RESUMO
Excavated soil and rock (ESR) and dredging spoils (DDS) account for 23 % of the total EU waste generation in 2020. This study performs a life cycle assessment and life cycle costing to quantify the potential environmental and cost savings resulting from increasing the level of ESR and DDS prepared for reuse and recycled in comparison to the business-as-usual practice. Scenarios for the waste management pathways based on the status quo, technical feasibility or normative impositions are assessed, including the potential contribution to achieving the European Green Deal goals. Results show that promoting preparing for reuse and recycling could lead to non-negligible GHG reductions (up to 3.6 Mt. CO2 eq.) and economic savings (EUR 12.3 billion) annually. Depending upon the scenario, 0.2 % to 1 % of the net annual GHG emissions reductions sought by the European Green Deal could be facilitated by scaling up improved circular management of ESR and DDS at the EU level. Finally, the study highlights the main barriers to scaling up to more circular (i.e., preparing for reuse and recycling) and better performing management options in Europe. The results provide new insights for the European Green Deal and circular economy policymaking for CDW.
RESUMO
BACKGROUND: People with asthma from ethnic minority groups experience significant morbidity. Culturally-specific interventions to reduce asthma morbidity are rare. We tested the hypothesis that a culturally-specific education programme, adapted from promising theory-based interventions developed in the USA, would reduce unscheduled care for South Asians with asthma in the UK. METHODS: A cluster randomised controlled trial, set in two east London boroughs. 105 of 107 eligible general practices were randomised to usual care or the education programme. Participants were south Asians with asthma aged 3 years and older with recent unscheduled care. The programme had two components: the Physician Asthma Care Education (PACE) programme and the Chronic Disease Self Management Programme (CDSMP), targeted at clinicians and patients with asthma respectively. Both were culturally adapted for south Asians with asthma. Specialist nurses, and primary care teams from intervention practices were trained using the PACE programme. South Asian participants attended an outpatient appointment; those registered with intervention practices received self-management training from PACE-trained specialist nurses, a follow-up appointment with PACE-trained primary care practices, and an invitation to attend the CDSMP. Patients from control practices received usual care. Primary outcome was unscheduled care. FINDINGS: 375 south Asians with asthma from 84 general practices took part, 183 registered with intervention practices and 192 with control practices. Primary outcome data were available for 358/375 (95.5%) of participants. The intervention had no effect on time to first unscheduled attendance for asthma (Adjusted Hazard Ratio AHR = 1.19 95% CI 0.92 to 1.53). Time to first review in primary care was reduced (AHR = 2.22, (1.67 to 2.95). Asthma-related quality of life and self-efficacy were improved at 3 months (adjusted mean difference -2.56, (-3.89 to -1.24); 0.44, (0.05 to 0.82) respectively. CONCLUSIONS: A multi-component education programme adapted for south Asians with asthma did not reduce unscheduled care but did improve follow-up in primary care, self-efficacy and quality of life. More effective interventions are needed for south Asians with asthma.
