@Article{info:doi/10.2196/67538,
author="van Bree, M. Egid
and Snijder, E. Lynn
and Ossebaard, C. Hans
and Brakema, A. Evelyn",
title="Environmental Impact of Physical Visits and Telemedicine in Nursing Care at Home: Comparative Life Cycle Assessment",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="4",
volume="27",
pages="e67538",
keywords="carbon footprint",
keywords="eHealth",
keywords="telemedicine",
keywords="telehealth",
keywords="sustainable health care",
keywords="digital health care",
keywords="environmental impact",
keywords="environment",
keywords="physical visits",
keywords="nursing",
keywords="life cycle assessment",
keywords="life cycle",
keywords="ecology",
keywords="sustainability",
keywords="footprint",
keywords="planetary health",
abstract="Background: The health care sector contributes notably to environmental harms, impacting human and ecosystem health. Hence, countries increasingly set ambitions to transition to environmentally sustainable health care, focusing on resource use, energy consumption, and patient travel. Telemedicine is often considered a promising solution to reduce travel-related carbon emissions. However, underlying environmental impact assessments lack important components such as staff travel and fail to adhere to standardized conduct and reporting. Moreover, assessments of telemedicine use in primary care are scarce. Objective: This study aims to quantify and compare the environmental impact of physical visits and telemedicine visits in the context of domiciliary care and home nursing. Methods: We conducted a life cycle assessment following international ISO-14040/44 standards of all resources required per individual patient visit, either in person at the patient's home or via video calling with a dedicated user-friendly tablet. We collected anonymous user data in collaboration with a telemedicine service company, complemented by consulting staff members of four nursing organizations. Telemedicine visits were elementary in nature, such as supporting patients in taking their medication or structuring their daily agenda. We quantified average environmental impacts from cradle to grave, using the Environmental Footprint method, and verified the robustness of the comparison via uncertainty analysis. The variability of environmental impacts in different settings was explored using scenario analyses for the available minimum to maximum ranges. Results: Compared to a single physical visit in the studied setting, a telemedicine visit contributed less to global warming (0.1 vs 0.3 kg of carbon dioxide equivalents [kgCO2eq]; --60\%), particulate matter formation (6.2 * 10--9 vs 1.8 * 10--8 disease incidence; --60\%), and fossil resource use (1.8 vs 4.4 megajoules; --60\%). Mineral/metal resource use was higher for telemedicine than for physical visits (1.1 * 10--5 vs 4.0 * 10--6 kg antimony equivalent; +180\%). Only water use was not consistently different in the uncertainty analysis. Scenario analyses indicated that telemedicine's environmental impact could become similar to physical visits only in urban settings (1-3 km of travel distance) with 50\%-100\% car commuting (0.1-0.4 vs 0.2-0.7 kgCO2eq). In rural settings (5-15 km of travel distance, 80\%-100\% car commute), physical visits' environmental impact was higher (1.0-3.5 kgCO2eq), mostly even for mineral/metal resource use. Conclusions: Using telemedicine for domiciliary care and home nursing mostly reduces its environmental impact compared to physical visits. Benefits are larger in rural settings, where travel distances between patients are larger, and apply to multiple environmental impacts but not always to mineral/metal resource use. In urban settings, factors that influence the degree to which telemedicine is environmentally beneficial are whether staff are working from home versus at the office, commuting to the office by bicycle versus by car, and reusing video-calling devices. Accordingly, considerate application of telemedicine is important to support care for both human and planetary health. ",
doi="10.2196/67538",
url="https://www.jmir.org/2025/1/e67538",
url="http://www.ncbi.nlm.nih.gov/pubmed/40184167"
}


@Article{info:doi/10.2196/63927,
author="Li, Zhi
and Xiang, Lianrui
and Ning, Jing
and Li, Wenbo
and Huang, Yong
and Xiao, Xue",
title="Pathways to Sustainable Health Care Development: Study on the Carbon Reduction Potential of Telemedicine in China",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="24",
volume="27",
pages="e63927",
keywords="telemedicine",
keywords="carbon reduction potential",
keywords="carbon emissions",
keywords="energy consumption",
keywords="sustainable development",
abstract="Background: Carbon emissions are a global concern due to their significant greenhouse effect. The health care sector's greenhouse gas (GHG) emissions must be controlled. Telemedicine in China continued to grow between 2020 and 2022, offering a promising solution for reducing carbon emissions in the country's health sector. Objective: This study explores the potential of telemedicine for reducing GHG emissions and saving energy through a life cycle assessment. Methods: This study used the Chinese Environmentally Extended Input-Output database, which is based on input-output models, to quantify the GHG emissions and energy consumption associated with care outpatient and telemedicine from a life cycle perspective. Data collected from the West China Second University Hospital of Sichuan University between 2020 and 2022 were incorporated into the analyses. Results: The findings indicated that telemedicine could reduce GHG emissions by 36 tCO2e. The GHG emissions per telemedicine session were only 19.14 kgCO2e and are expected to decrease from 2025 to 2030. Replacing in-person treatments with telemedicine can lead to an average reduction of 85.51 kgCO2e emissions. Conclusions: In the future, the widespread adoption of telemedicine could help achieve carbon neutrality in the health care sector. Telemedicine is crucial for establishing the sustainable development of the health care sector. ",
doi="10.2196/63927",
url="https://www.jmir.org/2025/1/e63927"
}


@Article{info:doi/10.2196/56766,
author="Mainer-Pearson, Graham
and Stewart, Kurtis
and Williams, Kim
and Pawlovich, John
and Graham, Scott
and Riches, Linda
and Cressman, Sonya
and Ho, Kendall",
title="Estimating Patient and Family Costs and CO2 Emissions for Telehealth and In-Person Health Care Appointments in British Columbia, Canada: Geospatial Mixed Methods Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="19",
volume="27",
pages="e56766",
keywords="virtual care",
keywords="economic evaluation",
keywords="patient costs",
keywords="lost productivity",
keywords="informal caregiving",
keywords="out-of-pocket costs",
keywords="environmental costs",
keywords="geospatial",
keywords="patient",
keywords="family",
keywords="CO2",
keywords="emission costs",
keywords="health care",
keywords="Canada",
keywords="virtual service",
keywords="emergency department",
keywords="hospitalization",
keywords="physician visit",
keywords="consultation",
keywords="sensitivity analysis",
keywords="patient-paid",
keywords="telehealth",
abstract="Background: Patients inevitably incur some cost for accessing health care, even in universal systems such as Canada. The COVID-19 pandemic dramatically shifted health care delivery from in-person to telehealth services, also shifting the proportion of costs offset by patients and their families by reducing the need to travel to in-person appointments. Objective: This study aimed to develop a method for estimating the costs patients and their families incur and CO2 emissions attributed to travel needed for emergency department (ED) visits, hospitalizations, and physician appointments. Methods: We present a method to evaluate the costs associated with in-person and telehealth care appointments from the perspective of patients, their families, and the environment. We used ED locations, road distances, and duration of appointment to account for costs paid by patients (ie, lost productivity, informal caregiving, and out-of-pocket expenses) attributed to travel to receive medical care. Costs to the environment were evaluated by calculating the amount of CO2 emitted per medical visit. Using our costs calculated per visit, we apply our method to calculate total patient costs for a simulated population over 1 year. Results: Our method estimates that patients in British Columbia pay up to \$300 (2023 CAD, CAD \$1=US \$0.86) on average to attend an in-person ED visit, depending on where they live; \$166 may be attributed to lost productivity, \$83 to informal caregiving, and \$50 to out-of-pocket expenses. These estimates are higher than most observed cost estimates. In addition, avoiding in-person care diverts up to 13 kg of CO2 per medical visit, depending on the distance and frequency of travel to appointments. This translates to up to \$0.70 in carbon costs per visit, or cumulatively \$44,120 per year in British Columbia, conventionally not included in patient cost estimates. Conclusions: We present a novel method for estimating patient-incurred costs and CO2 emissions from accessing health care and apply it to estimate that every year, patients in British Columbia pay upwards of 30 million dollars to access health care services, primarily for medical travel. Our method adds to the economic evaluation literature by providing a more comprehensive and context-modifiable calculation of patient costs that will allow for more informed decision-making regarding health care services. ",
doi="10.2196/56766",
url="https://www.jmir.org/2025/1/e56766",
url="http://www.ncbi.nlm.nih.gov/pubmed/39969971"
}


@Article{info:doi/10.2196/63217,
author="Block Ngaybe, G. Maiya
and Azurdia Sierra, Lidia
and McNair, Andrew
and Gonzalez, Myla
and Arora, Mona
and Ernst, Kacey
and Noriega-Atala, Enrique
and Iyengar, Sriram M.",
title="Resilience Informatics in Public Health: Qualitative Analysis of Conference Proceedings",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="16",
volume="9",
pages="e63217",
keywords="resilience",
keywords="public health",
keywords="informatics",
keywords="mobile phone",
keywords="artificial intelligence",
keywords="AI",
abstract="Background: In recent years, public health has confronted 2 formidable challenges: the devastating COVID-19 pandemic and the enduring threat of climate change. The convergence of these crises underscores the urgent need for resilient solutions. Resilience informatics (RI), an emerging discipline at the intersection of informatics and public health, leverages real-time data integration from health systems, environmental monitoring, and technological tools to develop adaptive responses to multifaceted crises. It offers promising avenues for mitigating and adapting to these challenges by proactively identifying vulnerabilities and fostering adaptive capacity in public health systems. Addressing critical questions regarding target audiences, privacy concerns, and scalability is paramount to fostering resilience in the face of evolving health threats. Objective: The University of Arizona held a workshop, titled Resilience Informatics in Public Health, in November 2023 to serve as a pivotal forum for advancing these discussions and catalyzing collaborative efforts within the field. This paper aims to present a qualitative thematic analysis of the findings from this workshop. Methods: A purposive sampling strategy was used to invite 40 experts by email from diverse fields, including public health, medicine, weather services, informatics, environmental science, and resilience, to participate in the workshop. The event featured presentations from key experts, followed by group discussions facilitated by experts. The attendees engaged in collaborative reflection and discussion on predetermined questions. Discussions were systematically recorded by University of Arizona students, and qualitative analysis was conducted. A detailed thematic analysis was performed using an inductive approach, supported by MAXQDA software to manage and organize data. Two independent researchers coded the transcripts; discrepancies in coding were resolved through consensus, ensuring a rigorous synthesis of the findings. Results: The workshop hosted 27 experts at the University of Arizona, 21 (78\%) of whom were from public health--related fields. Of these 27 experts, 8 (30\%) were from the field of resilience. In addition, participants from governmental agencies, American Indian groups, weather services, and a mobile health organization attended. Qualitative analysis identified major themes, including the potential of RI tools, threats to resilience (eg, health care access, infrastructure, and climate change), challenges with RI tools (eg, usability, funding, and real-time response), and standards for RI tools (eg, technological, logistical, and sociological). The attendees emphasized the importance of equitable access, community engagement, and iterative development in RI projects. Conclusions: The RI workshop emphasized the necessity for accessible, user-friendly tools bridging technical knowledge and community needs. The workshop's conclusions provide a road map for future public health resilience, highlighting the need for scalable, culturally sensitive, community-driven interventions. Future directions include focused discussions to yield concrete outputs such as implementation guidelines and tool designs, reshaping public health strategies in the face of emerging threats. ",
doi="10.2196/63217",
url="https://formative.jmir.org/2025/1/e63217"
}


@Article{info:doi/10.2196/64921,
author="Kraybill, P. Eric
and Chen, David
and Khan, Saadat
and Kalra, Praveen",
title="Reducing Greenhouse Gas Emissions and Modifying Nitrous Oxide Delivery at Stanford: Observational, Pilot Intervention Study",
journal="JMIR Perioper Med",
year="2025",
month="Jan",
day="9",
volume="8",
pages="e64921",
keywords="anesthetic gases",
keywords="emissions",
keywords="green house gas",
keywords="sustainability",
keywords="pilot study",
keywords="electronic health record",
keywords="implementation",
keywords="nitrous oxide",
keywords="global warming",
abstract="Background: Inhalational anesthetic agents are a major source of potent greenhouse gases in the medical sector, and reducing their emissions is a readily addressable goal. Nitrous oxide (N2O) has a long environmental half-life relative to carbon dioxide combined with a low clinical potency, leading to relatively large amounts of N2O being stored in cryogenic tanks and H cylinders for use, increasing the chance of pollution through leaks. Building on previous findings, Stanford Health Care's (SHC's) N2O emissions were analyzed at 2 campuses and targeted for waste reduction as a precursor to system-wide reductions. Objective: We aimed to determine the extent of N2O pollution at SHC and subsequently whether using E-cylinders for N2O storage and delivery at the point of care in SHC's ambulatory surgery centers could reduce system-wide emissions. Methods: In phase 1, total SHC (Palo Alto, California) N2O purchase data for calendar year 2022 were collected and compared (volume and cost) to total Palo Alto clinical delivery data using Epic electronic health records. In phase 2, a pilot study was conducted in the 8 operating rooms of SHC campus A (Redwood City). The central N2O pipelines were disconnected, and E-cylinders were used in each operating room. E-cylinders were weighed before and after use on a weekly basis for comparison to Epic N2O delivery data over a 5-week period. In phase 3, after successful implementation, the same methodology was applied to campus B, one of 3 facilities in Palo Alto. Results: In phase 1, total N2O purchased in 2022 was 8,217,449 L (33,201.8 lbs) at a total cost of US \$63,298. Of this, only 780,882.2 L (9.5\%) of N2O was delivered to patients, with 7,436,566.8 L (90.5\%) or US \$57,285 worth lost or wasted. In phase 2, the total mass of N2O use from E-cylinders was 7.4 lbs (1 lb N2O=247.5 L) or 1831.5 L at campus A. Epic data showed that the total N2O volume delivered was 1839.3 L (7.4 lbs). In phase 3, the total mass of N2O use from E-cylinders was 10.4 lbs or 2574 L at campus B (confirming reliability within error propagation margins). Epic data showed that the total N2O volume delivered was 2840.3 L (11.5 lbs). Over phases 2 and 3, total use for campuses A and B was less than the volume of 3 E-cylinders (1 E-cylinder=1590 L). Conclusions: Converting N2O delivery from centralized storage to point-of-care E-cylinders dramatically reduced waste and expense with no detriment to patient care. Our results provide strong evidence for analyzing N2O storage in health care systems that rely on centralized storage, and consideration of E-cylinder implementation to reduce emissions. The reduction in N2O waste will help meet SHC's goal of reducing scope 1 and 2 emissions by 50\% before 2030. ",
doi="10.2196/64921",
url="https://periop.jmir.org/2025/1/e64921"
}


@Article{info:doi/10.2196/59790,
author="Stachura, Kasia Nicole
and Brar, K. Sukham
and Davidson, Jacob
and Wilson, A. Claire
and Dann, Celia
and Apostol, Mike
and Vecchio, John
and Bilodeau, Shannon
and Gunz, Anna
and Casas-Lopez, Catalina Diana
and Noppens, Ruediger
and Leslie, Ken
and Strychowsky, E. Julie",
title="Exploring the Knowledge, Attitudes, and Perceptions of Hospital Staff and Patients on Environmental Sustainability in the Operating Room: Quality Improvement Survey Study",
journal="JMIR Perioper Med",
year="2024",
month="Nov",
day="28",
volume="7",
pages="e59790",
keywords="environmental sustainability",
keywords="sustainable healthcare",
keywords="operating room",
keywords="hospital",
keywords="recycling",
keywords="climate change",
keywords="global warming",
keywords="staff",
keywords="patient",
keywords="attitude",
keywords="opinion",
keywords="energy consumption",
abstract="Background: In Canada, the health care system has been estimated to generate 33 million metric tons of greenhouse gas emissions annually. Health care systems, specifically operating rooms (ORs), are significant contributors to greenhouse gas emissions, using 3 to 6 times more energy than the hospital's average unit. Objective: This quality improvement study aimed to investigate the knowledge, attitudes, and perceptions of staff members and patients on sustainability in the OR, as well as identify opportunities for initiatives and barriers to implementation. Methods: A total of 2 surveys were developed, consisting of 27 questions for staff members and 22 questions for patients and caregivers. Topics included demographics, knowledge and attitudes regarding environmental sustainability, opportunities for initiatives, and perceived barriers. Multiple-choice, Likert-scale, and open-ended questions were used. Results: A total of 174 staff members and 37 patients participated. The majority (152/174, 88\%) of staff members had received no and minimal training on sustainability, while 93\% (162/174) cited practicing sustainability at work as moderately to extremely important. Among patients and caregivers, 54\% (20/37) often or always noticed when a hospital is being eco-friendly. Both staff members and patients agreed that improving sustainability would boost satisfaction (125/174, 71.8\% and 22/37, 59.4\%, respectively) and hospital reputation (22/37, 59.4\% and 25/37, 69.5\%, respectively). The staff members' highest-rated environmental initiatives included transitioning to reusables, education, and improved energy consumption, while patients prioritized increased nature, improved food sourcing, and education. Perceived barriers to these initiatives included cost, lack of education, and lack of incentives. Conclusions: Staff members and patients and caregivers in a large academic health care center acknowledge the significance of environmental sustainability in the OR. While they do not perceive a direct impact on patient care, they anticipate positive effects on satisfaction and hospital reputation. Aligning initiatives with staff members and patient and caregiver preferences can help drive meaningful change within the OR and beyond. ",
doi="10.2196/59790",
url="https://periop.jmir.org/2024/1/e59790"
}


@Article{info:doi/10.2196/59345,
author="Vivion, Maryline
and Trottier, Val{\'e}rie
and Bouh{\^e}lier, {\`E}ve
and Goupil-Sormany, Isabelle
and Diallo, Thierno",
title="Misinformation About Climate Change and Related Environmental Events on Social Media: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Oct",
day="31",
volume="13",
pages="e59345",
keywords="misinformation",
keywords="disinformation",
keywords="infodemiology",
keywords="infoveillance",
keywords="climate change",
keywords="global warming",
keywords="greenhouse effect",
keywords="social media",
keywords="online social network",
keywords="environmental health",
keywords="public support",
keywords="global challenges",
keywords="Google",
keywords="health policy",
abstract="Background: Climate change and related environmental events represent major global challenges and are often accompanied by the spread of misinformation on social media. According to previous reviews, the dissemination of this misinformation on various social media platforms requires deeper exploration. Moreover, the findings reported applied mainly to the context of the United States, limiting the possibility of extending the results to other settings. Objective: This study aims to assess the current state of knowledge about misinformation concerning climate change and related environmental events that are circulating on social media. More specifically, we will explore past and current themes, actors, and sources, and the dissemination of this misinformation within the Canadian context. Methods: This scoping review protocol follows the methodological approach developed by Arksey and O'Malley and advanced by Levac, complemented by the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and the best practice guidance for the development of scoping review protocols. Following the identification of the research questions and assisted by a specialized librarian, we developed search strategies for selected bibliographic databases (MEDLINE, Embase, Web of Science, and GreenFILE) and for gray literature (Google and pertinent databases) searches. Bibliographic and gray literature will be searched to identify relevant publications. In total, 2 members of our team will use the review software Covidence (Veritas Health Innovation) to independently select publications to include in the review. Publications specifically addressing our research questions, peer-reviewed, evidence-based, and published from January 1, 2000, in the full-text version in English or French will be included. Data will be extracted from the included publications to chart, among other items, the years of publication, geographic areas, themes, actors, and sources of the climate change--related misinformation and conclusions reported. Our team will then synthesize the extracted data to articulate the current state of knowledge relating to our research inquiries. Results: The research questions were identified in January 2024. The search strategies were developed from January to March 2024 for MEDLINE, Embase, and Web of Science and in July 2024 for GreenFILE and gray literature. MEDLINE, Embase, and Web of Science searches were launched on March 26, 2024. The first of 2 rounds of selection of publications identified through these databases was achieved in April 2024. Conclusions: This protocol will enable us to identify the evolution of themes, actors, and sources of misinformation regarding climate change and related environmental events on social media, including the latest platforms, and to potentially identify a context particular to Canada. As misinformation is known to undermine actions and public support in the fight against climate change, we intend to facilitate the targeting of efforts to combat misinformation related to climate change in an up-to-date and contextualized manner. International Registered Report Identifier (IRRID): DERR1-10.2196/59345 ",
doi="10.2196/59345",
url="https://www.researchprotocols.org/2024/1/e59345"
}


@Article{info:doi/10.2196/54687,
author="Iyengar, Sriram M.
and Block Ngaybe, G. Maiya
and Gonzalez, Myla
and Arora, Mona",
title="Resilience Informatics: Role of Informatics in Enabling and Promoting Public Health Resilience to Pandemics, Climate Change, and Other Stressors",
journal="Interact J Med Res",
year="2024",
month="Aug",
day="12",
volume="13",
pages="e54687",
keywords="health informatics",
keywords="data science",
keywords="climate change",
keywords="pandemics",
keywords="COVID-19",
keywords="migrations",
keywords="mobile phone",
doi="10.2196/54687",
url="https://www.i-jmr.org/2024/1/e54687",
url="http://www.ncbi.nlm.nih.gov/pubmed/39133540"
}


@Article{info:doi/10.2196/54064,
author="Bhawra, Jasmin
and Elsahli, Nadine
and Patel, Jamin",
title="Applying Digital Technology to Understand Human Experiences of Climate Change Impacts on Food Security and Mental Health: Scoping Review",
journal="JMIR Public Health Surveill",
year="2024",
month="Jul",
day="23",
volume="10",
pages="e54064",
keywords="climate change",
keywords="digital health",
keywords="ecoanxiety",
keywords="environmental hazards",
keywords="food security",
keywords="mental health",
keywords="scoping review",
keywords="smartphone apps",
keywords="digital apps",
keywords="mobile health",
keywords="mobile phone",
abstract="Background: The global impact of climate change ranges from intense heatwaves to extreme weather events that endanger entire ecosystems and people's way of life. Adverse climate change events place undue stress on food and health systems, with consequences for human food security and mental health status. Ubiquitous digital devices, such as smartphones, have the potential to manage existing and emerging climate-related crises, given their ability to enable rapid response, instant communication, and knowledge sharing. Objective: This scoping review aimed to identify digital apps being used to capture or address climate change impacts on food security and mental health to inform the development of a digital citizen science initiative. Methods: A scoping review was conducted using 3 peer-reviewed databases (PubMed, IEEE Xplore, and Web of Science) and manual gray literature searches of relevant organizational (ie, governmental and nonprofit) websites to identify articles and reports published between January 2012 and July 2023. Three separate searches were conducted in each database to identify digital apps focused on climate change and (1) food security, (2) mental health, and (3) food security and mental health. Two reviewers conducted initial screening, with a third reviewer resolving any discrepancies. Articles focused on climate change impacts on wildlife or agriculture (ie, not human food security) were excluded. Full-text screening was conducted for shortlisted articles, and a final data abstraction table was generated, summarizing key app features, contextual factors, and participant involvement. Results: From the 656 records screened, 14 digital apps met the inclusion criteria. The food security apps (n=7, 50\%) aimed to capture traditional knowledge to preserve food systems, conduct food security assessments, and aid users in decreasing food insecurity risk. The mental health apps (n=7, 50\%) assessed climate change--related stress and provided users with coping strategies following adverse weather events. No digital apps examined the intersection of climate change, food security, and mental health. Key app features included user-to-user communication (n=5, 36\%), knowledge databases (n=5, 36\%), data collection and analysis (n=3, 21\%), gamification (n=1, 7\%), and educational resources (n=2, 14\%) to address climate change impacts on food security or mental health. In total, 3 approaches to participant involvement were used across studies, including contributory (n=1, 7\%), collaborative (n=1, 7\%), and cocreative (n=1, 7\%) approaches, to ensure the relevance and use of digital apps. Conclusions: Most digital apps identified provided a service to citizens to either prevent adverse climate change--related health impacts or manage these effects following an acute event or a natural disaster. The capacity of ubiquitous digital tools to enable near real-time communication, the involvement of various stakeholder groups, and their ability to share relevant educational resources in a timely manner are important for developing tailored climate change adaptation and mitigation strategies across jurisdictions. ",
doi="10.2196/54064",
url="https://publichealth.jmir.org/2024/1/e54064"
}


@Article{info:doi/10.2196/54669,
author="Matzke, Ina
and Huhn, Sophie
and Koch, Mara
and Maggioni, Anna Martina
and Munga, Stephen
and Muma, Okoth Julius
and Odhiambo, Ochieng Collins
and Kwaro, Daniel
and Obor, David
and B{\"a}rnighausen, Till
and Dambach, Peter
and Barteit, Sandra",
title="Assessment of Heat Exposure and Health Outcomes in Rural Populations of Western Kenya by Using Wearable Devices: Observational Case Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jul",
day="4",
volume="12",
pages="e54669",
keywords="wearables",
keywords="wearable",
keywords="tracker",
keywords="trackers",
keywords="climate",
keywords="Africa",
keywords="environment",
keywords="environmental",
keywords="heat",
keywords="weather",
keywords="exposure",
keywords="temperature",
keywords="rural",
keywords="fitness trackers",
keywords="climate change",
keywords="health",
keywords="sub-Saharan Africa",
keywords="Kenya",
keywords="outcome",
keywords="outcomes",
abstract="Background: Climate change increasingly impacts health, particularly of rural populations in sub-Saharan Africa due to their limited resources for adaptation. Understanding these impacts remains a challenge, as continuous monitoring of vital signs in such populations is limited. Wearable devices (wearables) present a viable approach to studying these impacts on human health in real time. Objective: The aim of this study was to assess the feasibility and effectiveness of consumer-grade wearables in measuring the health impacts of weather exposure on physiological responses (including activity, heart rate, body shell temperature, and sleep) of rural populations in western Kenya and to identify the health impacts associated with the weather exposures. Methods: We conducted an observational case study in western Kenya by utilizing wearables over a 3-week period to continuously monitor various health metrics such as step count, sleep patterns, heart rate, and body shell temperature. Additionally, a local weather station provided detailed data on environmental conditions such as rainfall and heat, with measurements taken every 15 minutes. Results: Our cohort comprised 83 participants (42 women and 41 men), with an average age of 33 years. We observed a positive correlation between step count and maximum wet bulb globe temperature (estimate 0.06, SE 0.02; P=.008). Although there was a negative correlation between minimum nighttime temperatures and heat index with sleep duration, these were not statistically significant. No significant correlations were found in other applied models. A cautionary heat index level was recorded on 194 (95.1\%) of 204 days. Heavy rainfall (>20 mm/day) occurred on 16 (7.8\%) out of 204 days. Despite 10 (21\%) out of 47 devices failing, data completeness was high for sleep and step count (mean 82.6\%, SD 21.3\% and mean 86.1\%, SD 18.9\%, respectively), but low for heart rate (mean 7\%, SD 14\%), with adult women showing significantly higher data completeness for heart rate than men (2-sided t test: P=.003; Mann-Whitney U test: P=.001). Body shell temperature data achieved 36.2\% (SD 24.5\%) completeness. Conclusions: Our study provides a nuanced understanding of the health impacts of weather exposures in rural Kenya. Our study's application of wearables reveals a significant correlation between physical activity levels and high temperature stress, contrasting with other studies suggesting decreased activity in hotter conditions. This discrepancy invites further investigation into the unique socioenvironmental dynamics at play, particularly in sub-Saharan African contexts. Moreover, the nonsignificant trends observed in sleep disruption due to heat expose the need for localized climate change mitigation strategies, considering the vital role of sleep in health. These findings emphasize the need for context-specific research to inform policy and practice in regions susceptible to the adverse health effects of climate change. ",
doi="10.2196/54669",
url="https://mhealth.jmir.org/2024/1/e54669",
url="http://www.ncbi.nlm.nih.gov/pubmed/38963698"
}


@Article{info:doi/10.2196/53437,
author="Cummins, R. Mollie
and Shishupal, Sukrut
and Wong, Bob
and Wan, Neng
and Han, Jiuying
and Johnny, D. Jace
and Mhatre-Owens, Amy
and Gouripeddi, Ramkiran
and Ivanova, Julia
and Ong, Triton
and Soni, Hiral
and Barrera, Janelle
and Wilczewski, Hattie
and Welch, M. Brandon
and Bunnell, E. Brian",
title="Travel Distance Between Participants in US Telemedicine Sessions With Estimates of Emissions Savings: Observational Study",
journal="J Med Internet Res",
year="2024",
month="May",
day="15",
volume="26",
pages="e53437",
keywords="air pollution",
keywords="environmental health",
keywords="telemedicine",
keywords="greenhouse gases",
keywords="clinical research informatics",
keywords="informatics",
keywords="data science",
keywords="telehealth",
keywords="eHealth",
keywords="travel",
keywords="air quality",
keywords="pollutant",
keywords="pollution",
keywords="polluted",
keywords="environment",
keywords="environmental",
keywords="greenhouse gas",
keywords="emissions",
keywords="retrospective",
keywords="observational",
keywords="United States",
keywords="USA",
keywords="North America",
keywords="North American",
keywords="cost",
keywords="costs",
keywords="economic",
keywords="economics",
keywords="saving",
keywords="savings",
keywords="finance",
keywords="financial",
keywords="finances",
keywords="CO2",
keywords="carbon dioxide",
keywords="carbon footprint",
abstract="Background: Digital health and telemedicine are potentially important strategies to decrease health care's environmental impact and contribution to climate change by reducing transportation-related air pollution and greenhouse gas emissions. However, we currently lack robust national estimates of emissions savings attributable to telemedicine. Objective: This study aimed to (1) determine the travel distance between participants in US telemedicine sessions and (2) estimate the net reduction in carbon dioxide (CO2) emissions attributable to telemedicine in the United States, based on national observational data describing the geographical characteristics of telemedicine session participants. Methods: We conducted a retrospective observational study of telemedicine sessions in the United States between January 1, 2022, and February 21, 2023, on the doxy.me platform. Using Google Distance Matrix, we determined the median travel distance between participating providers and patients for a proportional sample of sessions. Further, based on the best available public data, we estimated the total annual emissions costs and savings attributable to telemedicine in the United States. Results: The median round trip travel distance between patients and providers was 49 (IQR 21-145) miles. The median CO2 emissions savings per telemedicine session was 20 (IQR 8-59) kg CO2). Accounting for the energy costs of telemedicine and US transportation patterns, among other factors, we estimate that the use of telemedicine in the United States during the years 2021-2022 resulted in approximate annual CO2 emissions savings of 1,443,800 metric tons. Conclusions: These estimates of travel distance and telemedicine-associated CO2 emissions costs and savings, based on national data, indicate that telemedicine may be an important strategy in reducing the health care sector's carbon footprint. ",
doi="10.2196/53437",
url="https://www.jmir.org/2024/1/e53437",
url="http://www.ncbi.nlm.nih.gov/pubmed/38536065"
}


@Article{info:doi/10.2196/58311,
author="Almasri, Abdullah
and El-Kour, Y. Tatyana
and Silva, Liliana
and Abdulfattah, Yousef",
title="Evaluating the Energy Efficiency of Popular US Smartphone Health Care Apps: Comparative Analysis Study Toward Sustainable Health and Nutrition Apps Practices",
journal="JMIR Hum Factors",
year="2024",
month="May",
day="10",
volume="11",
pages="e58311",
keywords="mobile health",
keywords="energy consumption in health care smartphone apps",
keywords="dietary tracking apps",
keywords="optimization and sustainability in mobile health",
keywords="user engagement and experience",
keywords="Android apps performance",
keywords="digital health technologies",
keywords="app",
keywords="apps",
keywords="applications",
keywords="digital health",
keywords="energy",
keywords="consumption",
keywords="sustainable",
keywords="sustainability",
keywords="environment",
keywords="environmental",
keywords="use",
keywords="smartphone",
keywords="smartphones",
keywords="electricity",
keywords="electrical",
keywords="mobile phone",
abstract="Background: The emergence of smartphones has sparked a transformation across multiple fields, with health care being one of the most notable due to the advent of mobile health (mHealth) apps. As mHealth apps have gained popularity, there is a need to understand their energy consumption patterns as an integral part of the evolving landscape of health care technologies. Objective: This study aims to identify the key contributors to elevated energy consumption in mHealth apps and suggest methods for their optimization, addressing a significant void in our comprehension of the energy dynamics at play within mHealth apps. Methods: Through quantitative comparative analysis of 10 prominent mHealth apps available on Android platforms within the United States, this study examined factors contributing to high energy consumption. The analysis included descriptive statistics, comparative analysis using ANOVA, and regression analysis to examine how certain factors impact energy use and consumption. Results: Observed energy use variances in mHealth apps stemmed from user interactions, features, and underlying technology. Descriptive analysis revealed variability in app energy consumption (150-310 milliwatt-hours), highlighting the influence of user interaction and app complexity. ANOVA verified these findings, indicating the critical role of engagement and functionality. Regression modeling (energy consumption = $\beta$? + $\beta$? {\texttimes} notification frequency + $\beta$? {\texttimes} GPS use + $\beta$? {\texttimes} app complexity + $\epsilon$), with statistically significant P values (notification frequency with a P value of .01, GPS use with a P value of .05, and app complexity with a P value of .03), further quantified these bases' effects on energy use. Conclusions: The observed differences in the energy consumption of dietary apps reaffirm the need for a multidisciplinary approach to bring together app developers, end users, and health care experts to foster improved energy conservation practice while achieving a balance between sustainable practice and user experience. More research is needed to better understand how to scale-up consumer engagement to achieve sustainable development goal 12 on responsible consumption and production. ",
doi="10.2196/58311",
url="https://humanfactors.jmir.org/2024/1/e58311",
url="http://www.ncbi.nlm.nih.gov/pubmed/38729624"
}


@Article{info:doi/10.2196/56130,
author="Tostain, Jean-Baptiste
and Mathieu, Marina
and Oude Engberink, Agn{\`e}s
and Clary, Bernard
and Amouyal, Michel
and Lognos, B{\'e}atrice
and Demoly, Pascal
and Annesi-Maesano, Isabella
and Ninot, Gr{\'e}gory
and Molinari, Nicolas
and Richard, Arnaud
and Badreddine, Maha
and Duflos, Claire
and Carbonnel, Francois",
title="The Primary Care and Environmental Health e-Learning Course to Integrate Environmental Health in General Practice: Before-and-After Feasibility Study",
journal="JMIR Form Res",
year="2024",
month="May",
day="9",
volume="8",
pages="e56130",
keywords="environmental health",
keywords="medical education",
keywords="One Health",
keywords="environment",
keywords="environmental",
keywords="eLearning",
keywords="e-learning",
keywords="remote",
keywords="learning",
keywords="online learning",
keywords="primary care",
keywords="satisfaction",
keywords="awareness",
keywords="behavioral",
keywords="behavior change",
keywords="questionnaire",
keywords="survey",
keywords="course",
keywords="educational",
keywords="teaching",
keywords="GP",
keywords="general practice",
keywords="general practitioner",
abstract="Background: Environmental and behavioral factors are responsible for 12.6 million deaths annually and contribute to 25\% of deaths and chronic diseases worldwide. Through the One Health initiative, the World Health Organization and other international health organizations plan to improve these indicators to create healthier environments by 2030. To meet this challenge, training primary care professionals should be the priority of national policies. General practitioners (GPs) are ready to become involved but need in-depth training to gain and apply environmental health (EH) knowledge to their practice. In response, we designed the Primary Care Environment and Health (PCEH) online course in partnership with the Occitanie Regional Health Agency in France. This course was used to train GP residents from the Montpelier-Nimes Faculty of Medicine in EH knowledge. The course was organized in 2 successive parts: (1) an asynchronous e-learning modular course focusing on EH knowledge and tools and (2) 1 day of face-to-face sessions. Objective: This study assessed the impact of the e-learning component of the PCEH course on participants' satisfaction, knowledge, and behavior changes toward EH. Methods: This was a pilot before-and-after study. Four modules were available in the 6-hour e-learning course: introduction to EH, population-based approach (mapping tools and resources), clinical cases, and communication tools. From August to September 2021, we recruited first-year GP residents from the University of Montpellier (N=130). Participants' satisfaction, knowledge improvements for 19 EH risks, procedure to report EH risks to health authorities online, and behavior change (to consider the possible effects of the environment on their own and their patients' health) were assessed using self-reported questionnaires on a Likert scale (1-5). Paired Student t tests and the McNemar $\chi$2 test were used to compare quantitative and qualitative variables, respectively, before and after the course. Results: A total of 74 GP residents completed the e-learning and answered the pre- and posttest questionnaires. The mean satisfaction score was 4.0 (SD 0.9) out of 5. Knowledge scores of EH risks increased significantly after the e-learning course, with a mean difference of 30\% (P<.001) for all items. Behavioral scores improved significantly by 18\% for the participant's health and by 26\% for patients' health (P<.001). These improvements did not vary significantly according to participant characteristics (eg, sex, children, place of work). Conclusions: The e-learning course improved knowledge and behavior related to EH. Further studies are needed to assess the impact of the PCEH course on clinical practice and potential benefits for patients. This course was designed to serve as a knowledge base that could be reused each year with a view toward sustainability. This course will integrate new modules and will be adapted to the evolution of EH status indicators and target population needs. ",
doi="10.2196/56130",
url="https://formative.jmir.org/2024/1/e56130",
url="http://www.ncbi.nlm.nih.gov/pubmed/38722679"
}


@Article{info:doi/10.2196/50588,
author="Katumba, Godfrey
and Mwanja, Herman
and Mayito, Jonathan
and Mbolanyi, Betty
and Isaasi, Fred
and Kibombo, Daniel
and Namumbya, Judith
and Musoke, David
and Kabazzi, Jonathan
and Sekamatte, Musa
and Idrakua, Lillian
and Walwema, Richard
and Lamorde, Mohammed
and Kakooza, Francis
and Etimu, Simon",
title="Establishing Antimicrobial Resistance Surveillance in the Water and Environment Sector in a Resource-Limited Setting: Methodical Qualitative and Quantitative Description of Uganda's Experience From 2021 to 2023",
journal="JMIRx Bio",
year="2024",
month="May",
day="7",
volume="2",
pages="e50588",
keywords="antimicrobial resistance",
keywords="surveillance system",
keywords="water and environment sector",
abstract="Background: Antimicrobial irrational use and poor disposal in the human and animal sectors promote antimicrobial resistance (AMR) in the environment as these antimicrobials and their active ingredients, coupled with resistant microbes, are released into the environment. While AMR containment programs in the human and animal sectors are well established in Uganda, those in the water and environment sector still need to be established and strengthened. Therefore, the Ministry of Water and Environment set out to establish an AMR surveillance program to bolster the One Health efforts for the containment of AMR under the National Action Plan 2018-2023. Objective: This study aims to describe Uganda's experience in establishing AMR surveillance in the water and environment sector. Methods: A methodical qualitative and quantitative description of the steps undertaken between August 2021 and March 2023 to establish an AMR surveillance system in the water and environment sector is provided. The Uganda Ministry of Water and Environment used a stepwise approach. Governance structures were streamlined, and sector-specific AMR surveillance guiding documents were developed, pretested, and rolled out. The National Water Quality Reference Laboratory infrastructure and microbiology capacity were enhanced to aid AMR detection and surveillance using conventional culture-based methods. A passive and targeted active surveillance hybrid was used to generate AMR data. Passive surveillance used remnants of water samples collected routinely for water quality monitoring while targeted active surveys were done at selected sites around the Kampala and Wakiso districts. Excel and Stata 15 statistical software were used for data analysis. Results: A sector-specific technical working group of 10 members and focal persons is in place, providing strategic direction and linkage to the national AMR surveillance program. The National Water Quality Reference Laboratory is now at biosafety level 2 and conducting microbiology testing using conventional culture-based techniques. Up to 460 water samples were processed and 602 bacterial isolates were recovered, of which 399 (66.3\%) and 203 (33.7\%) were priority pathogens and nonpriority pathogens, respectively. Of the 399 priority pathogens, 156 (39.1\%), 140 (35.1\%), 96 (24.1\%), and 7 (1.8\%) were Escherichia coli, Klebsiella species, Enterococcus species, and Salmonella species, respectively. E coli showed resistance to ampicillin (79\%), ciprofloxacin (29\%), and ceftriaxone (29\%). Similarly, Klebsiella species showed resistance to ampicillin (100\%), ciprofloxacin (17\%), and ceftriaxone (18\%). Enterococcus species showed resistance to ciprofloxacin (52\%), vancomycin (45\%), and erythromycin (56\%). Up to 254 (63.7\%) of the priority pathogens recovered exhibited multiple and extensive resistance to the different antibiotics set. Conclusions: Initial efforts to establish and implement AMR surveillance in the water and environment sector have succeeded in streamlining governance and laboratory systems to generate AMR data using conventional culture-based methods. ",
doi="10.2196/50588",
url="https://bio.jmirx.org/2024/1/e50588"
}


@Article{info:doi/10.2196/44823,
author="Pickard Strange, Martha
and Booth, Amy
and Akiki, Melissa
and Wieringa, Sietse
and Shaw, E. Sara",
title="The Role of Virtual Consulting in Developing Environmentally Sustainable Health Care: Systematic Literature Review",
journal="J Med Internet Res",
year="2023",
month="May",
day="3",
volume="25",
pages="e44823",
keywords="virtual consulting",
keywords="environmental sustainability",
keywords="systematic review",
keywords="carbon footprinting",
keywords="net zero",
keywords="mobile phone",
abstract="Background: Health systems globally need to rapidly set and achieve targets for reaching net zero carbon emissions. Virtual consulting (including video- and telephone-based consulting) is regarded as one means by which this might be achieved, largely through reduced patient travel. Little is currently known about the ways in which forms of virtual consulting might contribute to the net zero agenda or how countries may develop and implement programs at scale that can support increased environmental sustainability. Objective: In this paper, we asked, What is the impact of virtual consulting on environmental sustainability in health care? and What can we learn from current evaluations that can inform future reductions in carbon emissions? Methods: We conducted a systematic review of published literature according to PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. We searched the MEDLINE, PubMed, and Scopus databases using key terms relating to ``carbon footprint,'' ``environmental impact,'' ``telemedicine,'' and ``remote consulting,'' using citation tracking to identify additional articles. The articles were screened, and full texts that met the inclusion criteria were obtained. Data on the approach to carbon footprinting reported reductions in emissions, and the opportunities and challenges associated with the environmental sustainability of virtual consultations were extracted into a spreadsheet, analyzed thematically, and theorized using the Planning and Evaluating Remote Consultation Services framework to consider the various interacting influences, including environmental sustainability, that shape the adoption of virtual consulting services. Results: A total of 1672 papers were identified. After removing duplicates and screening for eligibility, 23 papers that focused on a range of virtual consulting equipment and platforms across different clinical conditions and services were included. The focus on the environmental sustainability potential of virtual consulting was unanimously reported through carbon savings achieved by a reduction in travel related to face-to-face appointments. The shortlisted papers used a range of methods and assumptions to determine carbon savings, reporting these using different units and across varied sample sizes. This limited the potential for comparison. Despite methodological inconsistencies, all papers concluded that virtual consulting significantly reduced carbon emissions. However, there was limited consideration of wider factors (eg, patient suitability, clinical indication, and organizational infrastructure) influencing the adoption, use, and spread of virtual consultations and the carbon footprint of the entire clinical pathway in which the virtual consultation was provided (eg, risk of missed diagnoses from virtual consultations that result in the need for subsequent in-person consultations or admissions). Conclusions: There is overwhelming evidence that virtual consulting can reduce health care carbon emissions, largely through reducing travel related to in-person appointments. However, the current evidence fails to look at system factors associated with implementing virtual health care delivery and wider research into carbon emissions across the entire clinical pathway. ",
doi="10.2196/44823",
url="https://www.jmir.org/2023/1/e44823",
url="http://www.ncbi.nlm.nih.gov/pubmed/37133914"
}


@Article{info:doi/10.2196/42516,
author="Diallo, Thierno
and B{\'e}rub{\'e}, Anouk
and Roberge, Martin
and Audate, Pierre-Paul
and Larente-Marcotte, St{\'e}phanie
and Jobin, {\'E}dith
and Moubarak, Nisrine
and Guillaumie, Laurence
and Dup{\'e}r{\'e}, Sophie
and Guichard, Anne
and Goupil-Sormany, Isabelle",
title="Nurses' Perceptions of Climate Change: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2023",
month="Jan",
day="11",
volume="12",
pages="e42516",
keywords="perception",
keywords="climate change",
keywords="nurse",
keywords="scoping review",
keywords="review method",
keywords="environment",
keywords="nursing",
keywords="perspective",
keywords="search strategy",
keywords="global warming",
keywords="health care professional",
abstract="Background: Climate change is a major threat to human health. Nurses are in contact with patients suffering from the effects of climate change in their daily work. Therefore, they need to be involved in combating it at both the individual and collective levels. However, there is still very little known about nurses' perception of climate change and their role toward it. A few recent studies have embarked on the process of examining the perceptions of these health professionals relative to climate change, but no exploratory review of the literature has been conducted on nurses' perception of this phenomenon. Objective: The purpose of this protocol is to develop a research strategy for an exploratory review of the literature focused on identifying nurses' perceptions of climate change. Methods: Firstly, with the help of a specialized librarian, we defined keywords and their combinations, using an iterative process, to develop a documentary search strategy. This strategy was tested in the following four bibliographic databases: MEDLINE (PubMed), CINAHL, Embase, and Web of Science. A search of the grey literature will also be conducted to supplement the results of the bibliographic database search. The next step will be for 2 members of the research team to carry out a 2-stage selection process using the web-based systematic review software Covidence. They will carry out this selection process independently, with the aim of identifying relevant studies that meet the inclusion criteria for our exploratory review. Finally, data on year of publication, authors, geographic area, article type, study objectives, methodology, and key findings will be extracted from selected articles for analysis. The data will be analyzed by the research team based on an in-depth examination of the findings and will be directed toward answering the research question and fulfilling the study's objective. Results: The results will help in defining nurses' perceptions of climate change more clearly as well as the role they can play and what they need to be able to bring forward solutions to this phenomenon. The findings should also serve to guide the health sector and nursing faculty's interventions aimed at preparing health professionals to act on the potential threats associated with climate change. Conclusions: The preliminary search suggests a possible gap between the importance of the nursing role in addressing the health impacts of climate change and the nurses' lack of knowledge and awareness on this matter. The results will allow for raising nurses' awareness of their role in the fight against climate change and the ways to address its health effects. This study will also open up new research perspectives on how to equip nurses to better integrate response to climate change issues into their professional practice. International Registered Report Identifier (IRRID): DERR1-10.2196/42516 ",
doi="10.2196/42516",
url="https://www.researchprotocols.org/2023/1/e42516",
url="http://www.ncbi.nlm.nih.gov/pubmed/36630170"
}


@Article{info:doi/10.2196/40831,
author="Ramaswamy, Priya
and Shah, Aalap
and Kothari, Rishi
and Schloemerkemper, Nina
and Methangkool, Emily
and Aleck, Amalia
and Shapiro, Anne
and Dayal, Rakhi
and Young, Charlotte
and Spinner, Jon
and Deibler, Carly
and Wang, Kaiyi
and Robinowitz, David
and Gandhi, Seema",
title="An Accessible Clinical Decision Support System to Curtail Anesthetic Greenhouse Gases in a Large Health Network: Implementation Study",
journal="JMIR Perioper Med",
year="2022",
month="Dec",
day="8",
volume="5",
number="1",
pages="e40831",
keywords="clinical decision support",
keywords="sustainability",
keywords="intraoperative",
keywords="perioperative",
keywords="anesthetic gas",
keywords="waste reduction",
keywords="fresh gas flow",
abstract="Background: Inhaled anesthetics in the operating room are potent greenhouse gases and are a key contributor to carbon emissions from health care facilities. Real-time clinical decision support (CDS) systems lower anesthetic gas waste by prompting anesthesia professionals to reduce fresh gas flow (FGF) when a set threshold is exceeded. However, previous CDS systems have relied on proprietary or highly customized anesthesia information management systems, significantly reducing other institutions' accessibility to the technology and thus limiting overall environmental benefit. Objective: In 2018, a CDS system that lowers anesthetic gas waste using methods that can be easily adopted by other institutions was developed at the University of California San Francisco (UCSF). This study aims to facilitate wider uptake of our CDS system and further reduce gas waste by describing the implementation of the FGF CDS toolkit at UCSF and the subsequent implementation at other medical campuses within the University of California Health network. Methods: We developed a noninterruptive active CDS system to alert anesthesia professionals when FGF rates exceeded 0.7 L per minute for common volatile anesthetics. The implementation process at UCSF was documented and assembled into an informational toolkit to aid in the integration of the CDS system at other health care institutions. Before implementation, presentation-based education initiatives were used to disseminate information regarding the safety of low FGF use and its relationship to environmental sustainability. Our FGF CDS toolkit consisted of 4 main components for implementation: sustainability-focused education of anesthesia professionals, hardware integration of the CDS technology, software build of the CDS system, and data reporting of measured outcomes. Results: The FGF CDS system was successfully deployed at 5 University of California Health network campuses. Four of the institutions are independent from the institution that created the CDS system. The CDS system was deployed at each facility using the FGF CDS toolkit, which describes the main components of the technology and implementation. Each campus made modifications to the CDS tool to best suit their institution, emphasizing the versatility and adoptability of the technology and implementation framework. Conclusions: It has previously been shown that the FGF CDS system reduces anesthetic gas waste, leading to environmental and fiscal benefits. Here, we demonstrate that the CDS system can be transferred to other medical facilities using our toolkit for implementation, making the technology and associated benefits globally accessible to advance mitigation of health care--related emissions. ",
doi="10.2196/40831",
url="https://periop.jmir.org/2022/1/e40831",
url="http://www.ncbi.nlm.nih.gov/pubmed/36480254"
}


@Article{info:doi/10.2196/42839,
author="Muschol, Jennifer
and Heinrich, Martin
and Heiss, Christian
and Hernandez, Mauricio Alher
and Knapp, Gero
and Repp, Holger
and Schneider, Henning
and Thormann, Ulrich
and Uhlar, Johanna
and Unzeitig, Kai
and Gissel, Christian",
title="Economic and Environmental Impact of Digital Health App Video Consultations in Follow-up Care for Patients in Orthopedic and Trauma Surgery in Germany: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="24",
volume="24",
number="11",
pages="e42839",
keywords="carbon neutrality",
keywords="digital health",
keywords="environmental impact",
keywords="health economics",
keywords="net-zero",
keywords="orthopedic",
keywords="sustainability",
keywords="telemedicine",
keywords="trauma surgery",
keywords="video consultations",
abstract="Background: Following the Riyadh Declaration, digital health technologies were prioritized in many countries to address the challenges of the COVID-19 pandemic. Digital health apps for telemedicine and video consultations help reduce potential disease spread in routine health care, including follow-up care in orthopedic and trauma surgery. In addition to the satisfaction, efficiency, and safety of telemedicine, its economic and environmental effects are highly relevant to decision makers, particularly for the goal of reaching carbon neutrality of health care systems. Objective: This study aims to provide the first comprehensive health economic and environmental analysis of video consultations in follow-up care after knee and shoulder interventions in an orthopedic and trauma surgery department of a German university hospital. The analysis is conducted from a societal perspective. We analyze both economic and environmental impacts of video consultations, taking into account the goal of carbon neutrality for the German health care system by 2030. Methods: We conducted a prospective randomized controlled trial comparing follow-up care with digital health app video consultations (intervention group) to conventional face-to-face consultations in the clinic (control group). Economic impact included the analysis of travel and time costs and production losses. Examination of the environmental impact comprised the emissions of greenhouse gases, carbon monoxide, volatile hydrocarbons, nitrogen oxides, and particulates, and the calculation of environmental costs. Sensitivity analysis included calculations with a higher cost per ton of carbon dioxide equivalent, which gives equal weight to the welfare of present and future generations. Results: Data from 52 patients indicated that, from the patients' point of view, telemedicine helped reduce travel costs, time costs, and production losses, resulting in mean cost savings of {\texteuro}76.52 per video consultation. In addition, emissions of 11.248 kg of greenhouse gases, 0.070 kg of carbon monoxide, 0.011 kg of volatile hydrocarbons, 0.028 kg of nitrogen oxides, and 0.0004 kg of particulates could be saved per patient through avoided travel. This resulted in savings of environmental costs between {\texteuro}3.73 and {\texteuro}9.53 per patient. Conclusions: We presented the first comprehensive analysis of economic and environmental effects of telemedicine in the follow-up care of patients in orthopedic and trauma surgery in Germany. Video consultations were found to reduce the environmental footprint of follow-up care; saved travel costs, travel time, and time costs for patients; and helped to lower production losses. Our findings can support the decision-making on the use of digital health during and beyond the COVID-19 pandemic, providing decision makers with data for both economic and environmental effects. Thanks to the pragmatic design of our study, our findings can be applied to a wide range of clinical contexts and potential digital health applications that substitute outpatient hospital visits with video consultations. Trial Registration: German Clinical Trials Register DRKS00023445; https://tinyurl.com/4pcvhz4n ",
doi="10.2196/42839",
url="https://www.jmir.org/2022/11/e42839",
url="http://www.ncbi.nlm.nih.gov/pubmed/36333935"
}


@Article{info:doi/10.2196/31389,
author="Bhawra, Jasmin
and Skinner, Kelly
and Favel, Duane
and Green, Brenda
and Coates, Ken
and Katapally, Reddy Tarun",
title="The Food Equity and Environmental Data Sovereignty (FEEDS) Project: Protocol for a Quasi-Experimental Study Evaluating a Digital Platform for Climate Change Preparedness",
journal="JMIR Res Protoc",
year="2021",
month="Sep",
day="15",
volume="10",
number="9",
pages="e31389",
keywords="food security",
keywords="food sovereignty",
keywords="food equity",
keywords="mental health",
keywords="solastalgia",
keywords="climate change impacts",
keywords="climate change preparedness",
keywords="digital health",
keywords="digital dashboards",
keywords="Indigenous health",
keywords="mobile phone",
abstract="Background: Despite having the tools at our disposal to enable an adequate food supply for all people, inequities in food acquisition, distribution, and most importantly, food sovereignty, worsen food insecurity. The detrimental impact of climate change on food systems and mental health is further exacerbated by a lack of food sovereignty. We urgently require innovative solutions to enable food sovereignty, minimize food insecurity, and address climate change--related mental distress (ie, solastalgia). Indigenous communities have a wealth of Traditional Knowledge for climate change adaptation and preparedness to strengthen food systems. Traditional Knowledge combined with Western methods can revolutionize ethical data collection, engagement, and knowledge mobilization. Objective: The Food Equity and Environmental Data Sovereignty (FEEDS) Project takes a participatory action, citizen science approach for early detection and warning of climate change impacts on food sovereignty, food security, and solastalgia. The aim of this project is to develop and implement a sustainable digital platform that enables real-time decision-making to mitigate climate change--related impacts on food systems and mental well-being. Methods: Citizen science enables citizens to actively contribute to all aspects of the research process. The FEEDS Project is being implemented in five phases: participatory project planning, digital climate change platform customization, community-led evaluation, digital platform and project refinement, and integrated knowledge translation. The project is governed by a Citizen Scientist Advisory Council comprising Elders, Traditional Knowledge Keepers, key community decision makers, youth, and FEEDS Project researchers. The Council governs all phases of the project, including coconceptualizing a climate change platform, which consists of a smartphone app and a digital decision-making dashboard. Apart from capturing environmental and health-related big data (eg, weather, permafrost degradation, fire hazards, and human movement), the custom-built app uses artificial intelligence to engage and enable citizens to report on environmental hazards, changes in biodiversity or wildlife, and related food and mental health issues in their communities. The app provides citizens with valuable information to mitigate health-related risks and relays big data in real time to a digital dashboard. Results: This project is currently in phase 1, with the subarctic M{\'e}tis jurisdiction of {\^I}le-{\`a}-la-Crosse, Saskatchewan, Canada. Conclusions: The FEEDS Project facilitates Indigenous Peoples' self-determination, governance, and data sovereignty. All citizen data are anonymous and encrypted, and communities have ownership, access, control, and possession of their data. The digital dashboard system provides decision makers with real-time data, thereby increasing the capacity to self-govern. The participatory action research approach, combined with digital citizen science, advances the cocreation of knowledge and multidisciplinary collaboration in the digital age. Given the urgency of climate change, leveraging technology provides communities with tools to respond to existing and emerging crises in a timely manner, as well as scientific evidence regarding the urgency of current health and environmental issues. International Registered Report Identifier (IRRID): PRR1-10.2196/31389 ",
doi="10.2196/31389",
url="https://www.researchprotocols.org/2021/9/e31389",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524106"
}


@Article{info:doi/10.2196/32958,
author="Atwoli, Lukoye
and Baqui, H. Abdullah
and Benfield, Thomas
and Bosurgi, Raffaella
and Godlee, Fiona
and Hancocks, Stephen
and Horton, Richard
and Laybourn-Langton, Laurie
and Monteiro, Augusto Carlos
and Norman, Ian
and Patrick, Kirsten
and Praities, Nigel
and Olde Rikkert, GM Marcel
and Rubin, J. Eric
and Sahni, Peush
and Smith, Richard
and Talley, Nick
and Turale, Sue
and Vazquez, Damian",
title="\#HealthyClimate: Call for Emergency Action to Limit Global Temperature Increases, Restore Biodiversity, and Protect Health",
journal="JMIR Public Health Surveill",
year="2021",
month="Sep",
day="5",
volume="7",
number="9",
pages="e32958",
keywords="climate change",
keywords="global warming",
keywords="emergency action",
doi="10.2196/32958",
url="https://publichealth.jmir.org/2021/9/e32958",
url="http://www.ncbi.nlm.nih.gov/pubmed/34483097"
}


@Article{info:doi/10.5210/ojphi.v9i1.7712,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2017",
volume="9",
number="1",
pages="e7712",
doi="10.5210/ojphi.v9i1.7712",
url=""
}