This document discusses reducing the environmental impact of caring for patients with kidney disease. It presents a position statement from the Italian Society of Nephrology with 10 initial actions focused on dialysis management: 1) reducing the need for dialysis through conservative strategies; 2) limiting drugs and favoring lifestyle/diet approaches; 3) encouraging reuse of hospital materials; 4) recycling paper and glass; 5) recycling non-contaminated plastic; 6) reducing water usage; 7) reducing energy usage; 8) including environmental criteria when evaluating dialysis machines; 9) properly sorting contaminated and non-contaminated waste; 10) considering environmental impacts in facility construction. The statement aims to increase awareness and coordinate industry/social interactions to
IMPACTS OF SOIL AND WATER POLLUTION ON FOOD SAFETY AND HEALTH RISKSIAEME Publication
The food safety and environmental pollution is interlinked and considered to be important issues in today’s world. Historically, the soil and water pollution has impacted food safety and ultimately an important threat for health. The situation is very challenging in most of the countries where the pollution and risks of increasing food safety have affected large set of population. The scarcity of water, over application of pesticides, chemical application and other pollutants are most important factors which impacts food safety in a drastic manner. The study will cater to the waste and soil pollution and their impacts of human health. In present scenario, there is a shortage of water resources which led to the irrigation of waste for fulfillment of water requirements in the agricultural production. This kind of usage causes serous health impacts due to water and soil pollution.
IMPACTS OF SOIL AND WATER POLLUTION ON FOOD SAFETY AND HEALTH RISKSIAEME Publication
The food safety and environmental pollution is interlinked and considered to be important issues in today’s world. Historically, the soil and water pollution has impacted food safety and ultimately an important threat for health. The situation is very challenging in most of the countries where the pollution and risks of increasing food safety have affected large set of population. The scarcity of water, over application of pesticides, chemical application and other pollutants are most important factors which impacts food safety in a drastic manner. The study will cater to the waste and soil pollution and their impacts of human health. In present scenario, there is a shortage of water resources which led to the irrigation of waste for fulfillment of water requirements in the agricultural production. This kind of usage causes serous health impacts due to water and soil pollution.
Wetlands are one of the most multifunctional ecosystems of the world that provide a range of economical, biological, ecological, social, and cultural functions and services to human beings. In Ethiopia all types of wetlands except coastal and marine-related wetlands and extensive swamp-forest complexes are found and they are estimated to cover more than 2% of its total surface area coverage. Wetlands deliver a wide range of ecosystem services that contribute to human well-being such as food
and feed, construction materials,
VCE Environmental Science: Health human and the environment: PollutionPeter Phillips M.Ed.
This presentation looks at how pollution is defined, different types and sources of pollution, and how it can be measured. News reports and case studies are provided as examples.
Humans interact with the environment constantly. These interactions affect quality of life, years of healthy life lived, and health disparities.
The World Health Organization (WHO) defines Environment, as it relates to health, as 'All the Physical, Chemical, And Biological Factors External to a Person, and all the Related Behaviors.'
Climate Change And Water Crisis- Obstacle for the sustainable environment. Climate change is a complex problem that has increased the need for an integrated, multi-sectorial and multidisciplinary response. Apart from the normal water domain, decision-makers in other spheres (finance, trade, energy, housing, regional planning, agriculture) must use and consume water efficiently. Sustainable management and development of water resources will play a pivotal role in preparing societies’ ability to adapt to climate change in order to increase resilience and achieve development goals.
The seminar report aims to draw attention to the critical importance of better water resources management in adapting to climate change and gives reasons why it should be systematically integrated into national plans and international investment.
• Find out causes of climate change and its impact on the water crisis.
• Water sources and demand of water.
• Actions to improve the ability to understand impacts, vulnerability, and adaptation to climate change in the water sector;
• Actions were taken to enhance informed decisions on adaptation planning, measures, and action.
Environmental degradation is a result of socio-economical, technological and institutional activities. Degradation occurs when Earth's natural resources are depleted. These resources which are affected include:
Water
Air
Soil
The degradation also impacts our:
Wildlife
Plants
Animals
Micro-organisms
The problems resulting from environmental change and its degradation, pose new challenges for traditional public health science. It is an accepted fact that, environmental degradation is contributing to human health threats worldwide. We may have several questions in our mind.
Zero Waste Management for Schools: A module prepared by Prof. Liwayway Memije...Liwayway Memije-Cruz
RATIONALE: ZERO WASTE MANAGEMENT PROJECT
One of the more serious problems that our country and our university in particular encounter nowadays is pollution which is due to improper handling and disposal of solid wastes. This problem occurs not only in urban areas where population density is high and human activities are continuous and intense but is also felt in the regional and rural areas.
In Metro Manila, the population density is 14,440 persons per square kilometer, 63 times more than the national average. Per capita waste production daily is estimated at 0.66 kg. More than half a kilo of trash per person per day is a lot. The volume of daily wastes weights in a little over 6,000 tons. Only 85% of these wastes are collected. Uncollected wastes pile up and fester in street corners and marketplaces, vacant lots and other open (often unauthorized) dumpsites. Ubiquitous scavengers light into these waste piles to pick whatever they can salvage from the junk. These waste materials are the breeding ground of flies, mosquitoes, rats, and other manner of pests and disease-carrying organisms.
An irreducible amount of waste also finds its way into bodies of water, into ditches, storm drains, and sewer mains. This does not only contaminate and pollute our waters; come the rainy season, garbage plugs up the city’ sewerage and flood waters rise-causing untold damages to life and property. Common sense tells us that the most cost-effective way of managing waste is to do something at the source generation, that is, at home, at the office or at the institutional level.
I sette principi per un’agricoltura sostenibile descritti nel rapporto di Greenpeace sono:
1. restituire il controllo sulla filiera alimentare a chi produce e chi consuma, strappandolo alle multinazionali dell’agrochimica;
2. sovranità alimentare. L'agricoltura sostenibile contribuisce allo sviluppo rurale e alla lotta contro la fame e la povertà, garantendo alle comunità rurali la disponibilità di alimenti sani, sicuri ed economicamente sostenibili;
3. produrre e consumare meglio: è possibile già oggi, senza impattare sull’ambiente e la salute, garantire sicurezza alimentare e, contemporaneamente, lottare contro gli sprechi alimentari. Occorre diminuire il nostro consumo di carne e minimizzare il consumo di suolo
per la produzione di agro-energia. Dobbiamo anche riuscire ad aumentare le rese dove è necessario, ma con pratiche sostenibili;
4. incoraggiare la (bio)diversità lungo tutta la filiera, dal seme al piatto con interventi a tutto campo, dalla produzione sementiera all’educazione al consumo;
5. proteggere e aumentare la fertilità del suolo, promuovendo le pratiche colturali idonee ed eliminando quelle che invece consumano o avvelenano il suolo stesso;
6. consentire agli agricoltori di tenere sotto controllo parassiti e piante infestanti, affermando e promuovendo quelle pratiche (già esistenti) che garantiscono protezione e rese senza l'impiego di costosi pesticidi chimici che possono danneggiare il suolo, l'acqua,
gli ecosistemi e la salute di agricoltori e consumatori;
7. rafforzare la nostra agricoltura, perché si adatti in maniera efficace il sistema di produzione del cibo in un contesto di cambiamenti climatici e di instabilità economica.
Per contribuire alla crescita dell’agricoltura sostenibile, Greenpeace collabora con agricoltori e comunità rurali.
Wetlands are one of the most multifunctional ecosystems of the world that provide a range of economical, biological, ecological, social, and cultural functions and services to human beings. In Ethiopia all types of wetlands except coastal and marine-related wetlands and extensive swamp-forest complexes are found and they are estimated to cover more than 2% of its total surface area coverage. Wetlands deliver a wide range of ecosystem services that contribute to human well-being such as food
and feed, construction materials,
VCE Environmental Science: Health human and the environment: PollutionPeter Phillips M.Ed.
This presentation looks at how pollution is defined, different types and sources of pollution, and how it can be measured. News reports and case studies are provided as examples.
Humans interact with the environment constantly. These interactions affect quality of life, years of healthy life lived, and health disparities.
The World Health Organization (WHO) defines Environment, as it relates to health, as 'All the Physical, Chemical, And Biological Factors External to a Person, and all the Related Behaviors.'
Climate Change And Water Crisis- Obstacle for the sustainable environment. Climate change is a complex problem that has increased the need for an integrated, multi-sectorial and multidisciplinary response. Apart from the normal water domain, decision-makers in other spheres (finance, trade, energy, housing, regional planning, agriculture) must use and consume water efficiently. Sustainable management and development of water resources will play a pivotal role in preparing societies’ ability to adapt to climate change in order to increase resilience and achieve development goals.
The seminar report aims to draw attention to the critical importance of better water resources management in adapting to climate change and gives reasons why it should be systematically integrated into national plans and international investment.
• Find out causes of climate change and its impact on the water crisis.
• Water sources and demand of water.
• Actions to improve the ability to understand impacts, vulnerability, and adaptation to climate change in the water sector;
• Actions were taken to enhance informed decisions on adaptation planning, measures, and action.
Environmental degradation is a result of socio-economical, technological and institutional activities. Degradation occurs when Earth's natural resources are depleted. These resources which are affected include:
Water
Air
Soil
The degradation also impacts our:
Wildlife
Plants
Animals
Micro-organisms
The problems resulting from environmental change and its degradation, pose new challenges for traditional public health science. It is an accepted fact that, environmental degradation is contributing to human health threats worldwide. We may have several questions in our mind.
Zero Waste Management for Schools: A module prepared by Prof. Liwayway Memije...Liwayway Memije-Cruz
RATIONALE: ZERO WASTE MANAGEMENT PROJECT
One of the more serious problems that our country and our university in particular encounter nowadays is pollution which is due to improper handling and disposal of solid wastes. This problem occurs not only in urban areas where population density is high and human activities are continuous and intense but is also felt in the regional and rural areas.
In Metro Manila, the population density is 14,440 persons per square kilometer, 63 times more than the national average. Per capita waste production daily is estimated at 0.66 kg. More than half a kilo of trash per person per day is a lot. The volume of daily wastes weights in a little over 6,000 tons. Only 85% of these wastes are collected. Uncollected wastes pile up and fester in street corners and marketplaces, vacant lots and other open (often unauthorized) dumpsites. Ubiquitous scavengers light into these waste piles to pick whatever they can salvage from the junk. These waste materials are the breeding ground of flies, mosquitoes, rats, and other manner of pests and disease-carrying organisms.
An irreducible amount of waste also finds its way into bodies of water, into ditches, storm drains, and sewer mains. This does not only contaminate and pollute our waters; come the rainy season, garbage plugs up the city’ sewerage and flood waters rise-causing untold damages to life and property. Common sense tells us that the most cost-effective way of managing waste is to do something at the source generation, that is, at home, at the office or at the institutional level.
I sette principi per un’agricoltura sostenibile descritti nel rapporto di Greenpeace sono:
1. restituire il controllo sulla filiera alimentare a chi produce e chi consuma, strappandolo alle multinazionali dell’agrochimica;
2. sovranità alimentare. L'agricoltura sostenibile contribuisce allo sviluppo rurale e alla lotta contro la fame e la povertà, garantendo alle comunità rurali la disponibilità di alimenti sani, sicuri ed economicamente sostenibili;
3. produrre e consumare meglio: è possibile già oggi, senza impattare sull’ambiente e la salute, garantire sicurezza alimentare e, contemporaneamente, lottare contro gli sprechi alimentari. Occorre diminuire il nostro consumo di carne e minimizzare il consumo di suolo
per la produzione di agro-energia. Dobbiamo anche riuscire ad aumentare le rese dove è necessario, ma con pratiche sostenibili;
4. incoraggiare la (bio)diversità lungo tutta la filiera, dal seme al piatto con interventi a tutto campo, dalla produzione sementiera all’educazione al consumo;
5. proteggere e aumentare la fertilità del suolo, promuovendo le pratiche colturali idonee ed eliminando quelle che invece consumano o avvelenano il suolo stesso;
6. consentire agli agricoltori di tenere sotto controllo parassiti e piante infestanti, affermando e promuovendo quelle pratiche (già esistenti) che garantiscono protezione e rese senza l'impiego di costosi pesticidi chimici che possono danneggiare il suolo, l'acqua,
gli ecosistemi e la salute di agricoltori e consumatori;
7. rafforzare la nostra agricoltura, perché si adatti in maniera efficace il sistema di produzione del cibo in un contesto di cambiamenti climatici e di instabilità economica.
Per contribuire alla crescita dell’agricoltura sostenibile, Greenpeace collabora con agricoltori e comunità rurali.
A look at how nature provides us with services and how valuing these services is important to well-being. Slideshow from Millennium Ecosystem Assessment, UNEP
Greening deserts trillion trees initiative species rescue program and vertica...rk rimel
agroforestry
The world's first vertical farming startup for threatened or endangered tree species as well as important crops or plants develops further concepts for energy and resource-saving species conservation, climate and environmental protection. Botanical gardens, national parks and nature reserves are invited to join the Greening Deserts Species Rescue CES-RPP, Greening Camp and the Trillion Trees Initiative and related projects. The emergency program and projects for biodiversity conservation, ecosystem restoration and species rescue need international support. Developed sustainable and global solutions for some of the world hunger, food waste and palm oil issues.
In July 2014, experts from public, private and research sectors met at the Rockefeller Foundation's "Planetary Health" summit to explore ways to better value ecosystems today to ensure their healthy existence tomorrow.
Global greening deserts trillion trees initiative climate emergency peace bu...AmzadHosen3
Europe's and the world's first vertical farming startup for threatened or endangered tree species as well as important crops or plants develops further concepts for energy
and resource-saving species conservation, climate and environmental protection. Botanical gardens, national parks and nature reserves are invited to join the Greening Deserts
Species Rescue CES-RPP, Greening Camps and the Trillion Trees Initiative and related projects. The climate emergency and global greening program and projects to save species, restore biodiversity and ecosystems need international support - especially for the ongoing peace process.
TOO4TO Module 5 / Sustainable Resource Management: Part 1TOO4TO
This presentation is part of the Sustainable Management: Tools for Tomorrow (TOO4TO) learning materials. It covers the following topic: Sustainable Resource Management (Module 5). The material consists of 3 parts. This presentation covers Part 1.
You can find all TOO4TO Modules and their presentations here: https://too4to.eu/e-learning-course/
TOO4TO was a 35-month EU-funded Erasmus+ project, running until August 2023 in co-operation with European strategic partner institutions of the Gdańsk University of Technology (Poland), the Kaunas University of Technology (Lithuania), Turku University of Applied Sciences (Finland) and Global Impact Grid (Germany).
TOO4TO aims to increase the skills, competencies and awareness of future managers and employees with available tools and methods that can provide sustainable management and, as a result, support sustainable development in the EU and beyond.
Read more about the project here: https://too4to.eu/
This project has been funded with support from the European Commission. Its whole content reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein. PROJECT NUMBER 2020-1-PL01-KA203-082076
Imagine a world untouched by the influence of modern humanity, where nature reigns supreme, and ecosystems thrive in perfect harmony. “Unraveling Earth’s Potential: A World Without Modern Man” takes you on a journey through time, exploring the hypothetical scenario of a planet where modern civilization never existed. This thought-provoking article delves into the profound implications such a world would have on the environment, wildlife, and the overall balance of nature.
Please do for all few 20-30 different descriptions and mix tags.MsKarina
The world's first vertical farming startup for threatened or endangered tree species as well as important crops or plants develops further concepts for energy and resource-saving species conservation, climate and environmental protection. Arborists, botanists, conservationist, dendrologist, environmentalists, climate activists, tree and forest ecosystem experts are invited to join the global Greening Deserts Species Rescue CES-RPP, Greening Camps and the Trillion Trees Initiative and related projects.
GlobaPlease do for all few 20-30 different descriptions and mix tags.l Greeni...MsKarina
The world's first vertical farming startup for threatened or endangered tree species as well as important crops or plants develops further concepts for energy and resource-saving species conservation, climate and environmental protection. Arborists, botanists, conservationist, dendrologist, environmentalists, climate activists, tree and forest ecosystem experts are invited to join the global Greening Deserts Species Rescue CES-RPP, Greening Camps and the Trillion Trees Initiative and related projects.
Global Greening Deserts Trillion Trees Initiative Climate Emergency_ Peace Bu...AmzadHosen3
The world's first vertical farming startup for threatened or endangered tree species as well as important crops or plants develops further concepts for energy and resource-saving species conservation, climate and environmental protection. Botanical gardens, national parks, game and nature reserves are invited to join the global Greening Deserts Species Rescue CES-RPP, Greening Camps and the Trillion Trees Initiative and related projects. The global climate emergency program and projects to save species, restore biodiversity and ecosystems need international support. Please share and support the projects for global peace process. #globalgreening #peacebuilding #peaceprogress #peacespeech.org
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
sorella terra
1. Green Nephrology, Ecodialisi: parole o proposte?
Laudato si’, mi’ Signore, per sora nostra matre Terra, la quale ne sustenta et governa, et
produce diversi fructi con coloriti flori et herba
2. “La sfida urgente di proteggere la nostra casa
comune comprende la preoccupazione di unire tu5a
la famiglia umana nella ricerca di uno sviluppo
sostenibile e integrale, poiché sappiamo che le cose
possono cambiare.”
.”
3. Ques% problemi sono in%mamente lega% alla cultura dello scarto, che colpisce tanto
gli esseri umani esclusi quanto le cose che si trasformano velocemente in spazzatura.
Rendiamoci conto, per esempio, che la maggior parte della carta che si produce
viene ge<ata e non riciclata.
Sten%amo a riconoscere che il funzionamento degli
ecosistemi naturali è esemplare: le piante sinte%zzano
sostanze nutri%ve che alimentano gli erbivori; ques% a loro
volta alimentano i carnivori, che forniscono importan%
quan%tà di rifiu% organici, i quali danno luogo a una nuova
generazione di vegetali.
4. Then there is another viewpoint, not
just a question of ethics but a
question of our own survival. The
environment is very important not
only for this generation but also for
future generations. If we exploit the
environment in extreme ways, even
though we may get some money or
other benefit from it now, in the long
run we ourselves will suffer and
future generations will suffer. (…)
When they change dramatically, the
economy and many other things
change as well. So this is not merely
a moral question but also a question
of our own survival.
5. … The free-rider problem is well-known to
generate the “tragedy of commons”, as
illustrated by a myriad of case studies in
other realms. When herders share a common
parcel of land on which their herds graze,
overgrazing is a standard outcome, because
each herder wants to reap the private benefit
of an additional cow without taking account
of the fact that what he gains is matched by
someone else’s loss. Similarly, hunters and
fishers do not internalize the social cost of
their catches; overhunting and overfishing
led to the extinction of species, from the
Dodo of the island of Mauritius to the bears
of the Pyrenees and of the buffalos of the
Great Plains.
6. rsta.royalsocietypublishing.org
Research
Cite this article: Stahel WR. 2013 Policy for
material efficiency—sustainable taxation as a
departure from the throwaway society. Phil
Trans R Soc A 371: 20110567.
http://dx.doi.org/10.1098/rsta.2011.0567
One contribution of 15 to a Discussion Meeting
Issue ‘Material efficiency: providing material
services with less material production’.
Subject Areas:
materials science
Keywords:
sustainable taxation, circular economy,
regional job creation, caring, reuse,
service-life extension
Author for correspondence:
Walter R. Stahel
e-mail: walter_stahel@genevaassociation.org
Policy for material
efficiency—sustainable
taxation as a departure from
the throwaway society
Walter R. Stahel
7 chemin des Vignettes, Conches 1231, Switzerland
The present economy is not sustainable with
regard to its per capita material consumption. A
dematerialization of the economy of industrialized
countries can be achieved by a change in course,
from an industrial economy built on throughput
to a circular economy built on stock optimization,
decoupling wealth and welfare from resource
consumption while creating more work. The business
models of a circular economy have been known since
the mid-1970s and are now applied in a number of
industrial sectors. This paper argues that a simple
and convincing lever could accelerate the shift to a
circular economy, and that this lever is the shift to a
tax system based on the principles of sustainability:
not taxing renewable resources including human
labour—work—but taxing non-renewable resources
instead is a powerful lever. Taxing materials and
energies will promote low-carbon and low-resource
solutions and a move towards a ‘circular’ regional
economy as opposed to the ‘linear’ global economy
requiring fuel-based transport for goods throughput.
In addition to substantial improvements in material
and energy efficiency, regional job creation and
national greenhouse gas emission reductions, such a
change will foster all activities based on ‘caring’, such
as maintaining cultural heritage and natural wealth,
health services, knowledge and know-how.
1. Introduction
Previous patterns of growth have brought
increased prosperity, but through intensive
and often inefficient use of resources. The
role of biodiversity, ecosystems and their
services is largely undervalued, the costs of
waste are often not reflected in prices, current
c
⃝ 2013 The Author(s) Published by the Royal Society. All rights reserved.
on March 27, 2016
http://rsta.royalsocietypublishing.org/
Downloaded from
10. Posi%on statement: outline: clinics
Towards personalised, non only pharmacologic approaches.
• Nutritional management in all CKD stages (healthy
eating habits, retarding dialysis, maintaining
nutritional status).
• Physical activity (idem plus reducing the pill
burden, improving quality of life).
• Choice of RRT; development of home dialysis;
implementation of incremental and tailored
schedules; optimisation of the access to kidney
transplantation (reducing the burden of dialysis,
reducing costs).
13. ridurre i bisogni, senza ridurre i risultati…
“Globalization was purported to be the rising tide that
would lift all boats. However, the reality has been that it
lifted the big boats but tended to sink or swamp many
smaller ones”, Margaret Chan, World Conference on
Social Determinants of Health, 2011 (REF.1
).
Healthy people, living healthy lives on a healthy and
peaceful planet — these are the ultimate objectives of the
17 Sustainable Development Goals (SDGs), which were
formally adopted by all United Nations member states
in 2015, to be achieved by 2030 (REF.2
). The SDGs high-
light that achieving health and well-being for all requires
a robust, multisectoral approach.
Kidney disease is often a consequence of, or is exacer-
bated by, the lack of access to primary health care, early
diagnosis and essential medications. Consequently,
kidney disease disproportionately affects vulnerable
populations and exacerbates poverty. Kidney dysfunc-
tion is also associated with a high cost of care and is a
major contributor to morbidity and mortality, although
this effect is often obscured by its comorbid diseases3
.
Approximately 850 million people worldwide are esti-
mated to have kidney disease, including chronic kidney
disease (CKD), acute kidney injury (AKI) and kidney
failure, for which patients require kidney replacement
therapy (KRT) — dialysis or kidney transplantation —
for survival4
. Lack of access to dialysis has long been a
reality in low-income countries (LICs), but its impact has
now been dramatically highlighted even in high-income
countries (HICs), owing to critical shortages of dialysis
equipment and staff during the coronavirus disease 2019
(COVID-19) pandemic5
. CKD is the leading cause of
catastrophic health expenditure (that is, out-of-pocket
expenditure on health above 40% of household income
that further impoverishes the household) worldwide6
.
Global mortality from kidney disease might be as high
as 5 million annually, given the widespread lack or
limited access to life-saving KRT3,7,8
. CKD is projected
to become the world’s fifth leading cause of death by
2040 (REF.9
).
The recognition that health is key to maximizing our
individual capabilities underscores the importance of
ensuring that the SDGs do not become perpetual tar-
gets but instead become realized goals, leaving no one
behind10
(BOX 1). In this Review, we outline the relevance
Sustainable Development Goals
relevant to kidney health: an update
on progress
Valerie A. Luyckx 1,2,3 ✉, Ziyad Al-Aly 4,5
, Aminu K. Bello6
, Ezequiel Bellorin-Font7
,
Raul G. Carlini8
, June Fabian 9
, Guillermo Garcia-Garcia 10
, Arpana Iyengar11
,
Mohammed Sekkarie12
, Wim van Biesen 13
, Ifeoma Ulasi14
, Karen Yeates15
and
John Stanifer16
Abstract | Globally, more than 5 million people die annually from lack of access to critical
treatments for kidney disease — by 2040, chronic kidney disease is projected to be the fifth
leading cause of death worldwide. Kidney diseases are particularly challenging to tackle because
they are pathologically diverse and are often asymptomatic. As such, kidney disease is often
diagnosed late, and the global burden of kidney disease continues to be underappreciated. When
kidney disease is not detected and treated early, patient care requires specialized resources that
drive up cost, place many people at risk of catastrophic health expenditure and pose high
opportunity costs for health systems. Prevention of kidney disease is highly cost-effective but
requires a multisectoral holistic approach. Each Sustainable Development Goal (SDG) has the
potential to impact kidney disease risk or improve early diagnosis and treatment, and thus reduce
the need for high-cost care. All countries have agreed to strive to achieve the SDGs, but progress
is disjointed and uneven among and within countries. The six SDG Transformations framework
can be used to examine SDGs with relevance to kidney health that require attention and reveal
inter-linkages among the SDGs that should accelerate progress.
✉e-mail: Valerie.luyckx@
uzh.ch
https://doi.org/10.1038/
s41581-020-00363-6
REVIEWS
NATURE REVIEWS | NEPHROLOGY VOLUME 17 | JANUARY 2021 | 15
SUSTAINABLE DEVELOPMENT GOALS AND KIDNEY DISEASE
of the population has routine access to diagnostic tests
for kidney disease, including routine blood and urine
tests67
(FIG.2).
In 2017, a global survey reported that haemodialysis
was available in over 90% of countries68
. However, access
to and distribution of KRT across nations remains highly
inequitable and is often dependent on out-of-pocket
expenditure and access to private facilities in LICs.
Chronic peritoneal dialysis was available in over 90% of
upper-middle-income countries and HICs, in contrast
to 64% of LMICs and 35% of LICs68
. Acute peritoneal
dialysis had the lowest availability globally. Over 90% of
upper-middle-income countries and HICs offered kid-
ney transplantation, with over 85% of these countries
reporting both living and deceased donor programmes.
tion of risk factors and disease burdens, achievement of
universal health coverage (UHC) and delivery of quality
health care.
Poverty. Poverty (SDG 1) impacts how and where indi-
viduals live, their food choices, access to education,
employment opportunities, access to technology and
innovations, and their knowledge and exercise of their
rights70
. The proportion of people living in extreme pov-
erty(thatis,livingon<US$1.90aday)declinedfrom36%
in 1990 to 8.6% in 2018; however, the rate of decline has
slowed2
. Importantly, 8% of employed people live below
the poverty line, which reflects unjust working condi-
tions. More women than men live in poverty, and pov-
erty rates are higher in rural and conflict-affected areas.
Kidney health
in children
• Child rights
• Child advocacy
• Paediatric bioethics
• Regulations and policies
• Antenatal screening
• Genetic counselling
• Safe pregnancy
• Safe delivery
• Optimal maternal nutrition
• Maternal health
• Nutrition
• Education
• Equity
• Safety
• Low birthweight
• Prematurity
• Intrauterine
growth retardation
• Neonatal acute
kidney injury
• Adolescent health
• Self-care
• Sexual and
reproductive
education
• Distance to health centre
• Resources, infrastructure and supplies
• Referral system and continuity of care
• Lack of universal health coverage
• Out-of-pocket expenditure
• Catastrophic expenditure
• Safe homes
• Climate
• Sanitation
• Safe water
• Vulnerability to
infections and toxins
• Stunting
• Wasting
• Failure to thrive
• Obesity and overweight
• Nutritional deficiencies
• Family structure
• Socioeconomic status
• Racism
• Education
• Cultural factors
• Social habits
• Child education
• Health awareness
• Safety measures
Fig. 1 | Multiple structural factors influence kidney health in children.Conditionsexperiencedduringfetallifeandearly
childhoodaffectthephysicalandpsychosocialdevelopmentofchildren.Theeffectsoftheseconditionspersistthroughout
the life course and influence an individual’s future health and that of their children. Achievement of the Sustainable
Development Goals (SDGs) is urgent to enable each child to maximize their own capabilities and to improve the health
of future generations. Poverty has an overarching impact on child health and well-being. Children require a safe home
and school environment, access to healthy food, good education, freedom from forced labour and access to recreational
time and space to thrive and grow up healthy. Moreover, healthy and educated mothers have healthier children.
NATURE REVIEWS | NEPHROLOGY VOLUME 17 | JANUARY 2021 | 21
16. Journal of
Clinical Medicine
Concept Paper
Dialysis Reimbursement: What Impact Do Different
Models Have on Clinical Choices?
Giorgina Barbara Piccoli 1,2,* , Gianfranca Cabiddu 3 , Conrad Breuer 4, Christelle Jadeau 5,
Angelo Testa 6 and Giuliano Brunori 7
1 Department of Clinical and Biological Sciences, University of Torino Italy, 10100 Torino, Italy
2 Nephrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France
3 Nephrology, Brotzu Hospital, 09100 Cagliari, Italy; gianfranca.cabiddu@tin.it
4 Direction, Centre Hospitalier Le Mans, 72000 Le Mans, France; cbreuer@ch-lemans.fr
5 Centre de Recherche Clinique, Centre Hospitalier Le Mans, 72000 Le Mans, France; cjadeau@ch-lemans.fr
6 Association ECHO, 44000 Nantes, France; atesta@echo-sante.com
7 Nefrologia, Ospedale di Trento, 38100 Trento, Italy; gcbrunori@hotmail.com
* Correspondence: gbpiccoli@yahoo.it; Tel.: +33-669-733-371
Received: 12 January 2019; Accepted: 21 February 2019; Published: 25 February 2019
!"#!$%&'(!
!"#$%&'
Abstract: Allowing patients to live for decades without the function of a vital organ is a medical
miracle, but one that is not without cost both in terms of morbidity and quality of life and in economic
terms. Renal replacement therapy (RRT) consumes between 2% and 5% of the overall health care
expenditure in countries where dialysis is available without restrictions. While transplantation is
the preferred treatment in patients without contraindications, old age and comorbidity limit its
indications, and low organ availability may result in long waiting times. As a consequence, 30–70%
of the patients depend on dialysis, which remains the main determinant of the cost of RRT. Costs
of dialysis are differently defined, and its reimbursement follows different rules. There are three
main ways of establishing dialysis reimbursement. The first involves dividing dialysis into a series of
elements and reimbursing each one separately (dialysis itself, medications, drugs, transportation,
hospitalisation, etc.). The second, known as the capitation system, consists of merging these elements
in a per capita reimbursement, while the third, usually called the bundle system, entails identifying a
core of procedures intrinsically linked to treatment (e.g., dialysis sessions, tests, intradialyitc drugs).
Each one has advantages and drawbacks, and impacts differently on the organization and delivery
of care: payment per session may favour fragmentation and make a global appraisal difficult; a
correct capitation system needs a careful correction for comorbidity, and may exacerbate competition
between public and private settings, the latter aiming at selecting the least complex cases; a bundle
system, in which the main elements linked to the dialysis sessions are considered together, may
be a good compromise but risks penalising complex patients, and requires a rapid adaptation to
treatment changes. Retarding dialysis is a clinical and economical goal, but the incentives for
predialysis care are not established and its development may be unfavourable for the provider.
A closer cooperation between policymakers, economists and nephrologists is needed to ensure a high
quality of dialysis care.
Keywords: dialysis reimbursement; costs; renal replacement therapy; incremental dialysis;
predialysis care
1. Introduction
Renal replacement therapy (RRT) is a life-saving, long-lasting, expensive treatment. In Europe,
Japan, the United States and Canada, about one person in 1000 is presently alive thanks to dialysis or
J. Clin. Med. 2019, 8, 276; doi:10.3390/jcm8020276 www.mdpi.com/journal/jcm
ridurre i bisogni, senza ridurre i risultati…
22. la medicina di precisione si adatta bene alla dialisi
incrementale... che può anche essere “decrementale”
CURRENT
OPINION Precision medicine approach to dialysis including
incremental and decremental dialysis regimens
Mariana Murea
Purpose of review
Conventional standardization of haemodialysis for treatment of end-stage kidney disease (ESKD) is
predicated upon the fixed construct of one disease stage and one patient category. Increasingly
recognized are subgroups of patients for whom less-intensive haemodialysis, such as incremental or
decremental haemodialysis, could be employed.
Recent findings
Almost 30% of patients with incident ESKD have clinical and residual kidney function (RFK) parameters that
could accommodate less-intensive haemodialysis. In one study, patients with incident ESKD and substantial
RKF treated with low-dose haemodialysis had similar mortality rate as those treated with standard-dose
haemodialysis, adding to the evidence that endogenous kidney function – when present – can complement
less-intensive haemodialysis schedules. Hazards related to incremental haemodialysis include insidious
development of fluid overload and higher rates of fluid removal. Finally, deintensification of haemodialysis
treatment could be employed in patients with ESKD who seek conservative care.
Summary
A shift in approach to ESKD from a dichotomous frame – disease presence versus absence – to stages of
dialysis-dependent kidney disease, each stage associated with attuned haemodialysis intensity, has been
proposed. Haemodialysis standardization and personalization – often considered mutually exclusive – can
be combined in incremental haemodialysis. Data from ongoing and future randomized clinical trials,
comparing less-intensive with standard haemodialysis schedules, are required to change practice.
Keywords
clinical trials, decremental, end-stage kidney disease, haemodialysis, incremental
INTRODUCTION
End-stage kidney disease (ESKD) is marked by initi-
ation of kidney replacement therapy of which
chronic haemodialysis is the most common form
of dialysis therapy in the USA and other developed
countries. In its fundamental approach, the treat-
ment of patients with ESKD with chronic haemo-
dialysis has five main components: dialysis
frequency, treatment time per dialysis session, con-
trol of uremic symptoms, control of volume status
and management of metabolic imbalances. Among
these components and boxed by clinical practice
guidelines and reimbursement policies, providers
have little room to edit the haemodialysis pro-
gramme, in spite of the fact that many elements
of haemodialysis prescription (e.g. lower treatment
frequency, ultrafiltration rate, treatment time, dial-
ysate electrolyte concentrations) have not been val-
programme, equally prescribed to patients who
transition from chronic kidney disease to ESKD
(incident dialysis) and those with long-term ESKD
(prevalent dialysis). This ‘one-size-fits-all’ approach
to treating patients with ESKD is the norm in many
developed countries, even though some patients,
due to disease heterogeneity or by choice, might
fare better with different haemodialysis treatment
programs. Exemplary haemodialysis treatment
doses [i.e. minimum delivered single pool Kt/Vurea
(spKt/Vurea) !1.2 and urea reduction ratio (URR)
!65%] are the benchmark in all dialysis
Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
Correspondence to Mariana Murea, MD, Department of Internal Medi-
cine – Section on Nephrology,Wake Forest School of Medicine, Medical
Center Boulevard, Winston-Salem, NC 27157-1053, USA.
Tel: +1 336 716 4650; fax: +1 336 716 4318;
REVIEW
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with
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come
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haemo
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today’
owner
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KEY POINTS
! There is significant heterogeneity among patients with
ESKD; a shift from ‘one-size-fits-all’ approach to
haemodialysis therapy to ‘stage-based’ approach has
been proposed to tailor haemodialysis by
patient subgroups.
! At least one-third of patients with incident ESKD have
substantial RKF; these patients might not derive
additional benefit from being treated with standard
haemodialysis as opposed to less-
intensive haemodialysis.
! Patients treated with reduced-frequency haemodialysis
can develop insidious volume overload and be exposed
to high rates of fluid removal; adjuvant pharmacologic
therapy and timely adjustment in haemodialysis
prescription are of paramount importance.
! Combining standardized and personalized care in well
selected subgroups of patients with ESKD might
surmount some of the challenges of incremental HD.
! Multicentre clinical trials on comparative effectiveness
between less-intensive and standard haemodialysis
schedules are required to change current practice.
Novel therapeutic approaches in nephrology and hypertension
ridurre i bisogni, senza ridurre i risulta9…
23. Esiste probabilmente spazio per aumentare la dialisi
incrementale: l’esperienza di Le Mans è riassunta
così : periodo 2017-2021
DP : 18.6% dei nuovi pazienti
Tutti hanno iniziato in dialisi peritoneale
incrementale;
Tutti i pazienti che hanno iniziato la DP erano seguiti
in precedenza; 80% erano seguiti nell’unità di follow-
up “intensivo” UIRAV
ridurre i bisogni, senza ridurre i risultati…
24. Le Mans, emodialisi: periodo 2017-2021
105 pazienti iniziano
l’emodialisi in maniera
“non standard” :
incrementale (90) e
decrementale (15).
Solo 53 su 158 iniziano
e continuano in dialisi
trisettimanale.
ridurre i bisogni, senza ridurre i risultaG…
25. “i giochi sono fatti” nel periodo pre-dialisi:
All patients who started on PD started with incremental schedles; all
were followed previously, 80% in UIRAV
PD prevalence: 18.6% of new cases
ridurre i bisogni, senza ridurre i risultati…
28. la “riscoperta” dell’a0vità fisica ada4ata al paziente.
Original Investigation
Exercise Training in Adults With CKD: A Systematic Review and
Meta-analysis
Susanne Heiwe, RPT, PhD,1,2,3
and Stefan H. Jacobson, MD, PhD1,4
Background: Whether exercise can affect health outcomes in people with chronic kidney disease (CKD)
and what the optimal exercise strategies are for patients with CKD remain uncertain.
Study Design: Systematic review and meta-analysis of randomized controlled trials.
Setting & Population: Adults with CKD stages 2-5, dialysis therapy, or a kidney transplant.
Selection Criteria for Studies: Trials evaluating regular exercise training outcomes identified by searches
in Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL, Web of Science, BIOSIS, PEDro, AMED, AgeLine,
PsycINFO, and KoreaMed, without language restriction.
Intervention: Regular exercise training for at least 8 weeks.
Outcomes: Vary by study but could include aerobic capacity, muscular functioning, cardiovascular function,
walking capacity, and health-related quality of life. Treatment effects were summarized as standardized
difference with 95% CIs using random-effects meta-analysis.
Results: 41 trials (928 participants) comparing exercise training with sham exercise or no exercise were
included; overall, improved aerobic capacity, muscular functioning, cardiovascular function, walking capacity,
and health-related quality of life were associated with various exercise interventions, although the
preponderance of data were for dialysis patients and used aerobic exercise programs.
Limitations: Unclear or high risk of bias in 32% of the trials, few trial data concerning resistance training,
and limited data for several important outcomes.
Conclusions: Regular exercise training generally is associated with improved health outcomes in in-
dividuals with CKD. Correctly designed exercise rehabilitation may be an effective part of care for adults with
CKD. Future studies should examine longer term outcomes and strategies to translate exercise done in a
supervised setting to the home setting for broader applicability.
Am J Kidney Dis. 64(3):383-393. ª 2014 by the National Kidney Foundation, Inc.
INDEX WORDS: Kidney disease, chronic; exercise; physical fitness; exercise training; systematic reviews;
meta-analysis.
ridurre i bisogni, senza ridurre i risultati…
32. Ridurre gli spostamenti: una COVID-lesson?
la medicina a distanza: ecologica o spersonalizzante?
Carbon Footprint of Telemedicine Solutions -
Unexplored Opportunity for Reducing Carbon Emissions
in the Health Sector
Åsa Holmner1
*, Kristie L. Ebi2,4
, Lutfan Lazuardi3
, Maria Nilsson4
1 Department of Radiation Sciences, Umeå University, Umeå, Sweden, 2 ClimAdapt, LLC, Seattle, Washington, United States of America, 3 Department of Public Health,
Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia, 4 Department of public health and clinical medicine, epidemiology and global health, Umeå
University, Umeå, Sweden
Abstract
Background: The healthcare sector is a significant contributor to global carbon emissions, in part due to extensive travelling
by patients and health workers.
Objectives: To evaluate the potential of telemedicine services based on videoconferencing technology to reduce travelling
and thus carbon emissions in the healthcare sector.
Methods: A life cycle inventory was performed to evaluate the carbon reduction potential of telemedicine activities beyond
a reduction in travel related emissions. The study included two rehabilitation units at Umeå University Hospital in Sweden.
Carbon emissions generated during telemedicine appointments were compared with care-as-usual scenarios. Upper and
lower bound emissions scenarios were created based on different teleconferencing solutions and thresholds for when
telemedicine becomes favorable were estimated. Sensitivity analyses were performed to pinpoint the most important
contributors to emissions for different set-ups and use cases.
Results: Replacing physical visits with telemedicine appointments resulted in a significant 40–70 times decrease in carbon
emissions. Factors such as meeting duration, bandwidth and use rates influence emissions to various extents. According to
the lower bound scenario, telemedicine becomes a greener choice at a distance of a few kilometers when the alternative is
transport by car.
Conclusions: Telemedicine is a potent carbon reduction strategy in the health sector. But to contribute significantly to
climate change mitigation, a paradigm shift might be required where telemedicine is regarded as an essential component
of ordinary health care activities and not only considered to be a service to the few who lack access to care due to
geography, isolation or other constraints.
Citation:Holmner Å, Ebi KL, Lazuardi L, Nilsson M (2014) Carbon Footprint of Telemedicine Solutions - Unexplored Opportunity for Reducing Carbon Emissions in
the Health Sector. PLoS ONE 9(9): e105040. doi:10.1371/journal.pone.0105040
Editor:Igor Linkov, US Army Engineer Research and Development Center, United States of America
33. la medicina a distanza: ecologica o spersonalizzante?
Future Healthcare Journal 2021 Vol 8, No 1: e85–91 REVIEW
PROCESS AND SYSTEMS Does telemedicine reduce the carbon
footprint of healthcare? A systematic review
Authors: Amy Purohit,A
James SmithB
and Arthur HibbleC
In the rapidly progressing field of telemedicine, there is
a multitude of evidence assessing the effectiveness and
financial costs of telemedicine projects; however, there is
very little assessing the environmental impact despite the
increasing threat of the climate emergency. This report
provides a systematic review of the evidence on the carbon
footprint of telemedicine. The identified papers unanimously
report that telemedicine does reduce the carbon footprint
of healthcare, primarily by reduction in transport-associated
emissions. The carbon footprint savings range between
0.70–372 kg CO2e per consultation. However, these values are
highly context specific. The carbon emissions produced from
the use of the telemedicine systems themselves were found
to be very low in comparison to emissions saved from travel
reductions. This could have wide implications in reducing
the carbon footprint of healthcare services globally. In order
for telemedicine services to be successfully implemented,
further research is necessary to determine context-specific
considerations and potential rebound effects.
KEYWORDS: telemedicine, sustainability, e-health, carbon footprint
synchronous is real-time data transmission. The data may be
transmitted via a variety of media, such as audio, video or text.
This paper will focus on all forms of telemedicine involving direct
patient care where the carbon footprint of the telemedicine
project is compared to a face-to-face (FTF) scenario.
Telemedicine is a recent development within healthcare.
In this decade, there has been an explosion in telemedicine
research, focusing on specific medical specialties. The reported
advantages include lower financial costs, high patient
satisfaction, better rural access, decreased waiting times and
fewer missed appointment.2–7
There is less available evidence
from primary care; however, there are positive findings in
primary care chronic disease management.8–10
The main
disadvantages are erosion of the clinician–patient relationship
and concerns around quality of care. In terms of clinician–
patient relationship, this concern arises particularly from
elderly patients and healthcare providers themselves; however,
acceptance has been shown to be increasing.6,11,12
There are
mixed reports on the quality of care provided by telemedicine;
some sources report improved or maintained standards of care,
whereas others found a reduction in quality of care compared to
FTF scenarios.9,13–19
ABSTRACT
Ridurre gli spostamenti: una COVID-lesson?
35. Posi%on statement:
Spun% per la ricerca
• Qualità della dieta: la dieta
vegana planet- friendly
non è ...
• Qualità della dialisi: esiste l’ “iper-dialisi”?
• Valutazione dell’attività fisica anche in
termini di “risparmio” di farmaci, etc ...
• l’e-medicine dovrebbe essere un “plus”...
36. La clinica: in breve...
• La terapia nutrizionale, la terapia fisica, un
approccio olistico e personalizzato, la scelta di una
dialisi su misura non hanno solo un significato
clinico ma anche “ecologico”.
• Attenzione ai luoghi comuni, alle dimostrazioni
pleonastiche e agli alibi per ridurre il contatto con
i pazienti...
• La green nephrology è un “punto di vista”
“I did not become a vegetarian for my health, I did it for the
health of the chickens.”
Isaac Bashevis Singer
38. Posi%on statement: outline: technology
• Water conserva%on (reducing consump%on of natural
resources; recycling and reusing water).
• Energy conserva%on (reducing consump%on of natural
resources; employing alterna%ve energy).
• Waste management (reducing waste; promo%ng a wise
triage of contaminated and non contaminated waste;
introducing reuse and recycle whenever possible).
• Industrial design (influence the industry by considering
environmental impact a quality item; demand informa%on
throughout hardware, soDware and disposable lifecycle;
promote cradle to cradle approaches).