxic effects impact throughout the web of life. Lead mining and manufacturing is a small industry that generates enormous harms. Lead impairs the growth, development, and reproduction of microbes, insects, plants, and animals. The annual human costs of lead exposure include 5·5 million premature adult deaths from cardiovascular disease and US$1·4 trillion in losses to the global economy from lead impairing children's cognitive development. Although the lead industry touts lead as the most recycled metal, most recycling occurs within countries that are incapable of enforcing environmental regulations. Millions of metric tonnes of lead are dispersed into the environment each year, disproportionately in low-income and middle-income countries. Substitutes for lead in the economy are available and we should act in the best interests of the planet and human health by eliminating lead from the global economy by 2035.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 11","pages":"Pages e966-e972"},"PeriodicalIF":24.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/S2542-5196(24)00232-8
Arthur Sovi PhD , Constantin J Adoha MSc , Boulais Yovogan MSc , Chad L Cross PhD , Dominic P Dee MSc , Alphonse Keller Konkon PhD , Aboubakar Sidick MSc , Manfred Accrombessi PhD , Minassou Juvenal Ahouandjinou MSc , Razaki Ossè PhD , Edouard Dangbénon MSc , Linda Towakinou BSc , Clément Agbangla PhD , Germain Gil Padonou MSc , Thomas S Churcher PhD , Corine Ngufor PhD , Jackie Cook PhD , Natacha Protopopoff PhD , Martin C Akogbéto , Prof Louisa A Messenger PhD
<div><h3>Background</h3><div>Insecticide resistance among malaria vector species now occurs in 84 malaria-endemic countries and territories worldwide. Novel vector-control interventions, including long-lasting insecticidal nets (LLINs) that incorporate new active ingredients with distinct modes of action, are urgently needed to delay the evolution and spread of resistance and to alleviate reversals in malaria-control gains. We aimed to assess the longitudinal effect of two dual-active-ingredient LLINs on insecticide resistance during a cluster-randomised, controlled trial in Benin.</div></div><div><h3>Methods</h3><div>This 3-year, three-arm, cluster-randomised, controlled trial was conducted between Oct 17, 2019, and Oct 24, 2022, in three districts in southern Benin, to compare the effects of LLINs containing chlorfenapyr–pyrethroid or pyriproxyfen–pyrethroid with LLINs containing pyrethroid only. In 19 292 mosquitoes (<em>Anopheles gambiae</em> sensu lato) collected over 36 months—3 months of baseline followed by 3 years post-intervention—we measured longitudinal phenotypic insecticide resistance profiles using bioassays and genotypic resistance profiles using quantitative, real-time, reverse transcriptase PCR of metabolic resistance genes in two clusters per trial group. The trial was registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, <span><span>NCT03931473</span><svg><path></path></svg></span>.</div></div><div><h3>Findings</h3><div>In all three trial groups, a significant effect of LLINs on insecticide resistance selection was evident, with the median lethal dose (LD<sub>50</sub>) of α-cypermethrin approximately halving between baseline and 12 months post-LLIN distribution (pyrethroid-only LLIN cluster 21: LD<em><sub>50</sub></em> 78·78 μg/ml [95% CI 65·75–94·48] <em>vs</em> 35·93 [29·41–43.86] and cluster 31: 79·26 [65·40–96·44] <em>vs</em> 38·71 [30·88–48·53]; chlorfenapyr–pyrethroid LLIN cluster 43: 104·30 [82·97–133·58] <em>vs</em> 43·99 [35·30–54·86]; and pyriproxyfen–pyrethroid LLIN cluster 36: 63·76 [52·14–77·75] <em>vs</em> 37·96 [30·88–46·69] and cluster 53: 77·67 [57·63–104·56] <em>vs</em> 39·72 [29·26–53·97]). Over the subsequent 2 years, the LD<em><sub>50</sub></em> of α-cypermethrin increased past baseline values in all three trial groups (year 3 pyrethroid-only LLIN cluster 21: 141·01 [111·70–181·90] and cluster 31: 115·15 [93·90–143·09]; chlorfenapyr–pyrethroid LLIN cluster 43: 97·00 [77·24–123·54] and cluster 55: 126·99 [102·34–161·26]; and pyriproxyfen–pyrethroid LLIN cluster 36: 142·29 [112·32–184·84] and cluster 53: 109·88 [79·31–157·70]). We observed minimal reductions in chlorfenapyr susceptibility and variable but significant reductions in fertility after pyriproxyfen exposure, with an overall trend of increasing susceptibility across trial years. Several metabolic genes were implicated in resistance selection, including <em>CYP6P4</em> in the pyriproxyfen–pyrethroid LLIN group, which
{"title":"The effect of next-generation, dual-active-ingredient, long-lasting insecticidal net deployment on insecticide resistance in malaria vectors in Benin: results of a 3-year, three-arm, cluster-randomised, controlled trial","authors":"Arthur Sovi PhD , Constantin J Adoha MSc , Boulais Yovogan MSc , Chad L Cross PhD , Dominic P Dee MSc , Alphonse Keller Konkon PhD , Aboubakar Sidick MSc , Manfred Accrombessi PhD , Minassou Juvenal Ahouandjinou MSc , Razaki Ossè PhD , Edouard Dangbénon MSc , Linda Towakinou BSc , Clément Agbangla PhD , Germain Gil Padonou MSc , Thomas S Churcher PhD , Corine Ngufor PhD , Jackie Cook PhD , Natacha Protopopoff PhD , Martin C Akogbéto , Prof Louisa A Messenger PhD","doi":"10.1016/S2542-5196(24)00232-8","DOIUrl":"10.1016/S2542-5196(24)00232-8","url":null,"abstract":"<div><h3>Background</h3><div>Insecticide resistance among malaria vector species now occurs in 84 malaria-endemic countries and territories worldwide. Novel vector-control interventions, including long-lasting insecticidal nets (LLINs) that incorporate new active ingredients with distinct modes of action, are urgently needed to delay the evolution and spread of resistance and to alleviate reversals in malaria-control gains. We aimed to assess the longitudinal effect of two dual-active-ingredient LLINs on insecticide resistance during a cluster-randomised, controlled trial in Benin.</div></div><div><h3>Methods</h3><div>This 3-year, three-arm, cluster-randomised, controlled trial was conducted between Oct 17, 2019, and Oct 24, 2022, in three districts in southern Benin, to compare the effects of LLINs containing chlorfenapyr–pyrethroid or pyriproxyfen–pyrethroid with LLINs containing pyrethroid only. In 19 292 mosquitoes (<em>Anopheles gambiae</em> sensu lato) collected over 36 months—3 months of baseline followed by 3 years post-intervention—we measured longitudinal phenotypic insecticide resistance profiles using bioassays and genotypic resistance profiles using quantitative, real-time, reverse transcriptase PCR of metabolic resistance genes in two clusters per trial group. The trial was registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, <span><span>NCT03931473</span><svg><path></path></svg></span>.</div></div><div><h3>Findings</h3><div>In all three trial groups, a significant effect of LLINs on insecticide resistance selection was evident, with the median lethal dose (LD<sub>50</sub>) of α-cypermethrin approximately halving between baseline and 12 months post-LLIN distribution (pyrethroid-only LLIN cluster 21: LD<em><sub>50</sub></em> 78·78 μg/ml [95% CI 65·75–94·48] <em>vs</em> 35·93 [29·41–43.86] and cluster 31: 79·26 [65·40–96·44] <em>vs</em> 38·71 [30·88–48·53]; chlorfenapyr–pyrethroid LLIN cluster 43: 104·30 [82·97–133·58] <em>vs</em> 43·99 [35·30–54·86]; and pyriproxyfen–pyrethroid LLIN cluster 36: 63·76 [52·14–77·75] <em>vs</em> 37·96 [30·88–46·69] and cluster 53: 77·67 [57·63–104·56] <em>vs</em> 39·72 [29·26–53·97]). Over the subsequent 2 years, the LD<em><sub>50</sub></em> of α-cypermethrin increased past baseline values in all three trial groups (year 3 pyrethroid-only LLIN cluster 21: 141·01 [111·70–181·90] and cluster 31: 115·15 [93·90–143·09]; chlorfenapyr–pyrethroid LLIN cluster 43: 97·00 [77·24–123·54] and cluster 55: 126·99 [102·34–161·26]; and pyriproxyfen–pyrethroid LLIN cluster 36: 142·29 [112·32–184·84] and cluster 53: 109·88 [79·31–157·70]). We observed minimal reductions in chlorfenapyr susceptibility and variable but significant reductions in fertility after pyriproxyfen exposure, with an overall trend of increasing susceptibility across trial years. Several metabolic genes were implicated in resistance selection, including <em>CYP6P4</em> in the pyriproxyfen–pyrethroid LLIN group, which ","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 11","pages":"Pages e894-e905"},"PeriodicalIF":24.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/S2542-5196(24)00207-9
Prof Martin Hensher PhD , Leigh Blizzard PhD , Julie Campbell PhD , Ben Canny PhD , Craig Zimitat PhD , Prof Andrew Palmer MBBS
Background
Increasing health expenditure in low-income countries is associated with rapid gains in health status. Less attention has been paid to the possibility of diminishing marginal returns to health expenditure at high levels of spending, or to the relationship between health-care greenhouse gas emissions and outcomes. Our study aimed to investigate the existence, scale, and implications of diminishing marginal returns to health-care expenditure and emissions.
Methods
Segmented (piecewise) regression analysis was used to explore the relationship between two measures of health outcome from the Global Burden of Disease project (mortality amenable to health care [MAH] and health-adjusted life expectancy [HALE]), four aggregates of health expenditure per capita from the WHO Global Health Expenditure Database, and health-care sector greenhouse gas emissions per capita derived from a 2020 study by Lenzen and colleagues. Turning point knots—points at which the elasticity or velocity of increasing returns to expenditure and emissions changed substantially—were estimated and countries in the vicinity of these knots identified.
Findings
Rapidly increasing returns (improvements in population health as measured by MAH and HALE) to health expenditure were estimated in low-income and lower-middle-income countries; at levels of spending above approximately US$500 per capita, these returns start to slow. At levels of spending above those seen in high-income countries such as Italy (approximately US$3400), there is little or no evidence of further health returns to additional spending or to increasing health-care greenhouse gas emissions.
Interpretation
Dramatic improvements in population health outcomes could be achieved by additional investment in health expenditure in low-income countries. Conversely, continuing growth in health expenditure in high-income countries will, by itself, be unlikely to yield rapid improvements in health outcomes. Our findings inform the emerging debate on the importance of sufficiency within planetary boundaries—low-income countries need rapid growth in health expenditure, whereas high-income countries could potentially achieve better health outcomes at substantially lower levels of resource use.
Funding
None.
背景：低收入国家医疗支出的增加与健康状况的迅速改善有关。人们较少关注在高支出水平下医疗支出边际收益递减的可能性，也较少关注医疗保健温室气体排放与结果之间的关系。我们的研究旨在调查医疗支出和排放边际收益递减的存在、规模和影响：方法：采用分段（片断）回归分析来探讨全球疾病负担项目中的两种健康结果测量指标（适合医疗保健的死亡率[MAH]和健康调整后预期寿命[HALE]）、世界卫生组织全球卫生支出数据库中的四种人均卫生支出总量以及 Lenzen 及其同事的 2020 年研究中得出的医疗保健部门人均温室气体排放量之间的关系。我们估算了转折点--支出和排放的回报弹性或增加速度发生重大变化的点，并确定了这些转折点附近的国家：据估计，在低收入和中低收入国家，卫生支出的回报（以 MAH 和 HALE 衡量的人口健康改善）迅速增加；当人均支出水平超过约 500 美元时，这些回报开始减缓。当支出水平超过意大利等高收入国家的水平（约 3400 美元）时，几乎没有证据表明增加支出或增加医疗保健温室气体排放会带来进一步的健康回报：在低收入国家，通过增加医疗支出投资，可以显著改善人口的健康状况。相反，高收入国家医疗支出的持续增长本身不太可能迅速改善健康结果。我们的研究结果为正在出现的关于地球范围内充足性重要性的辩论提供了信息--低收入国家需要快速增长医疗支出，而高收入国家则有可能在大幅降低资源使用水平的情况下实现更好的健康结果：无。
{"title":"Diminishing marginal returns and sufficiency in health-care resource use: an exploratory analysis of outcomes, expenditure, and emissions","authors":"Prof Martin Hensher PhD , Leigh Blizzard PhD , Julie Campbell PhD , Ben Canny PhD , Craig Zimitat PhD , Prof Andrew Palmer MBBS","doi":"10.1016/S2542-5196(24)00207-9","DOIUrl":"10.1016/S2542-5196(24)00207-9","url":null,"abstract":"<div><h3>Background</h3><div>Increasing health expenditure in low-income countries is associated with rapid gains in health status. Less attention has been paid to the possibility of diminishing marginal returns to health expenditure at high levels of spending, or to the relationship between health-care greenhouse gas emissions and outcomes. Our study aimed to investigate the existence, scale, and implications of diminishing marginal returns to health-care expenditure and emissions.</div></div><div><h3>Methods</h3><div>Segmented (piecewise) regression analysis was used to explore the relationship between two measures of health outcome from the Global Burden of Disease project (mortality amenable to health care [MAH] and health-adjusted life expectancy [HALE]), four aggregates of health expenditure per capita from the WHO Global Health Expenditure Database, and health-care sector greenhouse gas emissions per capita derived from a 2020 study by Lenzen and colleagues. Turning point knots—points at which the elasticity or velocity of increasing returns to expenditure and emissions changed substantially—were estimated and countries in the vicinity of these knots identified.</div></div><div><h3>Findings</h3><div>Rapidly increasing returns (improvements in population health as measured by MAH and HALE) to health expenditure were estimated in low-income and lower-middle-income countries; at levels of spending above approximately US$500 per capita, these returns start to slow. At levels of spending above those seen in high-income countries such as Italy (approximately US$3400), there is little or no evidence of further health returns to additional spending or to increasing health-care greenhouse gas emissions.</div></div><div><h3>Interpretation</h3><div>Dramatic improvements in population health outcomes could be achieved by additional investment in health expenditure in low-income countries. Conversely, continuing growth in health expenditure in high-income countries will, by itself, be unlikely to yield rapid improvements in health outcomes. Our findings inform the emerging debate on the importance of sufficiency within planetary boundaries—low-income countries need rapid growth in health expenditure, whereas high-income countries could potentially achieve better health outcomes at substantially lower levels of resource use.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 10","pages":"Pages e744-e753"},"PeriodicalIF":24.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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