Public Health and Healthcare

Abstract: Polyendocrine Metabolic Ovarian Syndrome (PMOS) is the most common endocrine disorder in working women. Workplace screening could contribute to the early diagnosis and treatment of this chronic condition. Women who participated in a 2022 health food promotion campaign were interviewed about PMOS symptoms during their in-office medical examination. Suspected cases were offered further evaluation. 28 of the 1,170 women examined had symptoms of suspected PMOS. By 2023, 21 of these diagnoses had been confirmed. The prevalence of newly diagnosed PMOS was 2.7% (CI95% 1.7; 4.2). The predictive value of the clinical suspicion of PMOS was 75% (CI95% 55.1; 89.3). Female workers with PMOS had a significantly higher frequency of eating disorders than their pre-menopausal colleagues; higher body mass index values (26.9±5.2 vs. 23.3±4.3), higher glycemia (120.5±49.3 vs. 81.7±25.2, p<0.001) and higher cholesterol values (232.7±24.5 vs. 181.6±37.7, p<0.001). PMOS patients also had lower sleep quality, higher anxiety and higher depression symptom scores than other workers of childbearing age. In conclusion, with a short interview during mandatory medical examinations, the occupational physician can make a significant contribution to the diagnosis of PMOS, thereby improving the quality of life of women and reducing damage to their health.

Abstract: The emergence of resistance in Enterobacterales to commonly used antibiotics, particularly the pandemic spread of Extended Spectrum Beta-Lactamase (ESBL)-producing Escherichia coli (ESBLEC) and Klebsiella pneumoniae (ESBLKP), poses a significant public health challenge. Infections caused by these organisms severely restrict treatment options, yet global data on intestinal carriage of ESBLEC and ESBLKP remain limited. Malaysia, a middle-income country in Southeast Asia, has seen a large influx of economic migrants from Indonesia, Bangladesh, and Nepal since the early 2000s. ESBLEC and ESBLKP prevalence rates in these countries rank among the highest in WHO regions, and Malaysia has reported increasing rates of isolation in parallel with rising migration. This article reviews studies on prevalence of ESBLEC and ESBLKP in Malaysia, Indonesia, Bangladesh, and Nepal from the time of their first reported isolation, together with information on economic migration patterns into Malaysia. We propose potential internal and external modes of intestinal ESBL transmission, and highlight initiatives for intervention to monitor the spread of ESBLs across borders in slowing its pandemic dissemination.

Abstract: Background: Burnout and suicide-related outcomes are major concerns in health professions education, but the relationship between them has been studied across heterogeneous professions, training stages, measures and educational settings. This scoping review mapped the extent and architecture of the evidence, distinguished direct associations from mediated, conditional and contextual pathways, and translated the findings into an educational safety pathway.The synthesis used four analytically distinct evidence lanes: (1) direct or predictive associations between burnout and suicide-related outcomes; (2) mediated, moderated or dimension-specific pathways; (3) null or attenuated associations after adjustment; and (4) co-occurrence or shared educational determinants without a direct effect estimate. This architecture prevented co-occurrence from being misrepresented as causation and maintained separation between burnout, psychological distress and suicide-related constructs. Owing to substantial heterogeneity in populations, measures, cut-points and effect metrics, statistical pooling was not undertaken.The searches identified 32,847 records. After removal of 5,605 duplicates, 27,242 unique records were screened; 533 progressed to detailed eligibility assessment and 159 reports were assessed in full text. Of these, 52 studies met the eligibility criteria. The final selection process and reasons for exclusion are shown in Fig. 1.Conclusions: Burnout should be treated as an educational-system safety signal, not as a stand-alone proxy for suicide risk. Health professions programmes should measure the constructs separately, protect confidentiality, provide non-punitive clinically governed support, and correct harmful conditions in learning environments. EDU-SAFE offers an implementation-ready framework for institutional adaptation and prospective evaluation.

Abstract: Students who study abroad frequently contend with several stressors at once—among them academic workload, adjustment to an unfamiliar cultural setting, and worries over political events unfolding in their home countries. Because psychological stress has been linked to bruxism, the present study set out to determine whether socio-political stress and perceived stress were related to clinical bruxism findings among Iranian university students studying in Turkey. A total of 113 Iranian university students took part in this cross-sectional pilot study. Data were gathered with a sociodemographic questionnaire, a socio-political stress assessment, and the Perceived Stress Scale (PSS-10). Clinical bruxism findings were evaluated independently by two blinded examiners. The socio-political module showed good reliability (α=0.834); PSS-10 reliability was lower than expected (α=0.562). Inter-examiner agreement was excellent (κ=0.900–1.000, including κ=0.982 for the primary bruxism outcome). Bruxism findings occurred in 63/113 (55.8%). Socio-political stress and PSS-10 correlated significantly (r=0.397, p<0.001) but did not differ by bruxism status. PSS-10 did not predict bruxism status in any model. Age (OR=1.438) and caffeine intake (OR=2.128) independently predicted higher bruxism odds (p<0.05); smoking did not. Socio-political stress correlated with perceived stress, but perceived stress was not independently associated with bruxism after adjustment. Age and caffeine intake, not perceived stress, were independently associated with bruxism. Larger, longitudinal, comparison-group studies are needed.

Abstract: How guests are guided to notice a destination may be as important as the natural features themselves. This article reports a distinct set of outcomes from three facilitator-led arms of a four-condition randomised field experiment whose service-evaluation findings have been published separately. The parent experiment allocated 120 adult resort guests equally, by individual manual lottery, to sky-focused cloud observation, forest-therapy elements, an active control session, or an ordinary stay. The present complete-case dataset comprised 84 participants with linked measurements immediately before and after an organised activity: cloud observation (n = 29), forest-therapy elements (n = 28), and active control (n = 27). The ordinary-stay group was outside the analytical scope because no additional session, and therefore no matched session-level measurement interval, was available. Outcomes in this paper were state anxiety, positive and negative affect, subjective restoration, perceived stress, connectedness with nature, six activity-specific experiential ratings, resting pulse, and blood pressure. Relative to active control, both nature-focused sessions showed more favourable short-term patterns on the central psychological measures. The sky-focused arm was especially associated with awe, widened mental perspective, and distance from immediate concerns; the forest-focused arm showed stronger sensory absorption, bodily awareness, grounding, and the greatest increase in nature connectedness. Cardiovascular changes were small and interpreted only as supportive field observations. The earlier companion publication examined a different module—experience quality, satisfaction, novelty, added value, and recommendation intention—and none of those endpoints is reanalysed here. The present results therefore concern immediate restorative response rather than perceived service performance. Their applicability is limited by the single-resort setting, lack of blinding, complete-case analysis, and absence of follow-up.

Abstract: Background/Objectives: Occupational justice has expanded conceptually and empirically over the past two decades, addressing inequalities related to health, participation, and rights. However, there has been no comprehensive bibliometric analysis of its global scientific output. The objective of this study was to analyze evolution, distribution, editorial structure, collaboration networks, and thematic domains of the literature on occupational justice, using classical bibliometric laws and scientific mapping techniques. Methods: A bibliometric study was conducted on 238 articles and reviews indexed in the Web of Science Core Collection (1982–2026), retrieved using the subject equation TS=(occupational NEAR/0 justice). The laws of Price (growth), Lotka (prolific authors), Bradford (journal dispersion), and Zipf (semantic concentration) were applied. Scientific mapping was performed using co-authorship and co-occurrence analysis from Keywords Plus^® via VOSviewer. Results: Scientific output showed exponential growth (R² = 87.29%), with an acceleration beginning in 2015 and thematic diversification between 2021 and 2026. The geographic distribution revealed a marked centrality of the Global North, along with the emergence of research hubs in the Global South. Just ten journals accounted for 75% of the output, forming a robust editorial nucleus. Co-authorship networks revealed three transnational clusters and bridge authors who facilitate the circulation of knowledge. The thematic map identified three interdependent macro-clusters: health and well-being, occupational practice and science, and justice and rights. Conclusions: Bibliometrics highlights the rapid expansion and editorial concentration of occupational justice, identifies geographic and thematic gaps, and proposes new agendas in digital, environmental, and decolonial fields. Although limited by its sources and methods, it helps guide priorities for more inclusive research, policies, training, and interventions.

Abstract: Climate change is increasing the frequency and intensity of extreme heat events, raising concern about prenatal thermal exposure as a potential risk factor for fetal brain development and offspring neurodevelopment. This systematic review aimed to synthesize evidence on prenatal heat exposure, placental inflammatory or stress-response pathways, and neurodevelopmental outcomes in offspring. A systematic literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, Google Scholar and Embase from database inception to 30 June 2026. Human observational studies, animal experiments and in vitro mechanistic studies were included when they examined prenatal or early-life heat exposure in relation to placental function, inflammatory or oxidative pathways, fetal brain development or offspring neurodevelopment. The included evidence linked prenatal heat exposure or maternal hyperthermia with neural tube defects, neurodevelopmental delay, language impairment, autism spectrum disorder, cerebral palsy and altered brain morphology. Early pregnancy appeared to be the most consistent vulnerability window, although later gestational exposure was also relevant. Experimental evidence suggested disruption of placental barrier function, glucocorticoid and serotonin signaling, inflammatory and oxidative pathways, myelination, apoptosis, and neural progenitor development. Prenatal heat exposure may contribute to neurodevelopmental vulnerability through a heat-related placenta–brain axis. Further prospective and mechanistic studies are needed.

Abstract: Tobacco addiction is a complex process whose main component is the brain reward system, at the center of which lies nicotine-induced dopamine release. This mechanism is combined with behavioral and environmental factors that perpetuate the habit. Another key element of this addiction is genetic predisposition, which will be the focus of this review. We will describe how genetic studies—from early research in twins and families to candidate gene association studies and genome-wide association studies—have identified key pathways mediating the mechanisms of tobacco addiction. We will review the most important findings and how certain genetic variants, either alone or in combination with others, can modify the cardiovascular risk associated with tobacco use. In addition, we will explore the opportunities these studies offer in the field of personalized medicine for pharmacological cessation therapies. In the future, it is clear that a multidisciplinary approach—combining genetics, clinical practice, and social sciences—will be necessary to transform tobacco use management into a precision-based model and reduce its impact on public health.

Abstract: Rabbit odontogenic abscesses are among the most challenging chronic infections encountered in exotic animal medicine because of their polymicrobial etiology, biofilm-associated persistence, and poor response to conventional antimicrobial therapy. Biofilm formation plays a central role in disease pathogenesis by promoting bacterial adhesion, extracellular polymeric substance (EPS) production, quorum sensing, metabolic heterogeneity, and persister-cell formation, collectively reducing antimicrobial susceptibility and contributing to treatment failure and recurrence. In addition to biofilm-mediated tolerance, antimicrobial resistance (AMR) further complicates disease management through mechanisms including horizontal gene transfer, efflux pump activation, enzymatic antibiotic degradation, reduced membrane permeability, and target modification. This review summarizes current knowledge on the microbiology, biofilm dynamics, and resistance mechanisms associated with rabbit odontogenic infections while examining recent advances in molecular diagnostics, including culture-independent sequencing technologies, metagenomics, and advanced imaging approaches. Current and emerging anti-biofilm strategies, such as local antimicrobial delivery systems, enzymatic biofilm disruption, quorum-sensing inhibitors, bacteriophage therapy, antimicrobial peptides, photodynamic therapy, and nanotechnology-based approaches, are critically discussed in the context of their potential application in rabbits. Comparative evidence from human endodontic infections and other veterinary biofilm-associated diseases highlights the translational relevance of rabbit odontogenic abscesses as a naturally occurring model for chronic polymicrobial infections. Finally, key research gaps are identified, emphasizing the need for standardized experimental models, integrated multi-omics analyses, longitudinal clinical investigations, and evidence-based antimicrobial stewardship. By integrating microbiology, bio-film biology, antimicrobial resistance, and One Health concepts, this review provides a comprehensive framework to support future research and improve the diagnosis, treatment, and prevention of rabbit odontogenic infections.

Abstract: Hand gesture recognition still remains one of the most important problems in human-computer interaction owing to some restrictions of the single-modality approach. Occlusion is among the drawbacks of the vision-based systems; on the other hand, the sensor-based methods lack spatial understanding of the gesture. This paper introduces the robust hybrid system that combines Manus MetaGloves and Orbbec depth sensing camera in order to provide the high-precision hand gesture recognition. The proposed system captures movements of the fine-grained finger joints: Metacarpophalangeal (MCP), Proximal Interphalangeal (PIP), and Distal Interphalangeal (DIP) using flex sensors, as well as acquires 3D spatial and depth information using the vision sensor.Data acquisition process included recording of multiple instances of fundamental hand gestures such as open, curved, and closed position of both hands. Data is acquired in a multimodal form and processed by the fusion method in order to increase the accuracy of gesture recognition. System implementation is done in Unity environment in order to provide real-time visualizations and interaction with the system. Evaluation results show that the hybrid approach provides much better performance in comparison with single-modality systems.

Abstract: Silica nanoparticles (SiNPs) are common nanoparticles that are widely used in industrial and medical applications. Inhalation exposure to SiNPs is frequently inevitable in modern society. While the adverse effects of SiNPs on lung injury have been extensively documented, the intrinsic mechanisms underlying SiNPs-induced pulmonary inflammation remain incompletely understood. This study demonstrates that the stimulator of interferon genes (STING) plays an essential role in SiNPs-triggered lung inflammation. In vitro, SiNPs induced bone marrow derived macrophags (BMDMs) death and activated the STING pathway. Knockout the expression of STING alleviated SiNPs-induced inflammatory responses and subsequent cell death. Further mechanism investigations revealed that STING activation promotes nuclear translocation of NF-κB p65 and subsequent activation of the NF-κB pathway, ultimately driving the secretion of inflammatory factors. In vivo, SiNPs-induced NF-κB activation and inflammatory infiltration were significantly attenuated in STING-deficient (STING⁻/⁻) mice. These findings reveal that targeting the STING signaling pathway may represent a potential therapeutic strategy for mitigating lung inflammation caused by silica particles.

Abstract: Per- and polyfluoroalkyl substances (PFAS) are a large class of persistent synthetic chemicals of global concern because of their widespread environmental occurrence, bioaccumulation potential, and adverse human health effects. Although numerous reviews have addressed individual aspects of PFAS chemistry, toxicity, exposure, or regulation, integrated evaluations encompassing exposure pathways, toxicological mechanisms, biomonitoring, epidemiology, and health-risk assessment remain limited. This structured narrative review critically synthesises peer-reviewed literature and authoritative reports from international regulatory organisations to provide a comprehensive assessment of legacy and emerging PFAS. The review examines major exposure pathways, toxicokinetics, molecular mechanisms of toxicity, biomonitoring approaches, epidemiological evidence, and advances in human health-risk assessment. Particular emphasis is placed on well-characterised legacy PFAS, especially perfluorooctane sulphonate (PFOS) and perfluorooctanoic acid (PFOA), while recognising the limited evidence available for many emerging alternatives. Current evidence identifies drinking water and dietary intake as the dominant exposure pathways and consistently associates PFOS, PFOA, perfluorohexane sulphonate, and related compounds with endocrine, immune, metabolic, developmental, and cardiovascular effects. These findings support a shift from single-compound assessments towards cumulative risk assessment frameworks encompassing both legacy and emerging PFAS. Important uncertainties remain regarding chronic low-dose exposure, mixture toxicity, replacement PFAS, and long-term health outcomes, highlighting the need for longitudinal biomonitoring, advanced exposure assessment, and internationally harmonised regulatory strategies to strengthen evidence-based public health protection.

Abstract: Background/Objectives: Alpine destinations combine high tourism intensity with location-bound natural health resources that position them as potentially salutogenic settings; however, the evidence connecting tourism, public health, and well-being in this context has never been systematically mapped. This scoping review charts the concepts, evidence, and knowledge gaps at this intersection, focusing on South Tyrol (Italy). Methods: This review followed the Joanna Briggs Institute methodology and PRISMA-ScR. Five databases (PubMed, Embase, CINAHL, Web of Science, and Scopus) were searched, supplemented by Publish or Perish searches of Google Scholar, Crossref, and OpenAlex. Records were screened against a Population–Concept–Context framework, with geographic restrictions applied at screening. Data were synthesized descriptively without aggregating effect estimates. Results: Of 4,163 records identified, 3,343 were screened, and 128 were assessed in full text; 33 sources were included (22 conceptual, 11 empirical), divided almost evenly between tourism and health science journals. Empirical evidence has concentrated on residents' quality of life and subjective well-being, with findings differing by outcome, scale, and tourism intensity. None of the included studies measured mental health outcomes. Only four empirical studies originated from the Alpine region, each addressing a different level of the destination system, and none from South Tyrol; evidence on tourism workers and older populations was exclusively conceptual. Conclusions: The field rests mainly on conceptual work distributed across two largely separate literatures. The evidence gap map identifies measured resident health outcomes, worker health, and population-specific groups as research priorities for tourism-intensive Alpine regions, for which South Tyrol offers a suitable setting.

Abstract: Eco anxiety commonly known as distress relating to perceived climate and ecological crises is increasingly reported among young people, particularly in high income and highly climate exposed contexts such as Australia and other OECD countries. While empirical research on eco anxiety has expanded rapidly, the underlying conceptual and theoretical frameworks remain fragmented, with limited consensus on definitions, mechanisms, and normative implications. This systematic conceptual review synthesises and critically evaluates the theoretical and conceptual models used to study eco anxiety and related constructs among young adults (approximately 18–35 years) in Australia and across OECD nations. By conducting a systematic search of multidisciplinary databases, the paper explores English language studies published up to March 2026 that explicitly applied, developed, or implied conceptual frameworks of eco anxiety or climate change anxiety in young adult samples. A broad array of models are grouped into a typology of seven families: (1) clinical and psychopathology oriented models, (2) environmental attitudes and concern models, (3) risk perception and appraisal models, (4) existential and phenomenological frameworks, (5) socio ecological and political–economy models, (6) coping and resilience frameworks, and (7) integrative and emergent eco anxiety–specific frameworks. Across these families, eco anxiety is variously conceptualised as a maladaptive symptom, a rational moral emotion, a driver of climate engagement, or a sociopolitical affect rooted in structural injustice. Major gaps include conflicting definitions, limited attention to developmental specificity in young adulthood, sparse cross cultural and Indigenous perspectives in the Australian context, and insufficient theorisation of digital media, colonial histories, and policy in shaping eco anxiety. The paper proposes a conceptual typology that locates eco anxiety at the intersection of emotional, cognitive, relational, and sociopolitical processes. A future research trajectory underpinned by pragmatic theoretical bases that prioritise pluralistic, context sensitive models and mixed methods designs is suggested. Implications for measurement, intervention, and climate and mental health policy are discussed, with particular attention to young adults in Australia and OECD settings.

Abstract: Buildings and urban spaces affect a user’s body — through attention, emotion, orienta-tion, recovery, social behavior, and stress regulation — yet architectural evaluation often lacks feedback loops. This paper develops a theoretical framework for evi-dence-responsive design evaluation. AI is not used here to generate architectural images. Operational design consciousness is the capacity of registering the effects of built form on sentient users, transmitting that information into judgment, distinguishing evidence from narrative, and being able to revise later action. Under this criterion, dominant stu-dio-conditioned architectural culture can behave less consciously than an empirically constrained AI system. This conclusion follows, not because AI is subjectively conscious, but because it can be forced to apply evidence that professional discourse often discounts. The paper proposes an architectural analogue of Asimov’s First Law of Robotics: an ar-chitect may not design a building or urban space that imposes cognitive, emotional, physiological, or social harm on users, nor through inaction allow such harm to persist. Christopher Alexander’s pattern language is interpreted as an architectural memory system of empathic design based on accumulated embodied feedback. The inverse Tu-ring test proposed here distinguishes prestige-script design discourse from evi-dence-responsive reasoning. An LLM—reading only the statistical regularities of the profession’s public discourse—can reproduce its defense-scripts with recognizable fidel-ity. The result is a practical framework for AI-assisted design diagnostics, harm-sensitive architectural judgment, and post-occupancy correction.

Abstract: Limited and unreliable water supply remains a major public health concern in many in under-served South African communities and can compromise household hygiene, water storage practices, health, and daily living activities. Magxaki, a peri-urban settlement in the Eastern Cape, of South Africa, reflects the structural and environmental vulnerabilities associated with water scarcity. This study therefore assessed the impact of water scarcity on the health and livelihoods of people living in this community. A cross-sectional community-based mixed-method study was conducted among adult residents of Magxaki. Participant data was collected using a semi-structured questionnaire which included sections on resident demographic characteristics, water sources, water access, sanitation, and household coping practices during water scarcity. Quantitative data were analysed using descriptive statistics in SPSS 30, while open-ended responses were coded to contextualize experiences. Most participants were female, and all valid participants reported living in Magxaki for more than six months. Although municipal piped water and JoJo tanks were among the reported household water sources, access and supply was constrained. Interrupted water service delivery was reported by 92% of the respondents, with many assuming their water source was unsafe to drink and highlighted the need for more clean water. The qualitative findings showed that water scarcity is linked to unreliable municipal supply, unsafe household practices, inadequate hygiene infrastructure, livelihood disruption and governance failures. The findings show that residents in Magxaki are driven to adopt coping strategies such as increased water storage, unsafe containers, and costly alternatives which expose them to increased health risks.

Abstract: Active surveillance of congenital anomalies is essential for identifying spatial patterns, temporal trends, and risk factors. In Brazil, one of the primary data sources for congenital anomaly surveillance is the Live Birth Information System (SINASC). However, the large volume of data and the complexity of its structure pose significant challenges for healthcare professionals without expertise in programming or data science. In this context, this study presents three interactive applications for the analysis of SINASC data: one designed for analyses at the municipal and state levels, and two dedicated to analyses at the healthcare facility level, with the aim of supporting surveillance activities and identifying regional disparities. The applications were developed in the R programming language, primarily using the Shiny package, and provide interactive maps, tables, and graphical summaries, together with spatial and temporal filtering capabilities. The analyses revealed substantial regional disparities in the reporting of congenital anomalies, particularly congenital heart diseases. Differences were also observed across variables such as race/ethnicity, mode of delivery, maternal educational attainment, and prenatal care indicators, reflecting in- equalities in access to and quality of healthcare services. These applications facilitate the exploration and interpretation of SINASC data, thereby strengthening congenital anomaly surveillance and supporting evidence-based public health decision-making in Brazil.

Abstract: The construction industry is still one of the most dangerous industries around the world, and the safety management process within it continues to be highly hierarchical and designed by engineers, regulators, and site managers rather than those workers whose exposure to risks is the highest. In this paper, I argue that the asymmetry in the processes of design of safety is systemic and results from the intersection of hierarchy, power-distance of the nation, and subcontracting of multi-level nature which reduce both accountability and voice of the workers. Using the theoretical framework consisting of the analysis of the safety-voice, power distance, and STAMP literature in addition to structural analysis of the construction sector of Istanbul, this paper shows that the mechanisms of law, contract, and culture prevent the processes of feedback which are important for resilience-oriented safety management. Based on the thresholds of Turkish labor laws for union recognition, subcontracting data, and a case of worker protest on the construction of Istanbul’s largest infrastructure project, there are three mechanisms of exclusion identified in this paper: legal threshold of representation that excludes construction workers structurally, subcontracting chains that diffuse responsibility for safety results from workers who bear the risk, and organizational hierarchy that discourages safety voice long before reaching any channel. There is a list of design principles that re-integrate workers’ feedback into safety control structure suggested in this paper as a contribution to resilience engineering practice.

Abstract: Background/Objectives: Healthcare students face occupational risk of hepatitis B vi-rus (HBV) exposure during clinical training, often many years after receiving their primary vaccination series in infancy or childhood. Progressive waning of an-ti-hepatitis B surface (anti-HBs) antibody titres, heterogeneous vaccination histories in international student cohorts, high rates of underreported needlestick injuries, and variable occupational health protocols across institutions raise important questions about the adequacy of pre-clinical immunization surveillance in this population. This review aimed to synthesize current evidence on hepatitis B immunization among healthcare students, focusing on occupational exposure risk, long-term vac-cine-induced immunity, clinical management of low or absent anti-HBs titres includ-ing post-exposure prophylaxis, and the specific challenges posed by multicultural aca-demic settings. Methods: A narrative review was conducted through a systematic lit-erature search of PubMed/MEDLINE and Scopus, covering publications from January 2000 to December 2025, supplemented by key seminal references. Search terms in-cluded combinations of "hepatitis B", "HBV vaccination", "anti-HBs", "healthcare stu-dents", "occupational exposure", "seroprotection", "long-term immunity", "needlestick injury", and "post-exposure prophylaxis". A total of 49 references were selected for in-clusion. Results: Needlestick and sharps injuries occur at measurable rates during clinical training, with medical students accounting for approximately 30% of occupa-tional exposure events in some series, and with underreporting rates estimated at 19–80% across studies. Pooled seroprotection prevalence at clinical training entry is ap-proximately 73.8% (95% CI 69.1–78.0%), with substantially lower rates among stu-dents vaccinated in infancy — as low as 28% at 16–20 years post-vaccination in longi-tudinal data — compared with adolescence. The majority of students with non-protective titres retain immunological memory, with 90.9% (95% CI 87.7–93.3%) demonstrating an anamnestic response after a single booster dose. Post-exposure prophylaxis pathways depend critically on pre-existing immunological status, rein-forcing the operational value of pre-clinical serological screening. International stu-dent cohorts present additional complexity due to heterogeneous vaccination sched-ules, documentation gaps, and variable natural immunity profiles. Conclusions: Sys-tematic pre-clinical serological screening encompassing anti-HBs, HBsAg, and an-ti-HBc, combined with evidence-based stepwise immunization management and structured educational interventions on safe sharps handling and reporting culture, is essential to protect healthcare students from occupational HBV exposure. Documented seroprotection status determines post-exposure prophylaxis decisions and, in some regulatory frameworks such as the Italian occupational health system, directly informs fitness for clinical duty assessments. These findings support a proactive, integrated approach to hepatitis B immunization surveillance in healthcare education, aligned with the WHO 2030 viral hepatitis elimination targets.

Abstract: Urban planetary health describes the dependence of human health on the ecological systems affected by urbanisation. Yet this relationship remains difficult to translate into planning and design, especially when human experience, ecological condition, biodiversity and environmental exposure must be assessed together. This conceptual framework article develops the Urban Planetary Health Experience-Ecology Framework (UPHEx-Eco) from a targeted critical synthesis spanning urban health, planetary health, One Health, healthy sustainable cities, urban ecology, environmental psychology, ergonomics, urban design and multimodal assessment. The framework is organised around the design relation: an evaluable link between a modifiable urban design variable, a human-experience response and an ecological-health response. By examining both responses in relation to the same design decision, UPHEx-Eco makes it possible to identify synergies, trade-offs and perceptual-ecological mismatches. It connects planetary pressures and urban living systems to design decisions, multispecies exposure, evidence, interpretation, actionable outputs and longer-term urban planetary health outcomes. A biodiverse urban park illustrates the framework's practical logic, and a methodological agenda identifies priorities for integrated assessment, ecological monitoring, interpretable decision support, ethical data governance and justice-oriented urban design.