Public Health and Healthcare

Abstract: The increasing popularity of wilderness recreation, expedition travel, military deployments, and scientific missions in remote environments has heightened the importance of medical preparedness for conditions that cannot be managed through immediate access to definitive healthcare. Although dental emergencies rarely threaten life directly, they may cause severe pain, impair nutrition and hydration, reduce operational performance, and necessitate premature evacuation, potentially compromising the success of an expedition or mission. Despite these consequences, dental emergencies remain comparatively underrepresented in the wilderness medicine literature. This narrative review summarizes the current evidence regarding the epidemiology, prevention, diagnosis, and field management of dental emergencies occurring in wilderness, expeditionary, military, maritime, and other austere environments. Evidence was synthesized from studies involving trekking expeditions, Antarctic research stations, military operations, and other isolated settings, together with relevant publications from emergency dentistry and travel medicine. Across these environments, dental caries and failed restorations consistently represent the leading causes of dental emergencies, followed by pulpal and periapical disease, periodontal infections, third molar pathology, traumatic dental injuries, and prosthodontic complications. Most emergencies are potentially preventable through appropriate pre-departure dental assessment and optimization of oral health. Furthermore, many conditions can be managed conservatively in the field using basic analgesia, temporary restorative materials, and simple emergency dental kits, whereas a smaller proportion require evacuation for definitive treatment. Current evidence is largely derived from observational military and expedition studies, with limited data from civilian wilderness expeditions.

Abstract: Heatwaves are increasing in the Mediterranean regions due to climate change and urbanization. The primary objective of this study is to quantify the association between heatwave exposure and cardiovascular disease (CVD) mortality in Mediterranean urban populations. Following PRISMA guidelines, we systematically searched PubMed/MEDLINE, Embase, Web of Science, and Scopus to retrieve literature published between 1 January 2000 and 15 April 2026. Finally, 18 studies (25 city-specific estimates) met the inclusion criteria. Pooled relative risks (RR) with 95% confidence intervals (CIs) were calculated using random-effects models with Knapp-Hartung adjustment. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) and the ROBINS-I tool. Results demonstrate that heatwaves significantly increased CVD mortality risk (RR = 1.21; 95% CI: 1.18–1.25; p < 0.001), corresponding to a 21% increase. Quality assessment revealed generally high methodological rigor, with 12 studies (66.7%) rated as high quality (NOS ≥7 stars) and no studies at serious or critical risk of bias per ROBINS-I. Subgroup analyses showed higher risks in the Eastern Mediterranean (RR = 1.23) compared to the Western Mediterranean (RR = 1.18). Exploratory assessments suggested elevated vulnerability during prolonged events, among the elderly, and during high nighttime temperatures. In conclusion, heatwaves pose a substantial threat to cardiovascular health in Mediterranean cities, warranting targeted early warning systems and urban cooling strategies.

Abstract: Healthcare systems face increasing pressure from demographic, technological, and organizational changes that intensify psychosocial risks and threaten both healthcare workers’ well-being and patient safety. This study investigates whether burnout medi-ates the relationship between psychosocial risk factors and patient safety culture in healthcare settings. A cross-sectional study was conducted with 220 Portuguese healthcare workers using three validated instruments: the Psychosocial Risk Factors Scale (INSAT_ERPS), the Burnout Assessment Tool (BAT-23), and the Hospital Survey on Patient Safety Culture (HSOPSC). Descriptive statistics, Pearson correlations, and mediation analyses were performed using SPSS and the PROCESS macro. Results showed a moderately strong positive association between psychosocial risks and burnout, and a significant negative association between burnout and patient safety culture. Psychosocial risks were not directly associated with patient safety culture; however, burnout fully mediated this relationship, indicating that adverse working conditions impair safety perceptions primarily through their impact on psychological strain. These findings highlight burnout as a key mechanism linking unsustainable working conditions to unsafe care, indicating the relevance of the psychosocial envi-ronment. Targeted interventions to reduce psychosocial risks are thus fundamental to improving patient safety culture and promoting the sustainable functioning of healthcare systems.

Abstract: The African esophageal squamous cell carcinoma (ESCC) corridor extends from Ethiopia to the Eastern Cape and contains some of the highest age-standardised ESCC incidence rates reported anywhere, with five-year survival below 5%. The corridor's heterogeneous incidence (sex ratios from 1:1 to 7:1; tenfold variation between adjacent populations) has resisted single-factor explanation through more than half a century of investigation. We synthesise the multicentre evidence accumulated since the IARC 2018 Group 2A classification of very hot beverages (> 65°C), with particular attention to the African Esophageal Cancer Consortium (ESCCAPE) outputs and to whole-genome sequencing. We argue, on the convergent evidence of animal toxicology, human in vitro mucosa, and population genomics, that thermal exposure acts as a tumour promoter rather than initiator, and that the corridor's heterogeneous burden reflects heterogeneous chemical co-exposure profiles operating against a shared thermal-promoter substrate. Extending the comparative margin-of-exposure (MOE) methodology to oesophageal squamous carcinogenesis, we present an MOE framework distinguishing genotoxic compounds (within-mode-of-action additive) from thermal exposure (separate companion figure), and apply it to two corridor scenarios. The framework supports a four-lever prevention strategy combining tobacco control, alcoholic-strength reduction in unrecorded spirits, clean-cookstove deployment, and graduated thermal-exposure reduction.

Abstract: The hybrid methodology first employed the Fire Risk Assessment Method for Engineers Method (FRAME) for initial screening across thirty-one departments. The facilities department (Occupants Risk: 3.199) was subsequently identified as the critical department. A Building Information Modeling (BIM) model of the facilities department was developed for computational analysis: Fire tenability (Available Safe Egress Time (ASET)) was determined using PyroSim software, and evacuation dynamics (Required Safe Egress Time (RSET)) were modeled using Pathfinder software. The FRAME analysis showed 90% of assessed departments were unacceptable occupant risk. In the Facilities Department, baseline simulation confirmed untenable conditions (ASET= 154 s &lt; RSET, avg. 259.7 s). Post-intervention strategies (automatic suppression and optimized egress routes) led to a significant decrease in Occupants Risk (from 3.199 to 1.1) and substantially reduced the average evacuation time to 26.6 s. Integrating FRAME screening with advanced FDS and evacuation simulations provides a robust, two-stage methodology for fire safety engineering in complex buildings. The findings conclusively demonstrate the effectiveness of targeted interventions in converting a critically unsafe scenario into a secure, tenable environment, offering validated guidance for safety professionals.

Abstract: Risk perception is an important factor in individual and community disaster response, but there is a paucity of research on specific factors that influence it, particularly in rural and disadvantaged populations. In this observational study after the 2023 East Palestine train derailment, 288 participants (84 male; 198 female, 6 unknown; 94% white), completed a survey of their health and environmental concerns about drinking water, soil and air due to chemical exposures from the derailment. Factors potentially related to risk perception, {demographic, health (new and pre-existing symptoms), and temporal and geographic proximity to the derailment site], were measured. Binomial logistic regression assessed the relative relationships of these factors to outcomes. Residents with new symptoms had > 10 times the odds of having extreme health concerns (OR: 10.67, 95% CI: 3.90 – 29.19,) and >4 times the odds of environmental concerns (OR: 4.32, 95% CI: 1.70 – 10.99) than those without new symptoms, controlling for all other factors. Residents closer to the site had greater health and environmental concerns and had higher economic disadvantage. Environmental concerns increased over time and were higher for households with children and for non-smokers. Continued symptom monitoring and longitudinal studies are needed to accurately inform public health communications to residents. Messaging strategies in public health disasters should consider determinants of risk perception to achieve a balance between reducing perceived risk and validating community concerns.

Abstract: Food defense encompasses both the prevention of accidental contamination and the protection of food and water systems against deliberate adulteration. Within this framework, algal toxins deserve greater attention because they occupy a critical intersection of water security, seafood and drinking-water safety, environmental change, supply-chain continuity, and public health preparedness. The novelty of this review lies in reframing algal toxins from a primarily environmental, seafood-safety, or clinical-toxicology topic into an integrated food-and-water defense problem. This perspective brings together harmful algal bloom ecology, toxin toxicology, seafood safety, drinking-water protection, preparedness for intentional adulteration, climate-change risk, surveillance, and emergency response. Algal toxins can enter the human supply chain through multiple marine and freshwater pathways, are often undetectable by taste, odor, or appearance, may resist routine preparation measures, and can generate high-consequence disruptions even when contamination begins locally. The analysis further shows that prevention depends largely on upstream measures--including environmental surveillance, harvest-area restrictions, source-water protection, testing, supply-chain controls, and rapid public communication--rather than on consumer behavior. Framed in the context of the U.S. Food and Drug Administration’s Intentional Adulteration Rule under the Food Safety Modernization Act, this paper situates algal toxins within a preventive defense model that integrates monitoring, vulnerability reduction, and emergency preparedness. Although most harmful algal bloom events are naturally occurring, algal toxins warrant attention in food-defense planning because they can contaminate seafood and drinking-water systems, complicate detection and attribution, and expose vulnerabilities across interconnected food and water infrastructures.

Abstract: Indigenous youth in Canada experience disproportionate mental health challenges, highlighting the need to better understand behavioural and contextual factors influencing wellbeing. This study examined the association between alcohol use and self-reported mental health among Indigenous adolescents, with attention to gender and age differences. Cross-sectional data from 64 participants in the Smart Indigenous Youth (SIY) study were analyzed using Fisher’s exact tests, stratified analyses, and logistic regression models. In bivariate analyses, alcohol use was significantly associated with lower odds of positive self-reported mental health (OR = 0.31, 95% CI [0.09–0.96], p = .042). However, this association was attenuated and no longer statistically significant in adjusted models (OR = 0.64, p = .631). Gender emerged as a significant predictor, with male youth more likely to report positive mental health (OR = 4.99, 95% CI [1.65–15.10], p = .004). Stratified analyses demonstrated consistent directional associations across gender and age groups, although these did not reach statistical significance. Findings suggest that alcohol use is associated with poorer mental health among Indigenous youth, while gender and culturally relevant factors may shape resilience pathways. These results underscore the importance of culturally grounded, community-led approaches to youth mental health that move beyond individual behaviour-focused models.

Abstract: Sugarcane burning remains widely used in several sugarcane-producing regions and represents an important source of air pollution with potential impacts on human health. This systematic review aimed to synthesize scientific evidence regarding the adverse health effects associated with exposure to pollutants released from sugarcane burning. Searches were conducted in the PubMed, Web of Science, and SciELO databases, covering publications from 2002 to 2025 and following PRISMA guidelines. A total of 68 records were identified, of which 29 met the inclusion criteria. The findings demonstrated consistent associations between exposure to particulate matter (PM₁₀ and PM₂.₅) and increased respiratory morbidity, including hospital admissions, asthma exacerbations, pneumonia, and respiratory symptoms, particularly among children and older adults. Associations with cardiovascular outcomes, systemic inflammatory alterations, and increased morbidity in exposed populations were also observed. Sugarcane workers experienced higher exposure levels and significant health effects, including reduced pulmonary function, mucociliary alterations, heat stress, dehydration, renal dysfunction, and hormonal changes. Recent investigations have also reported genotoxic, ocular, immunological, infectious, and socio-environmental effects associated with exposure to sugarcane-burning emissions. Most of the available evidence originated from Brazil, although studies from Mexico, Costa Rica, and the United States indicate growing international interest in this topic. However, major sugarcane-producing countries remain underrepresented in the epidemiological literature, highlighting an important global research gap. Overall, the findings suggest that exposure to emissions generated by sugarcane burning is associated with adverse health outcomes in the populations studied. These results reinforce the need for continued environmental and epidemiological monitoring, the adoption of sustainable agricultural practices, and the expansion of research in underrepresented sugarcane-producing regions.

Abstract: Noise linked to industrialization has emerged as a pervasive yet often underestimated en-vironmental stressor affecting both ecological systems and human health. A large body of literature and peer-reviewed work links prolonged noise exposure to biodiversity disrup-tion, cardiovascular disease, sleep disturbance, psychological distress, impaired cognitive performance, and premature mortality. Despite these impacts, comparatively little research has sought to estimate the economic magnitude of the burden of environmental noise within a planetary health framework. This evaluation presents an economic assessment of noise-attributable mortality, using published epidemiological evidence and established economic valuation methods. A hazard-ratio-based framework was applied to estimate mortality attributable to chronic environmental noise exposure among populations ex-posed to 60- and 70-dB noise levels. Both tangible costs, representing forgone economic productivity, and intangible costs, representing societal welfare losses estimated through the Value of a Statistical Life framework, were examined. Under baseline assumptions, en-vironmental noise was associated with approximately 27,692 annual noise-attributable deaths and an estimated annual economic burden of US$361.19 billion, including US$7.28 billion in tangible costs and US$353.91 billion in intangible costs. Sensitivity analyses produced estimates ranging from roughly US$39.22 billion to US$1.20 trillion annually. The results highlight that environmental noise warrants consideration beyond its tradi-tional characterization as a nuisance as a consequential planetary health stressor with implication for biodiversity, public health, economic productivity, and societal well-being. Policies aimed at reducing environmental noise exposure, including technological, regu-latory, and urban-planning interventions, may subsequently produce substantial pub-lic-health and economic benefits while contributing to healthier, more sustainable and productive communities.

Abstract: In gas-shielded arc welding, selecting the appropriate gas mixture is crucial not only for welding quality but also for reducing harmful UV radiation, which poses an occupational health risk. The aim of this research was to investigate the intensity of UV-A and UV-B radiation (290–390 nm) in the low-current range (10–45 A) using pure argon (Ar), helium (He), nitrogen (N₂), and a 70% Ar / 30% He gas mixture. The measurements demonstrated that the composition of the shielding gas drastically affects UV emission. Under identical parameters, pure argon generates around three times higher radiation levels than pure helium. But when 30% helium was added to argon, the UV emission was significantly reduced by approximately 30%. The highest UV values were recorded with pure nitrogen. The tests revealed that the main reason is severe arc instability: the expanding plasma surface area significantly increases radiation. Overall, it can be concluded that in the low-current welding range, arc stability determines the magnitude of UV radiation to a greater extent than the emission characteristics of the gases. However, further measurements are needed to draw conclusions for higher amperages.

Abstract: Frontline local government unit (LGU) workers in the Philippines — spanning health, social welfare, disaster risk reduction and management (DRRM), fire protection, and public order roles — face chronic occupational stress and psychosocial burden yet remain underrepresented in the occupational mental health literature. Grounded in the Job Demands-Resources (JD-R) model and Conservation of Resources (COR) theory, this study investigated psychosocial wellbeing, occupational stressors, and coping strategies among multi-sector LGU frontline personnel in Pangasinan Province. A cross-sectional descriptive design was used. Proportional stratified random sampling (Slovin’s formula) recruited 90 respondents from eight LGU role categories (response rate: 90.0%). The researcher-developed Psychosocial Wellbeing Scale (PWS-10; α = 0.81) was used alongside a 27-item stressor checklist and 5-item coping inventory. Statistical analyses included Spearman’s correlation, Fisher’s Exact Test, and Kruskal-Wallis H with Dunn’s post-hoc (Bonferroni correction). Effect sizes were reported throughout. Overall wellbeing was positive (M = 4.06/5.00). Employment stability was the primary stressor (70.0%), followed by high-risk situational exposure (64.4%). Social support dominated coping (76.7%); professional help-seeking was lowest (40.0%). Years of service (rs = 0.278, p = 0.008) and educational attainment (p = 0.004) significantly predicted wellbeing. Significant inter-role differences emerged in spiritual/cultural wellbeing (H = 15.42, p = 0.038, η² = 0.17); DRRM response personnel scored significantly lower than health workers (pAdj = 0.041). LGU frontline workers show generally positive wellbeing profiles, with gaps in mental health service access and a specific spiritual wellbeing deficit among DRRM personnel. Findings support role-differentiated psychosocial programs aligned with the Philippine Mental Health Act (RA 11036).

Abstract: Condensation remains a significant food safety risk in meat processing environments. The problem is challenging to control and prevent, as food processing facilities experience continuous fluctuations in temperature and humidity. However, there is currently a lack of recent studies specifically focused on condensation in the meat industry. Moisture on the surfaces of the above facilities can lead to the formation of condensation droplets. These droplets can contain and carry various foodborne disease agents, including bacteria, viruses, and fungi, as well as chemical and physical contaminants. This literature review aims to describe the problem and based on existing research, to discuss the actual risks posed by condensation in food processing facilities. In addition, strategies for controlling and preventing condensation are discussed. Condensation droplets into food products or adjacent structures that contact food may compromise hygiene standards and pose a high risk of food contamination, particularly with pathogens such as Listeria monocytogenes. Although the prevention of condensation has been described in several food regulations in the Western world, the accurate assessment of its severity remains debated, especially when hygiene standards are met. The role of other pathogens than Listeria spp. and Salmonella spp. is still poorly understood. Currently, mitigation measures and their effectiveness also remain unclear. More research on risk assessment and management of condensation is needed to help food business operators better control and understand this finding.

Abstract: São Paulo is the largest city in Brazil and the second in Latin America. Its domestic waste production reached 3,515,678.96 tons in 2024. Historically, the city has a low recycling rate and several laws and policies have been implemented to reverse this situation. The objective of this study was to investigate whether there have been advances in the recycling of household solid waste in São Paulo 15 years after the National Solid Waste Policy, analyzing the period between 2006 and 2024. The methodology consisted of a longitudinal case study with analysis of legislation, official data from SP Regula, legislative documents, research, and evaluation of the fulfillment of the goals of the Integrated Management Plan (MISWMP) of 2014, and search for socio-spatial correlations. The results indicate that the selective collection rate grew from 0.69% in 2006 to 2.85% in 2024, but this volume represents less than 10% of the target originally projected for the period. A socio-spatial inequality was found, with higher recovery rates in central areas and rates below 1% in the peripheries, and a lack of dedicated collection for the organic fraction, which makes up 46.90% of the gravimetric flow. It is concluded that progress is incremental but limited by structural barriers and urban inequities. It proposes the fiscal sustainability of the system, the implementation of pilot projects for organic waste and the improvement of data transparency to enable the goals of decarbonization and universalization of services.

Abstract: Background: Policy and humanitarian decisions often require comparing heterogeneous harms (e.g., infectious disease, injury, disasters, displacement) that are reported in non-commensurate units. Time-based summary measures such as disability-adjusted life years (DALYs) and quality-adjusted life years (QALYs) quantify health loss, but are not designed to provide an explicitly calibrated, experience-based unit that can be applied transparently across health and selected non-health harms. Methods: We define Universal Suffering Units (USU) as an additive aggregate of intensity-over-time profiles on a bounded 0–10 ladder, with optional convexity via an exponent p and an explicit overlap rule for co-occurring harms. The unit is calibrated so that a reference renal-colic trajectory equals 1.0 USU. We propagate parametric uncertainty via Monte Carlo simulation (N = 20,000; fixed seed) and provide fully reproducible worked examples using public data. Results: In two worked examples (dengue illness episodes and flood-related internal displacement), USU combines affected population, modeled intensity, and duration on a common scale and yields medians, uncertainty intervals, and sensitivity analyses. A limited convergence check shows that the dengue results are broadly consistent in rank with a disability-weight framework. Conclusions: USU provides a calibrated unit for aggregating experienced suffering while keeping state mappings, overlap treatment, and uncertainty assumptions explicit. It is intended to complement DALYs/QALYs and operational indicators, not replace them.

Abstract: Background: Immunization programmes deliver substantial public health benefits, but their supply chains depend on energy-intensive cold-chain systems, transport networks, single-use products and waste-treatment pathways that generate greenhouse-gas emissions and environmental health risks. As health systems move towards climate-resilient and low-carbon operations, the environmental footprint of vaccine delivery requires greater policy and programmatic attention. Methods: A narrative review and policy analysis was conducted using peer-reviewed literature, technical reports, programme case studies, institutional guidance, preprints and grey literature published or available between January 2010 and June 2026. Evidence was synthesized across four domains: cold-chain energy use; vaccine transport and logistics; production, packaging and use of vaccines and ancillary supplies; and immunization-related healthcare waste management. The review also examined low-carbon and climate-resilient interventions, including solar refrigeration, logistics optimization, digital stock-management systems, controlled-temperature-chain approaches, safer waste treatment and cold-chain equipment lifecycle management. Findings: The evidence indicates that environmental impacts occur across the vaccine lifecycle but are concentrated in a limited number of supply-chain functions. UNICEF’s international supply-chain emissions baseline estimated 3.9 million tonnes of carbon dioxide equivalent from Scope 3 international supply emissions in 2019, with vaccines, cold-chain equipment, nutrition products and international freight accounting for 80–90% of these emissions. Cold-chain energy use, transport, ancillary supplies and waste treatment emerge as recurring hotspots. Programme evidence from Tunisia, Lebanon, India and Gavi-supported countries demonstrates that solarized cold chains, route optimization, electric vehicles, digital stock visibility and energy-efficient cold-chain equipment can reduce emissions or improve resilience while supporting vaccine availability. However, evidence remains limited on full life-cycle emissions, last-mile transport models, embedded emissions in ancillary supplies, and safe end-of-life management of cold-chain equipment. Interpretation: Low-carbon immunization supply chains are feasible when environmental sustainability is integrated into procurement, energy planning, logistics, digital systems, workforce capacity, waste management and decommissioning. Future assessments should use standardized functional units, such as carbon dioxide equivalent per administered dose and per fully immunized child, to improve comparability and guide investment.

Abstract: Stroke is a leading cause of death and disability worldwide. Short-term exposure to ambient air pollutants and the risk of stroke has been reported in many studies, but the results vary greatly among different regions. This study aims to investigate the association of short-term exposure to air pollution and the incidence of total stroke and its subtypes in Luohu District, Shenzhen. A time-stratified case-crossover study was conducted among 21973 newly stroke cases in Luohu, Shenzhen from 2014 to 2022. Residential exposure to air pollution was assessed using validated grid datasets. Distributed lag model (DLM) and conditional logistic regression model were implemented to evaluate the relationship between ambient air pollution and the incidence of stroke and its subtypes. We found a 10 µg/m3 increment of exposure to NO2 and SO₂ was positively associated with a 2.73 % (95 % confidence interval [CI]: 2.21%, 3.25 %) and 24.89 % (20.87 %, 29.06 %) increase in odd of total stroke incidence, respectively. Statistical significance has also been found in subtypes. Stronger associations were observed in females (SO₂) and elderly (NO₂ and SO₂). Our findings indicate that exposure to NO₂ and SO₂ exacerbates the risk of stroke, especially in elderly and females.

Abstract: Flood events have increased significantly in recent decades as a result of climate change, causing severe damage to cultural heritage and, in particular, to archival and library collections. Paper-based materials contaminated by floodwaters and alluvial mud are subject not only to physical and biological deterioration, but also to potential hygienic and sanitary hazards associated with the persistence of human pathogens. Current emergency recovery strategies mainly focus on stabilizing materials through freezing, freeze-drying and mechanical cleaning, while health risk assessment is rarely addressed systematically. This study proposes an operational protocol based on microbiological indicators for assessing health risks during the remediation of flood-damaged archival and library materials. The protocol was applied to collections from the Aurelio Saffi Municipal Library of Forlì (Italy), severely affected by the Emilia-Romagna floods of May 2023. Indicators of recent and past faecal contamination, total microbial loads and se-lected viral targets were analysed before and after freeze-drying and mechanical cleaning. The results demonstrate a substantial reduction in faecal contamination fol-lowing freeze-drying, alongside the persistence of environmentally resistant microbial taxa. These findings highlight the need to integrate health risk considerations into con-servation recovery workflows to ensure the safety of conservation professionals and users of recovered heritage materials.

Abstract: Traditional wet markets are critical components of Indonesia's urban food system, yet remain largely unexamined from an occupational health and safety (OHS) perspective. This study identified and prioritized OHS risks among vendors and visitors at Nanggalo Market, a high-density traditional market in Padang, West Sumatra. An observational qualitative design combined elicitation surveys with 45 participants (20 vendors, 20 visitors, 5 market managers), direct observation, and in-depth interviews with 7 key informants. Risk assessment followed the AS/NZS 4360:2014 matrix, classifying risks by likelihood and consequence severity. Ten potential hazards were identified across six activity zones: traffic and parking; buying and selling; culinary activities; building structures and floor conditions; security and stray animals; and emergency access. Seven risks were classified as high-level, including slipping on wet floors, lack of evacuation routes, lack of fire extinguishers, narrow circulation paths, poor toilet conditions, crowding, and traffic injuries, while three were moderate. All high-level risks lacked adequate controls. Recommended interventions span the full hierarchy of controls, prioritizing engineering and administrative measures, and propose community-based occupational health posts as a sustainable mechanism. These findings provide an evidence base for strengthening OHS governance in traditional wet markets across Indonesia and comparable low- and middle-income country settings.

Abstract: Background: Sedentary behaviour (SB) is a major risk factor for chronic diseases. While single interventions have been studied, limited evidence evaluates multiple integrated strategies for reducing SB and promoting wellbeing among university staff. The aim of this study was to evaluate the feasibility and impact of three workplace interventions on physical activity (PA), perceived health, wellbeing, and mood states among university employees. Methods: Three pre–post feasibility interventions were conducted at a UK university. Intervention 1 provided exercise bikes/rowers in staff offices for 11 weeks with participants (n=57). Intervention 2 introduced sit–stand desks for 8 weeks, participants (n=10). Intervention 3 compared seated, standing, and walking meetings on mood states, participants (n=61). Measures included various self-reported questionnaires, and PA logs. A significance level of p < 0.05 (two-tailed) and 95 % confidence intervals were applied throughout. Statistical tests included paired-sample t-tests, Wilcoxon Signed-Rank tests, Kruskal–Wallis H tests, and thematic analysis were also used throughout. Results: The total PA engagement across the 11 weeks of exercise equipment intervention increased from 330 minutes at baseline to 1287 minutes throughout the intervention and improved emotional wellbeing, though no significant p > 0.05 in quality of Life were observed. Sit–stand desks reduced sitting by 1153 minutes weekly, with significant improvements in physical functioning p < 0.05. Walking meetings significantly enhanced vigour, reduced confusion and depression p < 0.05 compared to seated or standing meetings which were associated with higher tension and fatigue. Conclusion: Providing access to exercise equipment, sit–stand desks, and walking meetings are feasible and acceptable strategies to reduce SB in university workplaces. Each intervention targeted distinct behavioural dimensions: PA engagement, sedentary reduction, and psychosocial wellbeing. A multi-component approach may therefore offer synergistic benefits for employee health and productivity, contributing to cultural change in HEIs. Larger controlled trials with longitudinal follow-up are needed.