Drawing a line from CO2 emissions to health-evaluation of medical students' knowledge and attitudes towards climate change and health following a novel serious game: a mixed-methods study.

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.

A comprehensive urban programme to reduce energy poverty and its effects on health and wellbeing of citizens in six European countries: study protocol of a controlled trial.

BACKGROUND: Nearly 11% of the European population is affected by energy poverty. Energy poverty is defined by the European Commission (2016) as the inability to afford basic energy services to guarantee a decent standard of living. Energy poverty is considered a complex, multidimensional problem that affects environment, housing, urban development, and health. Living in energy poverty conditions is associated with poorer human health and wellbeing. Hence, the WELLBASED intervention programme aims to design, implement and evaluate a comprehensive urban programme, based on the social-ecological model, to reduce energy poverty and its effects on the citizens' health and wellbeing in six European urban study sites: Valencia, Spain; Heerlen, The Netherlands; Leeds, United Kingdom; Edirne, Turkey; Obuda, Hungary, and; Jelgava, Latvia. METHODS: A controlled trial is performed. A total of 875 participants are recruited (125-177 per study site) to receive the WELLBASED intervention programme for 12 months (intervention condition) and 875 participants act as controls (control condition). Data will be collected with a baseline measurement at inclusion (T0), and follow-up measurements after 6 months (T1), 12 months (T2), and 18 months (T3). In both study arms, effects of the WELLBASED intervention programme are measured: health-related quality of life (HR-QoL), mental health, frailty in older adults, self-perceived health, chronic conditions, and care utilization. At the same time points, household expenditure on energy and energy consumption are obtained. In the intervention arm, health-monitoring data (i.e. peak flow, oxygen saturation, blood pressure, and heart rate) are obtained monthly and sleep quality with a three-month interval. Household data with regard to temperature, humidity and air quality are collected near real-time by home sensors. Qualitative interviews are conducted in each study site to evaluate the impacts of the WELLBASED intervention programme and to help explain findings. DISCUSSION: The WELLBASED intervention programme will provide new insights into the effectiveness of a comprehensive urban programme to tackle energy poverty and its effects on health and wellbeing across Europe. Hence, this study can contribute to European-wide replicable solutions for policy-makers and city practitioners to alleviate energy poverty. TRIAL REGISTRATION: ISRCTN registry number is ISRCTN14905838 . Date of registration is 15/02/2022.

Multidimensional energy poverty and acute respiratory infection in children under 5 years of age: evidence from 22 low-income and middle-income countries.

BACKGROUND: In low-income and middle-income countries (LMICs), energy poverty has predominantly been studied from the unidimensional perspective of indoor air pollution. Acute respiratory infection (ARI) in children under 5 years of age is the most important disease associated with indoor air pollution attributable to solid fuel use in LMICs. This study aimed to extend the existing knowledge on the association between energy poverty and ARI among children under 5 years of age in LMICs, by adopting a multidimensional perspective. METHODS: Using Demographic and Health Surveys from 22 LMICs, data from 483 088 children were analysed (mean age 2.00 years (SD 1.41); 51.3% male). Energy poverty was measured using the Multidimensional Energy Poverty Index (MEPI) (range 0-1), which comprises five dimensions of essential energy services. Binary logistic regression models were conducted to study the association between MEPI and ARI, adjusting for child, maternal, household and environmental characteristics. RESULTS: A 0.1 increase in MEPI score was associated with greater odds of ARI (aOR 1.05; 95% CI 1.04 to 1.07). Likewise, MEPI indicators using biomass for cooking (aOR 1.15; 95% CI 1.07 to 1.23) and lack of access to electricity (aOR 1.17; 95% CI 1.10 to 1.26), entertainment/education appliances (aOR 1.07; 95% CI 1.02 to 1.13) and household appliances (aOR 1.12; 95% CI 1.04 to 1.21) were associated with greater odds of ARI. CONCLUSION: Multidimensional energy poverty was associated with greater odds of ARI in children under 5 years of age living in 22 LMICs. Hence, our findings justify the design and implementation of interventions that address energy poverty from a multidimensional perspective, integrating energy affordability and accessibility.

Evidence-based interventions to reduce mortality among preterm and low-birthweight neonates in low-income and middle-income countries: a systematic review and meta-analysis.

BACKGROUND: Preterm birth is the leading cause of under-five-mortality worldwide, with the highest burden in low-income and middle-income countries (LMICs). The aim of this study was to synthesise evidence-based interventions for preterm and low birthweight (LBW) neonates in LMICs, their associated neonatal mortality rate (NMR), and barriers and facilitators to their implementation. This study updates all existing evidence on this topic and reviews evidence on interventions that have not been previously considered in current WHO recommendations. METHODS: Six electronic databases were searched until 3 March 2020 for randomised controlled trials reporting NMR of preterm and/or LBW newborns following any intervention in LMICs. Risk ratios for mortality outcomes were pooled where appropriate using a random effects model (PROSPERO registration number: CRD42019139267). RESULTS: 1236 studies were identified, of which 49 were narratively synthesised and 9 contributed to the meta-analysis. The studies included 39 interventions in 21 countries with 46 993 participants. High-quality evidence suggested significant reduction of NMR following antenatal corticosteroids (Pakistan risk ratio (RR) 0.89; 95% CI 0.80 to 0.99|Guatemala 0.74; 0.68 to 0.81), single cord (0.65; 0.50 to 0.86) and skin cleansing with chlorhexidine (0.72; 0.55 to 0.95), early BCG vaccine (0.64; 0.48 to 0.86; I2 0%), community kangaroo mother care (OR 0.73; 0.55 to 0.97; I2 0%) and home-based newborn care (preterm 0.25; 0.14 to 0.48|LBW 0.42; 0.27 to 0.65). No effects on perinatal (essential newborn care 1.02; 0.91 to 1.14|neonatal resuscitation 0.95; 0.84 to 1.07) or 7-day NMR (essential newborn care 1.03; 0.83 to 1.27|neonatal resuscitation 0.92; 0.77 to 1.09) were observed after training birth attendants. CONCLUSION: The findings of this study encourage the implementation of additional, evidence-based interventions in the current (WHO) guidelines and to be selective in usage of antenatal corticosteroids, to reduce mortality among preterm and LBW neonates in LMICs. Given the global commitment to end all preventable neonatal deaths by 2030, continuous evaluation and improvement of the current guidelines should be a priority on the agenda.