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This study assessed the hand hygiene performance in French nursing homes using the consumption of alcohol-based hand rubs (AHRs) as a surrogate. Nursing homes from the 17 French regions were contacted to collect their AHR consumption and occupancy in 2018 and 2019. A total of 1290 nursing homes from 15 French regions participated in the survey. The estimated median number of hand hygiene actions per resident-day was 1.48 (interquartile range: 1.04-2.03) in 2018 and 1.60 (1.10-2.26) in 2019. A significantly higher AHR consumption was observed in public nursing homes with an infection control team or link nurse.

In the light of the COP27 Climate Change Conference, the concept of the circular economy has come to the fore with promotion of reuse and recycling of appliances and materials from electronics to clothes. This concept has not been widely taken up by healthcare systems. In this perspective article, we discuss the idea of the circular economy and how, by extension, the concept of "circular medicine" with optimised hospital and medical clinic waste recycling might be promoted in the context of better stewardship of resources in healthcare management.

Water resource management in the UK is multifaceted, with a complexity of issues arising from acute and chronic stressors. Below average rainfall in spring 2020 coincided with large-scale changes to domestic water consumption patterns, arising from the first UK-wide COVID-19 lockdown, resulting in increased pressure on nationwide resources. A sector wide survey, semi-structured interviews with sector executives, meteorological data, water resource management plans and market information were used to evaluate the impact of acute and chronic threats on water demand in the UK, and how resilience to both can be increased. The COVID-19 pandemic was a particularly acute threat: water demand increased across the country, it was unpredictable and hard to forecast, and compounding this, below average rainfall resulted in some areas having to tanker in water to ‘top up’ the network. This occurred in regions of the UK that are ‘water stressed’ as well as those that are not. We therefore propose a need to look beyond ‘design droughts’ and ‘dry weather average demand’ to characterise the management and resilience of future water resources. As a sector, we can learn from this acute threat and administer a more integrated approach, combining action on the social value of water, the implementation of water trading and the development of nationwide multi-sectoral resilience plans to better respond to short and long-term disruptors.

Abstract We exploit changes in air quality seen during the COVID-19 lockdown over China to show how a cleaner atmosphere has notable co-benefits for solar concentrator photovoltaic energy generation. We use satellite observations and analyses of the atmospheric state to simulate surface broadband and spectrally resolved direct normal irradiance (DNI). Over Wuhan, the first city placed under lockdown, we show how the atmospheric changes not only lead to a 19.8% increase in broadband DNI but also induce a significant blue-shift in the DNI spectrum. Feeding these changes into a solar cell simulator results in a 29.7% increase in the power output for a typical triple-junction photovoltaic cell, with around one-third of the increase arising from enhanced cell efficiency due to improved spectral matching. Our estimates imply that these increases in power and cell efficiency would have been realised over many parts of China during the lockdown period. This study thus demonstrates how a cleaner atmosphere may enable more efficient large scale solar energy generation. We conclude by setting our results in the context of future climate change mitigation and air pollution policies.

Abstract In situ and ex situ spatially-resolved techniques are employed to investigate reactant distribution and its impacts in a polymer electrolyte fuel cell. Temperature distribution data provides further evidence for secondary flows inferred from reactant imaging data, highlighting the contribution of convection in heat as well as reactant distribution. Water build-up from neutron tomography is linked to component degradation, matching the pattern seen in the reactant distribution and thus suggesting that high, non-uniform local current densities shape degradation patterns in fuel cells. The correlations shown between different techniques confirm the use of the versatile reactant imaging technique, which is used to compare commonly used flow field designs. Among serpentine-type designs, the single serpentine is superior in both equivalent current density and reactant distribution, showing large contributions from convective flow. On the other hand, the interdigitated design is shown to produce larger equivalent current densities, while showing a somewhat poorer reactant distribution. Considering the correlations drawn between the techniques, this suggests that the interdigitated design compromises durability in favour of power output. The results highlight how established techniques provide a robust background for the use of a new and flexible imaging technique toward designing advanced flow fields for practical fuel cell applications.

Background: Sodium oxybate (SMO) has been shown to be effective in the maintenance of abstinence (MoA) in alcohol-dependent patients in a series of small randomized controlled trials (RCTs). These results needed to be confirmed by a large trial investigating the treatment effect and its sustainability after medication discontinuation. Aims: To confirm the SMO effect on (sustained) MoA in detoxified alcohol-dependent patients. Methods: Large double-blind, randomized, placebo-controlled trial in detoxified adult alcohol-dependent outpatients (80% men) from 11 sites in four European countries. Patients were randomized to 6 months SMO (3.3–3.9 g/day) or placebo followed by a 6-month medication-free period. Primary outcome was the cumulative abstinence duration (CAD) during the 6-month treatment period defined as the number of days with no alcohol use. Secondary outcomes included CAD during the 12-month study period. Results: Of the 314 alcohol-dependent patients randomized, 154 received SMO and 160 received placebo. Based on the pre-specified fixed-effect two-way analysis of variance including the treatment-by-site interaction, SMO showed efficacy in CAD during the 6-month treatment period: mean difference +43.1 days, 95% confidence interval (17.6–68.5; p = 0.001). Since significant heterogeneity of effect across sites and unequal sample sizes among sites ( n = 3–66) were identified, a site-level random meta-analysis was performed with results supporting the pre-specified analysis: mean difference +32.4 days, p = 0.014. The SMO effect was sustained during the medication-free follow-up period. SMO was well-tolerated. Conclusions: Results of this large RCT in alcohol-dependent patients demonstrated a significant and clinically relevant sustained effect of SMO on CAD. Trial registration: ClinicalTrials.gov Identifier: NCT04648423

As several contributions in this issue of International Journal of Public Health suggest (in particular that from Kjellstrom 2009), there is a wide range of potential—direct and indirect—health consequences of climate change. However, the science of such effects is still in its infancy and faces considerable challenges, as we try to suggest in our contribution (Xun et al. 2009). Possible events attributable to climate change range from rapid and catastrophic to slow and mild. For example, IPCC does not rule out (though it is very unlikely) a cascade of events leading to Bangladesh being swept away because of rapid Himalayan glacier melting. Apart from extreme and unlikely effects, some of the direct consequences of climate change are rather obvious and can be easily perceived, such as the deaths related to heat waves in Europe in 2003. The causal pathway in these cases is clear, and does not require any particularly sophisticated epidemiological technique. Confounding is irrelevant as far as we consider the causal association between the climate event (heat wave) and its direct health consequences. But still: were all heat waves in the recent past due to what we call climate change, i.e. a man-made trend in temperature and its related epiphenomena? Was the flood in Bangladesh in 1974 the first attributable to climate change, or the last not due to it? And what about the one in 1998? Clearly borders are fuzzy, and causal chains intricate. Uncertain inferences on the causal nature of events also concern the attribution to climate change of indirect health effects, such as infectious disease outbreaks, changes in food quality and availability, water salinization and the ensuing epidemic of hypertension (Xun et al. 2009). Even wars and conflicts (like in Darfur), mass migrations and effects on mental health have been attributed to climate change. In a survey conducted among children aged between 2 and 9 in Bangladesh, Durkin et al. (1993) found post-flood changes in behaviour and bedwetting. Children were reported to have ‘‘very aggressive behaviour’’ after floods, with a significant increase compared to the preflood situation. A qualitative study explored the experiences of female adolescents during the 1998 floods in Bangladesh, focusing on the implications of sociocultural norms related to notions of honour, shame, purity and pollution. A number of the girls were vulnerable to sexual and mental harassment through exposure to unfamiliar environment of flood shelters and relief camps. Common mental health disorders following climate-induced displacement include anxiety, depression, post-traumatic stress disorder, irritability, sleeplessness and suicide. Moreover, conflict situations that may arise among farmers in times of climate-induced natural disasters like droughts and floods need to be addressed. Is all of this attributable to what we call climate change? Where are the borders between the burden of events that would occur anyhow, particularly in low-income countries, even in the absence of climate change, and those attributable to the latter? How can we identify the chain of events that eventually explains the local outbreak? Again, fuzzy borders have to be acknowledged. It should be noted that the effects we have described are mainly occurring or Paolo Vineis is Chair of Environmental Epidemiology at Imperial College, London. His main interests are in the field of molecular epidemiology and gene–environment interactions. He also works on climate change with the Grantham Institute for Climate Change in London.