The carbon footprint of epidural steroid injections: A pilot study.

BACKGROUND: Epidural steroid injections are common procedures in physical medicine and rehabilitation practice. However, their environmental impact has not been characterized. OBJECTIVE: The primary aim is to estimate and compare the carbon footprint of two standard injection kits used to perform epidural steroid injections at a single academic institution. Secondary objectives were (1) to create a step-by-step guide for estimating the carbon footprint of materials and (2) to survey physicians on practice patterns and identify areas for improvement. DESIGN: Pilot study. SETTING: Academic medical center. PARTICIPANTS: N/A. INTERVENTIONS: N/A. OUTCOME MEASURES: Carbon emissions measured in CO2 equivalents (CO2 eq). METHODS: Using guidance from the Greenhouse Gas Protocol, the carbon footprint of the two kits was estimated by taking the sum of carbon emissions resulting from the production of the kit materials and the carbon emissions resulting from the waste disposal of the kit materials. RESULTS: The carbon footprint of the transforaminal epidural steroid injection (TFESI) kit was estimated at 1.328 kg CO2 eq. The carbon footprint of the interlaminar epidural steroid injection (ILESI) kit was estimated at 2.534 kg CO2 eq. For both kits, the carbon emissions resulting from the production of the kits were greater than the emissions resulting from disposal. The survey of interventionalists performing TFESI revealed all respondents required materials in addition to those provided in the standard epidural kit. Despite this, kit materials were typically wasted in 62% of respondents. CONCLUSION: Creating a methodology for quantifying carbon emissions is the first step to reducing carbon emissions. Once emissions are measured, the health care industry can determine the most effective strategies for reducing its impact. Our analysis has shown that it is feasible to perform emissions calculations and delineates a clear method with publicly available resources. Solutions to reduce epidural injection carbon footprint waste may include improved kit customization.

Expressed and unexpressed social needs in low-income adults in the U.S.

Many healthcare organisations are now routinely screening patients for social needs such as food and housing. It is largely unknown whether the needs they identify would have been expressed by the patient in the absence of screening. To better understand expressed and unexpressed social needs, we administered a social needs screener to 1,397 low-income adults who called a 2-1-1 helpline in Missouri seeking assistance with social needs between June 2017 and October 2019. Merging data from the screener and 2-1-1, we found that the screener identified all of the social needs expressed to 2-1-1 for about half the participants, and on average identified at least one social need not expressed to 2-1-1 (i.e., unexpressed needs). Certain social needs (utility payment assistance, housing) were much more likely to be expressed than unexpressed, while others (childcare, employment, personal safety) were almost universally unexpressed. In regression analyses, having certain expressed needs significantly increased the odds of having certain unexpressed needs. For example, those seeking transportation assistance from 2-1-1 had greater odds of unexpressed needs for food (OR = 3.19; 95% CI = 1.45-7.02) and healthcare (OR = 2.18; 95% CI = 1.06-4.48) than those not expressing transportation needs. Those seeking employment assistance from 2-1-1 had greater odds of unexpressed needs for personal safety (OR = 3.04; 95% CI = 1.20-7.68) and healthcare (OR = 2.58; 95% CI = 1.15-5.77) than those not expressing employment needs. Implications for healthcare (screening detects expressed and unexpressed needs) and social service organisations (certain requests may be markers for other needs) are discussed.

Water metal contaminants in a potentially mineral-deficient population of Haiti.

This study aimed to characterize metal contaminant concentrations and assess temporal and spatial variability in the main drinking water sources of Cap-Haïtien, Haiti. Water sources from five communities were sampled in two seasons, June (2014) and October (2014), and analysed for a suite of metals. A geographic information system was used to examine the spatial distribution of sampling points. Metal concentrations were below the US Environmental Protection Agency (USEPA) primary drinking water standards. Mean manganese concentrations were comparatively higher in wells (254.5 µg/L), exceeding the USEPA secondary drinking water standard (50 µg/L). Higher mean Mg/Ca and Ba/Ca ratios (range 2.3-3.4) may indicate different interactions between seawater and groundwater throughout the year. Although metal concentrations were within the limits of the USEPA drinking water standards, emerging contaminants, such as manganese, showed concentrations in excess of recommended limits. These metals may interact with background nutritional status with potential implications for growth and development.