Lancet Planetary Health最新文献_第7页

Towards climate-resilient health systems: implementation of climate adaptation for health in Western Cape, South Africa 建立适应气候变化的卫生系统：在南非西开普省实施适应气候变化的卫生措施

IF 21.6 1区医学 Q1 ENVIRONMENTAL SCIENCES

Lancet Planetary Health

Pub Date : 2025-11-01 DOI: 10.1016/j.lanplh.2025.101353

Amanda Victoria Quintana , Susannah H Mayhew

Background

As climate change accelerates, its impact on human health intensifies. For the health system to protect communities and effectively respond to climate-related shocks and stressors, climate adaptation should be prioritised. Although countries have made commitments to climate-resilient and sustainable health systems, their implementation remains understudied. The Western Cape province in South Africa, aff5cted by a severe drought in 2015–18 and extreme heat events, has emphasised health as a priority adaptation sector.

Methods

Through a policy document analysis and in-depth interviews, in this study, we investigated the factors influencing the implementation of climate adaptation for health in the Western Cape. The study comprised three interconnected analyses of responses to drought and heat. The first analysis involved assessment of the coherence of climate, environment, and health policies and revealed minimal connections at the national level, especially in relation to heat, and none at the provincial level. The second analysis highlighted the provincial health sector’s response to the 2017–18 drought, underscoring the importance of health-system software factors, such as values, knowledge, and relationships, in managing the response. The third analysis examined the governance of heat-related health risks and revealed fragmented local action despite a national heat health policy, with challenges linked to unclear responsibilities and inadequate contextualisation.

Findings

Collectively, this research shows that adaptive responses often emerge outside formal policies and are driven by informal practices and cross-sectoral collaboration between individuals and organisations.

Interpretation

Effective climate adaptation depends on context-specific, inclusive actions and the institutionalisation of learning to strengthen both individual and organisational adaptive capacity.

Funding

None.

随着气候变化的加速，其对人类健康的影响也在加剧。为了使卫生系统保护社区并有效应对与气候有关的冲击和压力源，应优先考虑气候适应。尽管各国已对气候适应型和可持续的卫生系统作出承诺，但其实施情况仍未得到充分研究。南非西开普省在2015-18年遭受严重干旱和极端高温事件的影响，强调卫生是优先适应部门。方法本研究通过政策文件分析和深度访谈，调查影响西开普省实施气候适应健康的因素。这项研究包括对干旱和高温反应的三个相互关联的分析。第一次分析涉及对气候、环境和卫生政策的一致性进行评估，结果显示，在国家一级，特别是在供暖方面，它们之间的联系微乎其微，而在省一级则没有联系。第二项分析强调了省级卫生部门对2017-18年干旱的反应，强调了卫生系统软件因素（如价值观、知识和关系）在管理反应中的重要性。第三项分析检查了与热相关的健康风险的治理，并揭示了尽管有国家热健康政策，但地方行动零散，挑战与责任不明确和背景化不足有关。总的来说，这项研究表明，适应性反应往往出现在正式政策之外，并由非正式实践和个人与组织之间的跨部门合作驱动。有效的气候适应取决于具体环境的包容性行动和学习的制度化，以加强个人和组织的适应能力。

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引用次数: 0

The role of health workers in Kenya’s transition to a net-zero health-care system: a mixed-methods study 卫生工作者在肯尼亚向净零卫生保健系统过渡中的作用：一项混合方法研究

IF 21.6 1区医学 Q1 ENVIRONMENTAL SCIENCES

Lancet Planetary Health

Pub Date : 2025-11-01 DOI: 10.1016/j.lanplh.2025.101352

Iris Martine Blom , Melvine Anyango Otieno , Marie-Claire Wangari , Agan Leonard , Winslet Mwende , Naomi Wanjiku Gitau , Iain Cross , Anita Berlin , Andy Haines , Sarah Whitmee

Background

Climate change presents a major challenge to health-care systems, particularly in low-income and middle-income countries such as Kenya. Health workers are key to leading the transition towards a sustainable, climate-resilient health-care system. This mixed-methods study explored the perceptions, knowledge, and roles of Kenyan health workers in mitigation and adaptation in health care.

Methods

An online questionnaire was used to assess the understanding of health workers regarding the impact of climate change on health, the health-care system’s role in emissions reduction and adaptation, and current practices. A subsequent focus group discussion delved deeper into the identified themes, with a particular focus on educating health workers to support climate action.

Findings

The questionnaire was completed by 118 health workers. Although the respondents recognised the health risks of climate change, financial constraints and insufficient training were major barriers to implementing sustainable practices. The focus group highlighted the need for practical, context-specific education to equip health workers with actionable knowledge and skills, while also fostering emotional resilience and ethical leadership.

Interpretation

We recommend co-creating educational programmes with communities and health workers, integrating climate–health modules into curricula, and using innovative approaches such as peer-led workshops and social media campaigns. These insights underscore the transformative potential of education in empowering health workers to lead Kenya’s transition to a sustainable, climate-resilient health-care system.

Funding

None.

气候变化对卫生保健系统提出了重大挑战，特别是在肯尼亚等低收入和中等收入国家。卫生工作者是领导向可持续、适应气候变化的卫生保健系统过渡的关键。这项混合方法研究探讨了肯尼亚卫生工作者在卫生保健减缓和适应方面的看法、知识和作用。方法采用在线调查问卷，评估卫生工作者对气候变化对健康的影响、卫生保健系统在减排和适应方面的作用以及当前做法的理解。随后的焦点小组讨论深入探讨了确定的主题，特别侧重于教育卫生工作者支持气候行动。118名卫生工作者完成了问卷调查。虽然答复者承认气候变化对健康的风险，但财政限制和培训不足是实施可持续做法的主要障碍。焦点小组强调，需要针对具体情况开展切实可行的教育，使卫生工作者掌握可付诸行动的知识和技能，同时培养情感韧性和道德领导力。我们建议与社区和卫生工作者共同制定教育方案，将气候卫生模块纳入课程，并采用创新方法，如由同行领导的讲习班和社交媒体活动。这些见解强调了教育在增强卫生工作者权能、领导肯尼亚向可持续、适应气候变化的卫生保健系统过渡方面的变革潜力。

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引用次数: 0

A scoping review of the contributions of integrated crop–livestock systems to human wellbeing in China 中国农牧一体化系统对人类福祉贡献的范围综述

IF 21.6 1区医学 Q1 ENVIRONMENTAL SCIENCES

Lancet Planetary Health

Pub Date : 2025-11-01 DOI: 10.1016/j.lanplh.2025.101361

Yan Yu , Huihui Liu , Su-Mia Akin , Pim Martens , Zixi Wan

Background

Agricultural production is essential to human wellbeing; at the same time, it is scrutinised regarding its environmental externalities and sustainability in this changing world. Integrated crop–livestock systems (ICLS) offer a promising avenue for future agricultural systems. Taking China as the focus, this scoping review aims to uncover the contributions of ICLS to human wellbeing.

Methods

A total of 3671 studies related to ICLS were collected from four major electronic databases, and 166 papers were eventually included for formal analysis after a two-round screening process.

Findings

The findings reveal a growing interest in this topic over the past 5 years. Most of the included studies were conducted in eastern (26%) or northern (18%) China at micro scales such as field or farm scales. Two major forms of crop–livestock interaction were identified: using livestock waste to fertilise crops (54%) and feeding livestock with resources from crop systems (34%). In terms of the contributions of ICLS to human wellbeing, the included studies gave equal attention to the environmental (45%) and economic (45%) aspects of wellbeing, whereas less focus was placed on societal (10%) wellbeing. Notably, the positive effects of ICLS predominate in most cases—84% for environmental, 71% for economic, and 63% for societal wellbeing. In particular, using livestock waste to fertilise crops shows an overall more substantial positive contribution to human wellbeing when compared with other types of ICLS.

Interpretation

Our analysis indicates that ICLS holds great potential for improving human wellbeing under uncertain risks. To further facilitate its implementation, more research should focus on southwestern, central, and northwestern China and new practices of ICLS beyond farm scales should be explored. The societal effects of ICLS should also be studied. By benefiting human wellbeing, ICLS can contribute to the achievement of many Sustainable Development Goals including no poverty, zero hunger, gender equality, and life on land.

Funding

This project was supported by the China Scholarship Council.

农业生产对人类福祉至关重要；与此同时，在这个不断变化的世界中，它的环境外部性和可持续性也受到了严格审查。作物-牲畜综合系统（ICLS）为未来的农业系统提供了一条有希望的途径。本研究以中国为研究焦点，旨在揭示ICLS对人类福祉的贡献。方法从四个主要的电子数据库中收集与ICLS相关的研究共3671篇，经过两轮筛选，最终纳入166篇论文进行正式分析。研究结果表明，在过去的5年里，人们对这个话题的兴趣越来越大。大多数纳入的研究是在中国东部（26%）或北部（18%）的微观尺度上进行的，如田地或农场规模。确定了作物-牲畜相互作用的两种主要形式：利用牲畜废物给作物施肥（54%）和用作物系统的资源喂养牲畜（34%）。就ICLS对人类福祉的贡献而言，纳入的研究对福祉的环境（45%）和经济（45%）方面给予了同等的关注，而对社会福祉的关注较少（10%）。值得注意的是，ICLS的积极影响在大多数情况下占主导地位——84%对环境，71%对经济，63%对社会福利。特别是，与其他类型的ICLS相比，利用牲畜废物为作物施肥对人类福祉的总体贡献更大。我们的分析表明，在不确定的风险下，ICLS具有改善人类福祉的巨大潜力。为进一步促进ICLS的实施，应将更多的研究重点放在中国的西南、中部和西北地区，并探索农场规模以外的ICLS新实践。ICLS的社会影响也应该被研究。ICLS造福人类福祉，有助于实现许多可持续发展目标，包括无贫困、零饥饿、性别平等和陆地生命。本项目由中国国家留学基金委资助。

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引用次数: 0

Sustainable diets and cancer: a systematic review and meta-analysis 可持续饮食与癌症：一项系统回顾和荟萃分析

IF 21.6 1区医学 Q1 ENVIRONMENTAL SCIENCES

Lancet Planetary Health

Pub Date : 2025-11-01 DOI: 10.1016/j.lanplh.2025.101351

Marina Kasper , Mirna al Masri , Tilman Kühn , Sabine Rohrmann , Katharina Wirnitze , Michael Leitzmann , Carmen Jochem

Background

Modern food systems contribute to environmental degradation, while prevailing unhealthy eating behaviours exacerbate the global cancer burden, creating a dual synergistic crisis for both planetary and human health. Investigating the impact of sustainable diets on cancer is therefore essential.

Methods

Following the 2020 PRISMA guidelines for reporting systematic reviews and meta-analysis, observational studies on cancer incidence and mortality among adults, assessing the sustainability of their diets using various metrics, were examined. Effect measures were pooled to compare the highest versus lowest adherence to sustainable dietary patterns. Summary effect estimates for cancer incidence and mortality were calculated using random-effects models. Subgroup analyses were conducted by sex, geographical region, study design, sustainability metric used, dietary assessment indexes reflecting sustainability, and cancer type. E-values were used to evaluate the robustness of associations against potential unmeasured confounding. The study was pre-registered in PROSPERO (ID CRD42024545102).

Findings

19 effect estimates from 17 studies, encompassing over 2·2 million participants, revealed a significant reduction in cancer incidence (hazard ratio 0·93, 95% CI 0·88−0·98, I² 84·67%) and cancer mortality (hazard ratio 0·88; 95% CI 0·85–0·92, I² 21·25%) associated with higher adherence to sustainable diets. Subgroup analyses indicated that the overall effect was modified by study design, sustainability metrics, and dietary assessment index.

Interpretation

These findings support evidence linking sustainable diets with reduced cancer incidence and mortality, underscoring their potential role in cancer prevention while providing concurrent environmental benefits. The notable variability in sustainability metrics highlights the need for standardised approaches in future research.

Funding

None.

现代粮食系统加剧了环境退化，而普遍存在的不健康饮食行为加剧了全球癌症负担，给地球和人类健康造成了双重协同危机。因此，研究可持续饮食对癌症的影响至关重要。方法遵循2020年PRISMA报告系统评价和荟萃分析指南，对成人癌症发病率和死亡率的观察性研究进行了检查，使用各种指标评估其饮食的可持续性。研究人员将效果指标汇总起来，比较对可持续饮食模式坚持程度最高和最低的人群。使用随机效应模型计算癌症发病率和死亡率的总效应估计。按性别、地理区域、研究设计、使用的可持续性指标、反映可持续性的饮食评估指标和癌症类型进行亚组分析。e值用于评估关联对潜在未测量混杂因素的稳健性。该研究已在PROSPERO预注册（ID CRD42024545102）。来自17项研究的结果，包括超过220万参与者的效应估计，显示癌症发病率（风险比0.93,95% CI 0.88 - 0.98, I2 84.67%）和癌症死亡率（风险比0.88,95% CI 0.85 - 0.92, I2 21.25%）的显著降低与更高的可持续饮食依从性相关。亚组分析表明，总体效果受到研究设计、可持续性指标和饮食评估指数的影响。这些发现支持了将可持续饮食与降低癌症发病率和死亡率联系起来的证据，强调了它们在预防癌症方面的潜在作用，同时提供了环境效益。可持续性指标的显著变化凸显了在未来研究中采用标准化方法的必要性。

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引用次数: 0

Health co-benefits of sustainable urban transport: an umbrella review with GRADE assessment 可持续城市交通的健康协同效益：综合评价与GRADE评估

IF 21.6 1区医学 Q1 ENVIRONMENTAL SCIENCES

Lancet Planetary Health

Pub Date : 2025-11-01 DOI: 10.1016/j.lanplh.2025.101355

Alessio Perilli , Simona Vecci , Manuela De Sario , Francesca De' Donato , Andrea Adduci , Walter Ricciardi , Paola Michelozzi

Background

Sustainable transport reduces climate change impacts while offering direct health benefits through increased physical activity and indirect benefits via air pollution reduction. In this study, we aimed to synthesise evidence on health benefits of sustainable transport and barriers to its adoption.

Methods

Following PRISMA guidelines, a systematic search was conducted in April 2024 across MEDLINE, Embase, and Web of Science. Systematic reviews examining sustainable transport and health outcomes were included, synthesised, and assessed using AMSTAR-2 and GRADE.

Findings

Of 40 included systematic reviews, 13 focused on active transport. Meta-analyses showed health co-benefits associated with active transport for total mortality (hazard ratio 0·91, 95% CI 0·85–0·97), cardiovascular mortality (0·85, 0·73–0·97) and morbidity, as well as reduced obesity and endometrial cancer risk in adults. In adult populations, walkability was associated with reduced diabetes, obesity, and hypertension, and public transport initiation was associated with lower BMI. Traffic management interventions appeared to reduce accidents. Evidence certainty was generally very low, mainly due to study design, risk of bias, and heterogeneity. Active transport interventions were consistently cost effective. Absence of protected routes, long distances, lack of infrastructure, adverse weather, and costs were identified as barriers to adopting sustainable modes of transport.

Interpretation

Active transport shows the health benefits, particularly for adults. Due to heterogeneity and low-quality evidence, further research is needed, especially regarding subgroups who might benefit most. These findings support integrating public health objectives into urban mobility policies.

Funding

The study was developed within the project “Health and equity co-benefits in support of plans to respond to climate change in Italy – COBENEFIT” funded by the National Plan for Complementary Investments of the Ministry of Health.

可持续交通减少了气候变化的影响，同时通过增加身体活动提供直接健康效益，并通过减少空气污染提供间接效益。在这项研究中，我们的目的是综合可持续交通的健康效益和采用它的障碍的证据。方法遵循PRISMA指南，于2024年4月在MEDLINE、Embase和Web of Science上进行系统检索。采用AMSTAR-2和GRADE纳入、综合和评估了检查可持续交通和健康结果的系统审查。40项研究结果包括系统综述，13项研究结果侧重于主动运输。荟萃分析显示，主动运输与总死亡率（危险比0.91,95% CI 0.85 - 0.97）、心血管死亡率（0.85,0.73 - 0.97）和发病率以及降低成人肥胖和子宫内膜癌风险相关。在成年人中，步行与减少糖尿病、肥胖和高血压有关，而乘坐公共交通与降低BMI有关。交通管理干预措施似乎减少了事故。证据确定性通常很低，主要是由于研究设计、偏倚风险和异质性。积极的交通干预措施始终具有成本效益。缺乏受保护的路线、路途遥远、缺乏基础设施、恶劣的天气和成本被认为是采用可持续运输方式的障碍。积极的交通方式显示出对健康的好处，尤其是对成年人。由于异质性和低质量的证据，需要进一步的研究，特别是关于可能受益最大的亚组。这些发现支持将公共卫生目标纳入城市交通政策。这项研究是在卫生部国家补充投资计划资助的“卫生和公平共同利益支持意大利应对气候变化计划——共同利益”项目范围内开展的。

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引用次数: 0

Investigating infectious health-care waste management at a university dental clinic 调查一所大学牙科诊所的传染性卫生保健废物管理情况

IF 21.6 1区医学 Q1 ENVIRONMENTAL SCIENCES

Lancet Planetary Health

Pub Date : 2025-11-01 DOI: 10.1016/j.lanplh.2025.101365

Tamás Demeter , Csilla Erdei , Andrea Fanni Vass , Krisztina Márton

Background

Infectious health-care waste (IHW) contributes substantially to the environmental burden of health-care institutions. This study aimed to assess and compare the composition of daily generated IHW and waste segregation awareness among clinical specialists’ (STR) and clinical educational treatment rooms (ETR) at the dental clinic of Semmelweis University Faculty of Dentistry, with special focus on single-use plastics (SUP) and personal protective equipment (PPE) used in patient care.

Methods

Three waste audits were conducted in 2023 to quantify and analyse the complete daily production of IHW during dental care. Collected clinical waste were analysed and categorised; fractions were weighed using kitchen scales. Measurement data of the three audits were summarised and averaged. Independent samples t-test (significance level: p<0·05) was used to compare waste quantities among STRs and ETRs.

Findings

The average daily amount of IHW generated in the dental centre weighed 59 596 g in total and 93 g per patient. The heaviest fractions were medical gloves (22 197 g), paper towels (12 107 g), and disposable patient bibs (5673 g). Discarded PPE and SUP used in patient care were responsible for 34 154 g (57%) 59 596 g IHW weight. Significantly more IHW was produced per patient in ETRs than in STRs (p=0·007).

Interpretation

Excessive use of SUP and PPE in dentistry, together with overproduction, inappropriate collection, and mismanagement of dental IHW has negative planetary health consequences. Switching to reusable, sterilisable utensils; implementing sustainable procurement and circular economy strategies; and educating stakeholders about proper waste disposal might help to mitigate the negative effects of SUP and PPE use.

Funding

None.

背景：传染性卫生保健废物在很大程度上加重了卫生保健机构的环境负担。本研究旨在评估和比较塞梅尔魏斯大学牙科学院牙科诊所的临床专家（STR）和临床教育治疗室（ETR）每日产生的IHW的组成和废物分类意识，特别关注患者护理中使用的一次性塑料（SUP）和个人防护装备（PPE）。方法于2023年进行了三次废物审计，量化和分析了牙科保健期间IHW的日常产生量。对收集的医疗废物进行分析和分类；分数用厨房秤称重。对三次审计的测量数据进行汇总和平均。采用独立样本t检验（显著性水平：p<； 0.05）比较str和ETRs之间的浪费量。结果牙科中心平均每日产生的废物总量为59 596克，每名病人平均为93克。最重的部分是医用手套（22 197 g）、纸巾（12 107 g）和一次性患者围兜（5673 g）。患者护理中使用的废弃个人防护用品和SUP造成34 154 g (57%) 59 596 g IHW重量。ETRs组每位患者产生的IHW显著高于STRs组（p= 0.007）。在牙科中过度使用SUP和PPE，再加上生产过剩、收集不当和管理不善，对全球健康造成了负面影响。改用可重复使用、可消毒的餐具；实施可持续采购和循环经济战略；并教育利益相关者如何正确处理废物，可能有助于减轻使用SUP和个人防护装备的负面影响。

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引用次数: 0

Leveraging green finance to mitigate zoonotic risk: an Investor Alliance model for sustainable land use and Lassa fever control in Nigeria 利用绿色金融减轻人畜共患病风险：尼日利亚可持续土地利用和拉沙热控制的投资者联盟模式

IF 21.6 1区医学 Q1 ENVIRONMENTAL SCIENCES

Lancet Planetary Health

Pub Date : 2025-11-01 DOI: 10.1016/j.lanplh.2025.101363

Emmanuel Ifechukwude Benyeogor , Akanimo Iniobong

Background

Lassa fever, a rodent-borne zoonotic disease endemic to Nigeria, is closely linked to environmental degradation driven by agricultural expansion. Deforestation and land fragmentation in high-rainfall zones (900–2100 mm annually) create ideal habitats for Mastomys natalensis, increasing human–rodent contact and outbreak risk. This study explores a business-oriented solution: an international Investor Alliance model that mobilises green financing to reduce Lassa fever risk through sustainable land-use practices.

Methods

We conducted a spatial overlay analysis of Sentinel-2 deforestation imagery (2023–24), Lassa fever epidemiological data (National Centre for Disease Control), and rainfall distribution to identify ecological hot spots. Investment flows from Japan, South Korea, Malaysia, and Singapore were reviewed for alignment with sustainability goals. A blended finance model was developed linking investor returns to health and environmental co-benefits.

Results

Outbreaks peaked during dry seasons, coinciding with rodent migration and land clearance. Regions with high investment potential overlapped with high-risk zones. Practices such as agroforestry, ecological buffers, and zero-deforestation certification schemes offer viable entry points for green financing.

Interpretation

The Investor Alliance model reframes zoonotic disease prevention as an investable opportunity. Asian investors bring capital and environmental, social, and governance frameworks, while Nigerian partners ensure local ownership. By aligning planetary health outcomes with private sector incentives, this model provides a scalable strategy to reduce zoonotic spillover, support sustainable agriculture, and strengthen health system resilience in line with global biodiversity and climate targets.

Funding

None.

拉沙热是尼日利亚特有的一种啮齿动物传播的人畜共患疾病，与农业扩张导致的环境退化密切相关。高降雨量地区（年降雨量900-2100毫米）的森林砍伐和土地破碎化为Mastomys natalensis创造了理想的栖息地，增加了人类与啮齿动物的接触和爆发风险。本研究探索了一个面向商业的解决方案：一个国际投资者联盟模式，通过可持续的土地利用实践动员绿色融资来降低拉沙热风险。方法对Sentinel-2森林砍伐影像（2023 - 2024年）、拉沙热流行病学数据（国家疾病控制中心）和降雨分布进行空间叠加分析，识别生态热点。对来自日本、韩国、马来西亚和新加坡的投资流动进行了审查，以确保与可持续发展目标保持一致。开发了一种混合融资模式，将投资者回报与健康和环境的共同效益联系起来。结果在旱季暴发高峰，与啮齿动物迁徙和土地清理相吻合。高投资潜力地区与高风险地区重叠。农林业、生态缓冲和零毁林认证计划等做法为绿色融资提供了可行的切入点。投资者联盟模式将人畜共患疾病预防重新定义为一个可投资的机会。亚洲投资者带来了资本和环境、社会和治理框架，而尼日利亚的合作伙伴则确保了当地的所有权。通过将全球卫生成果与私营部门激励措施相结合，该模式提供了一项可扩展的战略，以减少人畜共患病溢出效应，支持可持续农业，并根据全球生物多样性和气候目标加强卫生系统的复原力。

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引用次数: 0

Methodological guidance for selecting buffers in greenspace–health studies 绿色空间健康研究中选择缓冲的方法学指导。

IF 21.6 1区医学 Q1 ENVIRONMENTAL SCIENCES

Lancet Planetary Health

Pub Date : 2025-11-01 DOI: 10.1016/j.lanplh.2025.101370

Mohammad Javad Zare Sakhvidi PhD , Matthew H E M Browning PhD , Karl Samuelsson PhD , S M Labib PhD , Achilleas Psyllidis PhD , Adeladza Kofi Amegah PhD , Prof Thomas Astell-Burt PhD , Albert Bach PhD , Prof Michael Jerrett PhD , Gregory N Bratman PhD , Matilda van den Bosch MD PhD , Kees de Hoogh PhD , Sjerp de Vries PhD , Angel M Dzhambov MD DSc , Rohollah Fallah Madvari , Prof Xiaoqi Feng PhD , Amanda Fernandes PhD , Elaine Fuertes PhD , Vincenzo Giannico PhD , Prof Nelson Gouveia PhD , Prof Payam Dadvand MD PhD

Greenspace can promote health via diverse pathways. A common approach to assessing greenspace exposure is to estimate vegetation availability within buffers surrounding locations where people reside or spend time. However, no clear framework for informed buffer selection exists, and choices made show considerable heterogeneity, impeding evidence synthesis and causal inference. In this Personal View conducted by an interdisciplinary panel of experts, we aimed to establish a framework for informed buffer selection for epidemiological studies on greenspace. We began by reviewing available approaches for the selection of buffer types, which range from single fixed-location approaches to high-resolution mobility-based activity-space approaches, as well as different buffer sizes. We then summarised the determinants of buffer type and size selection including health outcomes and underlying mechanisms, study population, contextual factors, and data characteristics. Finally, based on these determinants, we developed recommendations for future research. Buffer type and size selection should be hypothesis driven, reflecting presumed greenspace–health mechanisms. Buffer selection should target activity-based approaches where feasible, and multiple buffer sizes should be tested. Overall, the assessment of greenspace exposure should shift from ad-hoc approaches to personalised, multiscale, and context-specific methods. We call for standardising and reporting the rationale for buffer selection to minimise bias and enhance comparability and evidence synthesis across studies.

绿色空间可以通过多种途径促进健康。评估绿地暴露的一种常用方法是估计人们居住或停留地点周围缓冲区内的植被可用性。然而，目前还没有明确的知情缓冲选择框架，所做的选择显示出相当大的异质性，阻碍了证据合成和因果推理。在这个由跨学科专家小组进行的个人观点中，我们的目标是建立一个框架，为绿色空间的流行病学研究提供知情的缓冲选择。我们首先回顾了选择缓冲区类型的可用方法，从单一的固定位置方法到基于高分辨率移动性的活动空间方法，以及不同的缓冲区大小。然后，我们总结了缓冲区类型和大小选择的决定因素，包括健康结果和潜在机制、研究人群、背景因素和数据特征。最后，基于这些决定因素，我们提出了未来研究的建议。缓冲区类型和大小的选择应该是假设驱动的，反映假定的绿色空间健康机制。在可行的情况下，缓冲区选择应该针对基于活动的方法，并且应该测试多个缓冲区大小。总体而言，绿色空间暴露的评估应从临时方法转向个性化、多尺度和特定环境的方法。我们呼吁对缓冲选择的基本原理进行标准化和报告，以尽量减少偏倚，增强研究之间的可比性和证据综合。

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引用次数: 0

Seeds of change: a longitudinal evaluation of the impact of the Planetary Health Report Card impact on institutional action 变革的种子：对《地球健康报告卡》对机构行动影响的纵向评价

IF 21.6 1区医学 Q1 ENVIRONMENTAL SCIENCES

Lancet Planetary Health

Pub Date : 2025-11-01 DOI: 10.1016/j.lanplh.2025.101349

Allison Dana Chhor , Anthony James Goodings , Stephanie Howe , Alex Sy , Yasmine Zenmi , Hela Kabani , Sydney Ruller , Husein Moloo

Background

The Planetary Health Report Card (PHRC) is an institutional advocacy tool designed to encourage medical schools to integrate planetary health into their curricula, research, and operations. The primary objective of this study was to assess the 3-year impact of the PHRC on promoting institutional changes at the Faculty of Medicine, University of Ottawa. The secondary objective was to identify facilitators and barriers to planetary health work.

Methods

Quantitative data was retrospectively collected from the PHRCs published in 2022, 2023, and 2024. We examined outcomes in five domains: Curriculum, Interdisciplinary Research, Community Outreach and Advocacy, Institutional Support, and Campus Sustainability.

Findings

Over 3 years, there was a 13·9% increase in overall PHRC score. In the Curriculum domain, there has been a sustained effort to implement a longitudinal planetary health programme. Establishment of the Planetary Health Research Lab has facilitated progress in Interdisciplinary Research. Community Outreach and Advocacy has improved through new community partnerships. However, Institutional Support has declined due to lack of student engagement. The Campus Sustainability domain has remained consistent. Increased student-faculty collaboration through the Planetary Health Director role has facilitated institutional improvements; however, a lack of faculty awareness of planetary health is a barrier.

Interpretation

By comparing 3 years of PHRC implementation and institutional changes, areas of progress and opportunities for further development were identified. The PHRC is effective in driving change and can inform future efforts to enhance institutional engagement with planetary health.

Funding

None.

行星健康报告卡（PHRC）是一个机构宣传工具，旨在鼓励医学院将行星健康纳入其课程，研究和业务。本研究的主要目的是评估PHRC在促进渥太华大学医学院制度变革方面的3年影响。次要目标是确定地球健康工作的促进因素和障碍。方法回顾性收集2022年、2023年和2024年发表的phrc定量数据。我们研究了五个领域的成果：课程、跨学科研究、社区推广和宣传、机构支持和校园可持续性。结果3年多来，患者的PHRC总分提高了13.9%。在课程领域，一直在努力执行一项纵向的全球保健方案。行星健康研究实验室的建立促进了跨学科研究的进展。通过新的社区伙伴关系，社区外展和宣传得到了改善。然而，由于缺乏学生参与，机构支持有所下降。校园可持续性领域保持一致。通过行星卫生主任的作用，加强了学生与教师的合作，促进了机构的改进；然而，教员缺乏对行星健康的认识是一个障碍。通过比较3年来PHRC的实施和制度变化，确定了进一步发展的领域和机会。PHRC在推动变革方面是有效的，可以为未来加强机构参与地球健康的努力提供信息。

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引用次数: 0

Scope sustainability: slashing single-use plastic bottles 范围可持续性：削减一次性塑料瓶

IF 21.6 1区医学 Q1 ENVIRONMENTAL SCIENCES

Lancet Planetary Health

Pub Date : 2025-11-01 DOI: 10.1016/j.lanplh.2025.101364

Hilalion (San) Ahn , Allison Williams , Karlie Kelly , Husein Moloo

Background

The health-care sector is a substantial contributor to greenhouse gas emissions, with single-use plastic sterile water bottles generating considerable waste. To address this issue, our endoscopy programme implemented a multistep quality improvement initiative replacing sterile water in disposable plastic bottles with tap water in reusable containers for upper and lower endoscopic procedures, excluding endoscopic retrograde cholangiopancreatography.

Methods

We first performed a scoping review that identified no clinical difference between sterile water and tap water in upper and lower endoscopic procedures, highlighting both economic and environmental benefits. A multidisciplinary team, including representatives from infection prevention, infectious diseases, hospital facilities, patient safety, ethics, and endoscopy quality improvement, collaborated to ensure safety and feasibility of using tap water. Institutional approval was obtained, and implementation is being evaluated using an interrupted time series analysis, tracking complications at 1 week and 30 days post procedure. Ongoing surveys collect feedback to refine the process.

Findings

Each 1 L sterile water bottle generates approximately 0·575 kg CO₂ and contains 240 000 microplastics and nanoplastics. Within the first 2 weeks of using tap water, usage of 480 bottles was discontinued, reducing CO₂ emissions by 276 kg and preventing the release of 115 million microplastics and nanoplastics. Annual cost savings from all three hospital sites are projected at CAD 47 145, based on eliminating 15 715 bottles used for colonoscopies. No increase in complications has been observed.

Interpretation

This initiative effectively reduced plastic waste and emissions while maintaining patient safety. It provides a replicable model for sustainable health-care practices, promoting environmental stewardship and mitigating potential health risks from microplastic exposure.

Funding

None.

卫生保健部门是温室气体排放的主要来源，一次性塑料无菌水瓶产生了大量废物。为了解决这个问题，我们的内窥镜检查项目实施了一项多步骤的质量改进计划，将一次性塑料瓶中的无菌水替换为可重复使用的容器中的自来水，用于上下内窥镜检查，不包括内窥镜逆行胆管胰胆管造影。方法我们首先进行了一项范围综述，发现无菌水和自来水在上、下内镜手术中没有临床差异，强调了经济和环境效益。一个多学科小组，包括来自感染预防、传染病、医院设施、患者安全、伦理和内窥镜检查质量改进的代表，合作确保使用自来水的安全性和可行性。获得了机构批准，并正在使用中断时间序列分析评估实施情况，跟踪手术后1周和30天的并发症。正在进行的调查收集反馈以改进流程。每1升无菌水瓶产生约0.575千克二氧化碳，含有24万个微塑料和纳米塑料。在使用自来水的前两周内，停止了480瓶的使用，减少了276公斤的二氧化碳排放，防止了1.15亿个微塑料和纳米塑料的排放。在消除用于结肠镜检查的15 715个瓶子的基础上，所有三家医院每年预计节省的费用为47 145加元。未观察到并发症的增加。这一举措有效地减少了塑料废物和排放，同时维护了患者的安全。它为可持续保健做法提供了一个可复制的模式，促进了环境管理，减轻了接触微塑料带来的潜在健康风险。

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引用次数: 0