Nature-based social prescribing programmes: opportunities, challenges, and facilitators for implementation.

BACKGROUND: Evidence on the health benefits of spending time in nature has highlighted the importance of provision of blue and green spaces where people live. The potential for health benefits offered by nature exposure, however, extends beyond health promotion to health treatment. Social prescribing links people with health or social care needs to community-based, non-clinical health and social care interventions to improve health and wellbeing. Nature-based social prescribing (NBSP) is a variant that uses the health-promoting benefits of activities carried out in natural environments, such as gardening and walking. Much current NBSP practice has been developed in the UK, and there is increasing global interest in its implementation. This requires interventions to be adapted for different contexts, considering the needs of populations and the structure of healthcare systems. METHODS: This paper presents results from an expert group participatory workshop involving 29 practitioners, researchers, and policymakers from the UK and Germany's health and environmental sectors. Using the UK and Germany, two countries with different healthcare systems and in different developmental stages of NBSP practice, as case studies, we analysed opportunities, challenges, and facilitators for the development and implementation of NBSP. RESULTS: We identified five overarching themes for developing, implementing, and evaluating NBSP: Capacity Building; Accessibility and Acceptability; Networks and Collaborations; Standardised Implementation and Evaluation; and Sustainability. We also discuss key strengths, weaknesses, opportunities, and threats for each overarching theme to understand how they could be developed to support NBSP implementation. CONCLUSIONS: NBSP could offer significant public health benefits using available blue and green spaces. We offer guidance on how NBSP implementation, from wider policy support to the design and evaluation of individual programmes, could be adapted to different contexts. This research could help inform the development and evaluation of NBSP programmes to support planetary health from local and global scales.

Systematic review on factors influencing the effectiveness of alcohol-based hand rubbing in healthcare.

BACKGROUND: The effectiveness of hand rubbing with alcohol-based handrub (ABHR) is impacted by several factors. To investigate these, World Health Organization (WHO) commissioned a systematic review. AIM: To evaluate the impact of ABHR volume, application time, rubbing friction and hand size on microbiological load reduction, hand surface coverage or drying time. METHODS: Medline, CINAHL, Web of Science and ScienceDirect databases were searched for healthcare or laboratory-based primary studies, published in English, (1980- February 2021), investigating the impact of ABHR volume, application time, rubbing friction or hand size on bacterial load reduction, hand coverage or drying time. Two reviewers independently performed data extraction and quality assessment. The results are presented narratively. FINDINGS: Twenty studies were included in the review. Categories included: ABHR volume, application time and rubbing friction. Sub-categories: bacterial load reduction, hand size, drying time or hand surface coverage. All used experimental or quasi-experimental designs. Findings showed as ABHR volume increased, bacterial load reduced, and drying times increased. Furthermore, one study showed that the application of sprayed ABHR without hand rubbing resulted in significantly lower bacterial load reduction than poured or sprayed ABHR with hand rubbing (- 0.70; 95%CI: - 1.13 to - 0.28). Evidence was heterogeneous in application time, volume, technique, and product. All studies were assessed as high risk of bias. CONCLUSIONS: There is insufficient evidence to change WHO recommendation of a palmful of ABHR in a cupped hand applied for 20-30 s or manufacturer-recommended volume applied for about 20 s (Centers for Disease Control and Prevention). Future hand hygiene research should standardise volume, application time, and consider hand size.

"Kids Get in Shape with Nature": A Systematic Review Exploring the Impact of Green Spaces on Childhood Obesity.

Green and blue spaces (GABS) are vital components of sustainable and healthy communities. Evidence suggest that GABS positively affect population health and wellbeing. However, few studies examine GABS influence on childhood obesity. This systematic review investigates the impact of GABS on childhood obesity particularly on children's physical activity and eating behavior. The search protocol identified 544 studies from PubMed, Medline, PsycINFO, CINAHL, and Web of Science. A two-tier screening process document using the PRISMA flow diagram identified 16 studies which underwent quality analysis using the National Heart, Lung, and Blood Institute (NHLBI) and Critical Appraisal Skills Programme (CASP) tools. Data were interpreted using thematic analysis and narrative synthesis. Selected studies show varying sociodemographic characteristics of sampled populations located in urban and rural settings. The influence of GABS on children's physical activity and eating behaviour depends on the type, location, proximity, density, facilities, and activity types that interplay with gender, ethnicity, and parent-child relationship. The review demonstrates the significant effect of GABS on children's physical activity and eating behaviour. GABS provide children with safe venues for socialisation and long, intensive, and enjoyable physical activity; and influence children's perceptions on vegetable consumption supporting healthier eating behaviour. These spaces have the potential to eradicate childhood obesity if policy, social, economic, environmental, and organisational considerations are addressed.