Public Health and Healthcare

Abstract: Background: In 2023, community-initiated biomonitoring was conducted among residents near the Daikin Industries Yodogawa Plant (DIYP), where PFOA contamination had previously been identified. Methods: Serum PFOA and questionnaire data were analyzed in 1,174 participants; 1,084 had complete data for 15 prespecified variables. Log10(PFOA) was modeled using multivariable regression, with model selection by AIC and Bonferroni correction. A sensitivity analysis excluded six consumers of self-grown agricultural products. We also theoretically examined the relationship between serum concentration and time-weighted average exposure using a one-compartment model with a lognormal Ornstein–Uhlenbeck exposure process. Results: Residence, age, fish consumption, drinking habit, laxative use, and tap-water use were significant determinants. Residents nearest DIYP had a geometric mean PFOA concentration of 5.95 ng/mL and adjusted concentrations 18%–21% higher than other areas. Predicted and observed stratum means were strongly correlated (r=0.927). Results remained significant in sensitivity analysis. The theoretical analysis showed that the white-noise limit provides a global lower bound for the serum–exposure correlation; for averaging over three biological half-lives, ρ≥0.858. Conclusions: Elevated PFOA near DIYP suggests that local exposure may have persisted after production ceased in 2012. Continued biomonitoring is warranted.

Abstract: Emerging and re-emerging zoonotic viruses transmitted by arthropods such as ticks, biting midges, and mosquitoes pose increasing public health concerns in Europe. Among these, Crimean-Congo haemorrhagic fever virus (CCHFV) stands out due to its high case fatality and expanding geographic range. In Portugal, growing ecological and climatic shifts, along with human and animal migration, create favourable conditions for the virus emergence. This review provides an overview of CCHFV epidemiology in Portugal, exploring the relevance of applying the Stockholm paradigm and the DAMA (Document, Assess, Monitor, Act) protocol as proactive tools for preparedness and mitigation. By incorporating ecological and evolutionary principles, these frameworks enable the anticipation of disease emergence and inform on targeted surveillance and response strategies. The integration of interdisciplinary approaches and early warning systems is crucial for strengthening One Health preparedness and ensuring timely action against CCHFV and other emerging vector-borne diseases in response to changing environmental conditions.

Abstract: Toxic elements (TEs) are widespread environmental contaminants that act as systemic toxicants and are recognized contributors to atherosclerotic cardiovascular disease (ASCVD) morbidity and mortality, posing significant health risks even at low levels of exposure. Increasing evidence indicates that, beyond their direct genotoxic effects, TEs exert pathogenic actions through epigenetic mechanisms that regulate gene expression without altering the underlying DNA sequence. Major epigenetic alterations associated with TE exposure include aberrant DNA methylation and dysregulation of non-coding RNAs, particularly microRNAs (miRNAs). These modifications may disrupt key vascular cellular processes involved in atherogenesis, including endothelial dysfunction, oxidative stress responses, inflammatory signaling, and lipid metabolism, thereby promoting the initiation and progression of atherosclerotic lesions. This literature review examines the epigenetic effects of TEs and highlights their role as potential mediators linking environmental exposures to increased susceptibility to atherosclerosis. Specifically, it summarizes the major classes of TEs, evaluates the evidence associating TE exposure with atherosclerotic cardiovascular outcomes, and discusses the mechanisms through which TE-induced epigenetic alterations may contribute to the development and progression of atherosclerotic disease.

Abstract: Background/Objectives: Strengthening public administration of epidemiological surveillance is a policy priority for the Republic of Kazakhstan amid globalization, the emergence of new pathogens, cross-border importation of quarantinable infections, and the high economic cost of recurrent epidemics. This study analyzed Kazakhstan’s sanitary-epidemiological legislation and evaluated the effectiveness of the public administration of its infectious disease surveillance system. Methods: We conducted a comparative analysis of current and repealed Kazakhstani legal acts against the World Health Organization International Health Regulations (2005), benchmarked against United States and Australian border-health law; a descriptive analysis of national infectious disease incidence per 100,000 population (2022–2024); and a multivariable ordinary least squares regression on a cross-sectional comparator sample of 12 countries (Kazakhstan, 10 Organisation for Economic Co-operation and Development [OECD] member countries, and Romania, an OECD accession candidate; 2023–2024) relating log-transformed 2024 measles incidence to 2023 second-dose (MCV2) measles vaccination coverage and the 2023 World Bank Government Effectiveness index. Results: The legal analysis identified substantial gaps, including the absence of a statutory definition of epidemiological surveillance and of public health emergency criteria, and fragmented regulation of border sanitary control. Vaccine-preventable disease incidence rose sharply in 2023–2024 despite consistently high (98.8%) average official first-dose (MCV1) measles vaccination coverage. The regression model explained 68.3% of cross-country variance in measles incidence (R² = 0.683; F(2,9) = 9.70; p = 0.006); government effectiveness was a significant predictor (B = −2.79; p = 0.007), whereas second-dose (MCV2) vaccination coverage was not (B = −0.03; p = 0.667). Conclusions: In the full-sample conventional OLS model, government effectiveness was associated with measles incidence whereas MCV2 coverage was not; however, this pattern was sensitive to the exclusion of Kazakhstan and to robust standard-error estimation, and should therefore be considered exploratory and hypothesis-generating rather than a confirmed determinant, given the small sample (n = 12). Kazakhstan should prioritize closing identified regulatory gaps and strengthening surveillance governance, informed by consolidated border-health models such as those of the United States and Australia.

Abstract: Background: Advanced glycation end products (AGEs) may link diet, systemic inflammation, and cognitive function; however, evidence in healthy young adults is limited. Objective: To examine the associations of dietary AGEs (dAGEs) intake, circulating AGE–RAGE biomarkers, inflammation, and oxidant–antioxidant markers with cognitive performance. Methods: This cross-sectional study included healthy young adults aged 19–26 years. dAGEs intake was estimated independently using a food-frequency questionnaire (FFQ) and a three-day food record (3D-FR). Serum AGEs (sAGEs), soluble RAGE (sRAGE), interleukin-6, tumour necrosis factor-alpha (TNF-α), malondialdehyde, catalase, superoxide dismutase, and glutathione were measured. Cognitive performance was assessed using Digit Span Forward, Backward, and Total scores and Stroop Interference. Separate multivariable linear regression models were adjusted for age, sex, body mass index, and depressive symptoms, with Benjamini–Hochberg false-discovery-rate correction. Covariate-adjusted partial least squares structural equation modelling (PLS-SEM) examined the prespecified AGE–RAGE–inflammation pathways. Results: Neither FFQ-derived nor 3D-FR-derived dAGEs intake was associated with serum AGEs. In the separate regression models, higher sAGEs (β = −0.36, 95% CI −0.54 to −0.16) and TNF-α (β = −0.33, 95% CI −0.53 to −0.13) were associated with poorer Digit Span Backward performance after false-discovery-rate correction. No other cognitive associations remained significant. In PLS-SEM, sAGEs were positively associated with sRAGE (β = 0.505, p < 0.001), and sRAGE was positively associated with inflammation (β = 0.601, p < 0.001). Greater inflammation was associated with poorer Digit Span Backward performance (β = −0.398, 95% CI −0.697 to −0.110, p = 0.009), whereas the direct sRAGE–Digit Span Backward path was not significant. An indirect inverse association between sRAGE and Digit Span Backward through inflammation was supported (β = −0.239, 95% bootstrap CI −0.457 to −0.057). Conclusions: Circulating AGE–RAGE-related and inflammatory activity, rather than estimated dAGEs intake, was associated with selected aspects of cognitive performance in healthy young adults. Longitudinal studies with larger samples are needed to establish temporality and confirm the significance of these associations.

Abstract: Uranium mining in Canada has been central to global nuclear development, from its early role in weapons production during World War II to its current use in nuclear energy and medical applications. This review examines the historical and contemporary effects of uranium mining on Indigenous peoples in Canada. A narrative review was conducted using peer-reviewed databases and Indigenous-led advocacy and knowledge platforms. Grey literature and community testimonies were also included to capture Indigenous perspectives, which are often absent from academic discourse. Overall, uranium mining has produced widespread and enduring consequences for Indigenous communities and their lands. Historical operations exposed workers and families to radiation, contributing to elevated rates of cancer and chronic disease. Contemporary projects continue to generate environmental contamination, food insecurity, and cultural disruption, while economic benefits remain inequitably distributed. Regulatory frameworks such as the Duty to Consult and Impact and Benefit Agreements have evolved but often fail to ensure free, prior, and informed consent. Indigenous activism and governance initiatives have driven policy shifts, yet gaps in health equity, environmental remediation, and recognition of sovereignty persist. These struggles mirror broader global patterns where Indigenous communities face disproportionate burdens of resource extraction to this day.

Abstract: This review assesses the influence of ADRB2 (beta-2 adrenergic receptor) gene polymorphisms on athletic performance and physiological function in humans. The literature was analysed for associations with results in cyclic endurance and speed-strength sports and for effects on the cardiovascular, respiratory and metabolic systems. The GG genotype of ADRB2 is associated with the body mass index of female rhythmic gymnasts and is positively related to successful performance in competition. The Arg16Gly variant influences the cardiovascular and respiratory systems and the expression of endurance in athletes. ADRB2 (rs1042713) has been linked to insulin resistance and to increased fat content in the central part of the body in non-athletes; carriers of the Gln/Gln genotype have less body fat than those with the Gln/Glu and Glu/Glu genotypes (rs1042714) (p = 0.050 and p = 0.009, respectively). The polymorphisms rs1042718 and rs1042719 are associated with longevity in men (A-C haplotype: OR = 1.49, p = 0.0007), and the GG genotype of rs1042714 increases the risk of myocardial infarction 3.3-fold (p = 0.021), indicating an indirect link between ADRB2 and life expectancy mediated by cardiovascular disease. The Arg16Gly and Gln27Glu polymorphisms are also associated with an increased risk of respiratory pathology. The data obtained across studies are highly contradictory, which may be due to differences in the populations studied, study design, ethnicity, measurement scales, nutrition and sample size. At present, the ADRB2 gene may be considered a candidate marker for talent identification in sport and for the assessment of the risk of certain diseases and injuries, although the available evidence remains inconsistent.

Abstract: Several studies have established a link between outdoor air quality and cardiovascular disease (CVD), with air pollution causing millions of premature deaths annually according to the WHO. However, a similar link has not been clearly established for indoor air quality (IAQ), despite the fact that people spend much of their time indoors. In this prospective observational study, we monitored IAQ parameters for several weeks in the homes of 49 patients referred for coronary CT angiography (CCTA) at two outpatient cardiology clinics in Amsterdam and compared them with their CCTA results. The monitored IAQ parameters were PM_2.5, PM₁₀ (particulate matter), and CO₂, while the CCTA outcomes included CAD-RADS scoring, coronary calcium quantification, vessel involvement, and the presence of obstructive disease. Patients were recruited from two Amsterdam neighborhoods with contrasting socioeconomic profiles, Amsterdam Zuid (n = 24) and Amsterdam Nieuw-West (n = 25). We found no strong systematic difference in indoor air quality between the two recruitment sites, but observed substantial within-neighborhood variability, suggesting that household-level factors may play an important role in indoor air quality. In this cohort, we found no significant association between residential indoor PM levels and CAD or obstructive CAD.

Abstract: The aim of the study was to compare a sample of Swedish military veterans with a sample of Ukrainian active-duty military personnel in terms of combat exposure, moral injury symptoms and indices of PTSD, depression and anxiety. Data collection took place in 2024, and questionnaire responses were obtained from 504 Swedish individuals (288 active-duty veterans and 216 veterans who had left the armed forces) and 308 Ukrainian active-duty military personnel using established scales. The Ukrainian respondents reported higher combat exposure and higher mean scores on scales designed to measure the severity of moral injury indication, PTSD indication, depression and anxiety. A profile (cluster) analysis based on all participants summarized the study findings. Profile I (n = 509) was dominated by Swedish participants and showed favorable results on the health scales. Profile II (n = 221) scored in the middle and Profile III (n = 71) was Ukrainian dominated and reported the least favorable scores on the health indices, including 70 of 71 scoring above the cutoff value on the PTSD indication scale. A practical suggestion for military healthcare, is to use moral injury indication scales and mental health scales for screening purposes.

Abstract: Urban green spaces (UGS) are increasingly recognized as important environmental resources that contribute to public health and psychological well-being in rapidly urbanizing cities. This study examines the relationship between urban green space usage and mental health outcomes, specifically psychological well-being (WHO-5) and anxiety (GAD-7), among residents of Baku, Azerbaijan. The study also aims to identify key patterns of green space use and evaluate their potential effects using Structural Equation Modeling (SEM). A cross-sectional design was employed, and data were collected using validated instruments, including the WHO-5 Well-Being Index and the GAD-7 Anxiety Scale, alongside a structured questionnaire assessing green space usage behaviors. The sample primarily consisted of students and young adults. Descriptive analyses were used to examine demographic characteristics and usage patterns, while SEM was applied to test the relationships between variables. The findings revealed that frequency of park visits, proximity to green spaces, and duration of park use did not have statistically significant direct effects on either psychological well-being or anxiety. However, a significant negative relationship was observed between well-being and anxiety, indicating that higher levels of well-being are associated with lower anxiety symptoms. The results suggest that green space usage alone may not directly predict mental health outcomes in the context of Baku, where green space availability and usage patterns are relatively limited and primarily short-term. Overall, the study highlights the importance of considering qualitative and contextual factors in understanding the mental health benefits of urban green spaces. The findings provide valuable implications for urban planning and public health policies aimed at improving the design, accessibility, and functionality of green spaces to better support psychological well-being in urban populations.

Abstract: Background: Work-related Musculoskeletal Disorders (WMSDs) are a prevalent issue in wall construction tasks due to repetitive movement and awkward postures. The current study aimed to evaluate the postural risks and joint reaction forces (JRFs) of the shoulder, elbow, and neck joints during wall construction tasks performed at 0 cm (foot) and 77 cm working heights. Methods: Twelve male students (age: 21.83±1.27 years) performed four simulated construction tasks. Actual body movement data were captured with Inertial Measurement Unit (IMU) sensors and processed in the AnyBody Modeling System via a 3D musculoskeletal (MSK) model. The Rapid Upper Limb Assessment (RULA) method was used to evaluate the postural risk level. The joint reaction forces were calculated by inverse dynamics simulation and analyzed using a two-way ANOVA. Results: Working at 0 cm height resulted in high RULA scores of 7 (very high risk) during mortar scooping and picking up the brick. Working at 77 cm height, all tasks had modal and median RULA scores of 4, indicating lower postural risk. ANOVA results showed highly significant main and interaction effects of working height and tasks on shoulder, elbow, and neck JRFs (all p<0.001). Height exhibited exceptionally large effect sizes on shoulder (partial η² = 0.98), and elbow (partial η² = 0.92) joints. Conclusions: Therefore, a working height approximately midway between the worker's knee and waist heights (averaging 77 cm) effectively minimizes both postural risk and biomechanical joint loading during wall construction tasks.

Abstract: Background: The Adult/Adolescent Sensory History (ASH) is a comprehensive self-report measure of sensory processing and integration in adolescents and adults. This study aimed to translate and culturally adapt the ASH into Turkish using an established cross-cultural adaptation process. Methods: A multistage process included forward translation, synthesis, linguistic review, back-translation, expert committee review, expert evaluation and pretesting. The adaptation team comprised 39 translators, linguists, multidisciplinary professionals and representatives of the target population. Qualitative feedback and descriptive statistics were used to evaluate linguistic clarity, conceptual equivalence, cultural appropriateness and comprehensibility. Results: The Turkish ASH demonstrated semantic, idiomatic, experiential and conceptual equivalence with the original. Minor linguistic modifications improved readability and fluency without altering conceptual content. Expert evaluation supported its clarity, comprehensibility, internal coherence and cultural relevance. During pretesting, participants considered the questionnaire clear, comprehensible and culturally appropriate; no items required conceptual modification. Although some participants noted that completion required considerable time and concentration, no further revisions were necessary. Conclusion: The Turkish ASH was successfully translated and culturally adapted while preserving the conceptual integrity of the original instrument. Further research should establish its psychometric properties in clinical and non-clinical populations.

Abstract: Survival of severe acute illness in rural frontier regions frequently results in discharge to distant institutional care rather than a return to the patient's home community. This care fragmentation creates community dislocation, stripping patients of local support systems during vulnerable recovery phases and generating unique transitional spiritual distress. Using 559 chronic and acute disease discharges from the New Mexico Hospital Inpatient Discharge Data (2021 to 2023), we isolated 74 Skilled Nursing Facility (SNF) transfers (13.2 percent of the cohort), of which 42 followed prolonged acute hospitalizations exceeding 14 days. We developed a Community Dislocation Index (CDI) integrating SNF transfer rates, prolonged acute stays, and rehabilitation-heavy diagnosis burdens. Spatial mapping revealed that rural counties experiencing high volumes of acute crises disproportionately exile recovering patients to urban institutional settings. The findings demonstrate that hospital chaplaincy must expand beyond end-of-life care to address the moral injury of autonomy loss and family separation, offering a reproducible framework for transitional spiritual care deployment in geographically fragmented healthcare networks.

Abstract: Semiconductor manufacturing relies on specialized yellow lighting in lithography fabs to prevent photoresist degradation, but such artificial lighting may raise concerns regarding human health and ESG goals. This study evaluates whether natural light-style candlelight can replace conventional yellow lighting while remaining photoresist- and human-friendly. We compare the two lighting conditions from fabrication, retinal, physiological, psychological, concentration, and visual perspectives. The findings provide seven reasons supporting candlelight: it better prevents photoresist degradation, reduces retinal stress, causes less melatonin suppression, improves reported comfort and psychological well-being, maintains working concentration, and provides favorable viewing clarity and ocular responses. Its chromaticity is also closer to the blackbody radiation locus, supporting a more natural lighting environment. These results indicate that blue-less candlelight-style illumination can satisfy key lithography-lighting requirements while supporting worker well-being. The proposed transition may therefore contribute to healthier and more sustainable semiconductor manufacturing environments and offers broader relevance to healthcare, education, architecture, and interior lighting applications.

Abstract: Increasing government attention on loneliness as a global health threat places pressure on public health agencies to develop evidence-based approaches. However, numerous systematic reviews in loneliness research have failed to explain the complexity of pop-ulation loneliness, with knowledge spread out across diverse natural and social science disciplines. An interdisciplinary review was conducted to identify common ground across disciplines on key causal mechanisms that can explain how loneliness epidemics are produced. Five stages of interdisciplinary reviews were followed to limit disciplinary bias and improve the logic of integrating knowledge across disciplines. The process identified 13 authoritative experts in loneliness. Their body of work on loneliness theory was compared for common ground with three public health frameworks that explain how society and human social life directly impact population health outcomes. A total of 85 books, book chapters, textbooks, review articles, research articles and government agency reports were included in this review. Literature primarily came from sociology, psychology, neuroscience, public health (general, social epidemiology, and environ-mental health), ecology, evolutionary biology, and philosophy of science. They identi-fied eight causal mechanisms contributing to loneliness outcomes. Results are integrated in a final Adapted Social Exposome Model on Loneliness.

Abstract: Background: Women constitute a growing yet underrecognized segment of the informal automobile repair sector in sub-Saharan Africa (SSA), entering male-dominated technical trades amid economic necessity and limited formal employment opportunities. These female artisans face compounded occupational health risks from chemical exposures, physical hazards, and gender-based discrimination, yet remain largely invisible in occupational health research and policy frameworks. This synthesis examines the epidemiology, hazard profile, reproductive health implications, and structural determinants of health among female automobile artisans in SSA. Methods: We conducted a narrative synthesis of peer-reviewed literature retrieved from Scopus, PubMed and Google Scholar databases. Search terms combined concepts of informal sector employment, automobile repair trades, occupational health hazards, gender, reproductive health, and SSA contexts. Inclusion criteria prioritized empirical studies, systematic reviews, and policy analyses addressing female participation in automobile trades, occupational exposures in informal automotive workshops, and gender dimensions of informal sector work. Quality appraisal emphasized methodological rigor, sample representativeness, and relevance to the synthesis objectives. Thematic synthesis organized findings across nine domains: epidemiology, hazard characterization, personal protective equipment access, reproductive health, psychosocial stressors, economic precarity, empowerment pathways, regulatory frameworks, and Sustainable Development Goal (SDG) alignment. Results: Female participation in automobile trades remains marginal across SSA, with women concentrated in lower-skill, lower-income activities and systematically excluded from technical apprenticeships and trade leadership. Occupational hazard profiles include lead exposure exceeding biological exposure indices, organic solvents with documented reproductive toxicity, polycyclic aromatic hydrocarbons, particulate matter, ergonomic stressors, thermal extremes, and traumatic injuries. Personal protective equipment remains scarce, gender-inappropriate in sizing and design, and underutilized due to cost barriers and workplace norms. Reproductive health implications are severe: lead crosses the placenta, solvents disrupt endocrine function, and absence of maternity protection forces women to work through pregnancy without accommodation. Psychosocial stressors include pervasive sexual harassment, workplace hostility, gender-based stigma, and the double burden of domestic and professional labor. Economic precarity traps women in poverty, with lower earnings than male counterparts, limited credit access, and intersecting vulnerabilities related to education, marital status, and geographic location. Regulatory frameworks systematically exclude informal workers from occupational health and safety legislation, labor protections, and social security. Despite explicit commitments under SDGs 3, 5, 8, and 10, evidence-policy gaps remain vast. Conclusions: Female automobile artisans in SSA face a syndemic of occupational health hazards, reproductive risks, gender-based violence, and structural exclusion. Addressing this crisis requires gender-responsive occupational health interventions, enforcement of labor protections in the informal economy, maternity safeguards, skills training pathways, and deliberate efforts to dismantle gender-based barriers in technical trades. Research priorities include prospective cohort studies of reproductive outcomes, biomonitoring of chemical exposures, intervention trials of gender-appropriate personal protective equipment, and participatory action research centering women's voices and agency.

Abstract: Background: AI chatbots are increasingly used to access health and nutrition information, but the quality and alignment of their responses with evidence-based dietary guidance remain uncertain. This study evaluated whether healthy eating recommendations generated by four AI chatbots aligned with the Dietary Guidelines for the Brazilian Population (DGBP) and whether their responses included content reflecting food corporations’ narratives. Methods: Between February and March 2026, ChatGPT, Gemini, DeepSeek, and Grok were evaluated using two questionnaires: a validated instrument developed to assess health professionals’ knowledge of the DGBP (GAB-1); and the second simulated a citizens’ interaction based on DGBP recommendations. Responses were assessed using the GAB-1 scoring system and two author-developed instruments assessing alignment with the DGBP and food corporations’ narratives. Results: All AI chatbots provided information consistent with the DGBP in the GAB-1 assessment. However, in the citizens’ interaction, they produced at least one response containing content misaligned with the DGBP or reflecting food corporations’ narratives. AI chatbots covered less than 50% of the DGBP’s main content, with no significant differences among them (p = 0.219). Conclusions: Although AI chatbots performed well when queried using technical terms, their nutrition advice to citizens included content inconsistent with the DGBP or reflecting food corporations’ narratives.

Abstract: Plastic waste co-processing in cement kilns is expanding in settings where independent emissions and health monitoring remain limited. This study examines community-reported concerns regarding possible cement-kiln plastic co-processing and associated environmental-health conditions in Obajana, Kogi State, Nigeria. A comparative cross-sectional survey and participatory exposure mapping were conducted from September to October 2023 among 616 participants: 313 in a community adjacent to the cement plant and 303 in a comparison community approximately 15 km away. Reported symptom prevalence was higher in Obajana for upper-respiratory symptoms (41% vs. 13%), dermatological symptoms (27% vs. 7%), and ocular symptoms (33% vs. 12%). Residents also described visible smoke plumes, particulate fallout, and ash-like deposition on household surfaces and water-storage containers. The study did not independently verify the facility’s waste feed or operating conditions and lacked site-specific pollutant measurements, clinical verification, individual-level exposure data, and adjustment for potential confounding. The findings therefore do not establish causation, source at- tribution, or the agents responsible; they constitute a community-level signal warranting independent environmental monitoring and more rigorous epidemiological investigation. The paper proposes a Grassroots-Informed Risk Assessment Framework that integrates community testimony, rapid expo- sure appraisal, participatory mapping, symptom screening, vulnerability assessment, precautionary risk characterization, and policy translation in data-scarce settings.

Abstract: Characterizing how the built environment shapes the health of aging populations is a growing priority for environmental assessment and for the spatial decision-support tools that inform age-friendly planning. Geographic information systems (GIS) allow neighborhood resources to be treated as measurable environmental exposures for older residents. We examined whether geographic information system (GIS)-derived measures of spatial accessibility to key urban resources are associated with cognitive impairment, physical and cognitive frailty subtypes, and polypharmacy in a cross-sectional study of 317 community-dwelling adults aged ≥65 years in the city of Talca, Chile. Physical frailty was assessed with the Fried phenotype, cognitive impairment with an abbreviated Mini-Mental State Examination, and polypharmacy as the daily use of ≥5 medications. A summary Urban Quality Index (UQI), a distance-based measure of spatial accessibility to neighborhood resources, was constructed from Euclidean distances and analyzed in quartiles and as a binary indicator. Cognitive impairment (25.2%), polypharmacy (49.5%), and frailty (35.0%) were highly prevalent and frequently co-occurred. In multivariable models adjusted for age, sex, education, body mass index, and nutritional risk, low UQI was not significantly associated with any outcome. Resource-specific distance patterns should be considered exploratory. These findings suggest that residence-based, straight-line accessibility may not capture the environmental exposures most relevant to healthy aging—consistent with the uncertain geographic context problem—and that richer indicators, such as walkability, public-space quality, physical barriers, and mobility-based exposure, are needed before such indices can support environmental decision-making. Given the cross-sectional design, the results are preliminary spatial associations and do not demonstrate that environmental accessibility influences these outcomes.

Abstract: This scoping review synthesized current evidence on the epidemiology of highly pathogenic avian influenza (HPAI) A(H5N1) clade 2.3.4.4b in U.S. dairy cattle and occupationally exposed workers, and identified potential mitigation strategies. Literature searches were conducted in PubMed, Web of Science, CAB Abstracts, FSTA, and AGRICOLA across three search periods (spanning January 1, 2024–September 30, 2025), supplemented with gray literature. A total of n = 53 peer-reviewed articles and n = 8 gray literature sources met the inclusion criteria. Current evidence suggests that the outbreak likely resulted from a single spillover from wild birds followed by sustained cattle-to-cattle transmission, with the mammary gland serving as a major site of viral replication. Human infections occurred primarily among occupationally exposed workers through direct contact with infected cattle or contaminated milk, with conjunctivitis being the predominant clinical presentation. Consistently recommended mitigation strategies included enhanced surveillance, biosecurity, improved milking hygiene, pre-movement testing of cattle, use of personal protective equipment, and worker education within a One Health framework. However, important knowledge gaps remain regarding the primary route of viral entry into cattle, the relative contribution of respiratory and fomite transmission, viral dissemination beyond the mammary gland, infection risk in beef cattle, and the effectiveness of current mitigation strategies under field conditions. Limited evidence is also available for protecting occupational groups other than dairy farmworkers. Overall, this review highlights the need for coordinated One Health approaches and further research to strengthen evidence-based prevention strategies for both animal and worker health.