Public Health and Healthcare

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.

Abstract: This paper establishes a comprehensive theoretical and practical framework for salutogenic lighting design, shifting architectural illumination from a historically reactive focus on mere visibility and pathogenic risk reduction toward a proactive mechanism for human vitality, stress recovery, and holistic well-being. Grounded in Aaron Antonovsky’s Sense of Coherence (SOC) model – encompassing comprehensibility, manageability, and meaningfulness – and integrated with the Substance Abuse and Mental Health Services Administration’s (SAMHSA) eight dimensions of wellness and the tripartite biophilic framework, this research positions lighting as a direct salutary "nudge" within the built environment. The paper articulates four core hypotheses mapping fundamental lighting variables (intensity, spectrum, spatial distribution, and temporal dynamics) to non-visual neuroendocrine pathways (ipRGC-RHT-SCN entrainment), autonomic nervous system shifts, and prefrontal cognitive restoration. To translate these theoretical intersections into verifiable practice, a unified cross-analytical matrix aligns wellness dimensions and SOC attributes with construction-ready technical criteria, including melanopic metrics (m-EDI, m-DER), unified glare ratings (UGR < 16), high colour fidelity (CRI ≥ 90, TM-30 Rf ≥ 90, Rg ≥ 100), and flicker-free driver standards (IEEE 1789). The model's empirical validity is demonstrated through an applied domain case study in commercial aviation cabin lighting (Airbus A350-1000 and Boeing B787-8), where scene-based multi-layer illumination was prototyped in Hamburg and Seattle mock-up facilities as a non-pharmacological countermeasure against circadian desynchronosis. Finally, the discussion addresses critical industry implementation hurdles, advocating for post-occupancy evaluation (POE) protocols, cross-disciplinary control system integration (DALI-2 DT8), and regulatory revisions to bridge the gap between high-concept health theory and real-world construction standards.

Abstract: Background/Objectives: Ultra-processed foods (UPFs) are industrial formulations linked to rising non-communicable diseases (NCDs) globally. In West Africa, rapid urbanization and retail modernization have accelerated UPF availability among youth, yet the NCD implications remain under-synthesized. This narrative review examines the relationship between UPF consumption and NCD risk among West African adolescents and young adults aged 10–24 years from 2015 to 2025. Methods: We systematically searched PubMed, Scopus, and Web of Science for English-language studies published between 1 January 2015 and 31 December 2025 examining UPF intake and metabolic outcomes in West African youth. A thematic synthesis was organized by dietary patterns, adiposity, cardiometabolic markers, and policy responses. Supplementary hand-searching of reference lists and grey literature was conducted. Results: Evidence indicates that UPFs contribute an estimated 15-30% of energy intake among urban West African youth, displacing traditional diets based on fermented cereals, legumes, leafy vegetables, and fish. Higher UPF consumption is associated with increased overweight and obesity risk (Africa subgroup OR = 2.98; 95% CI: 1.88–4.73), elevated blood pressure, insulin resistance, and dyslipidemia. Sugar-sweetened beverages (SSBs) and fast foods are primary drivers. Regulatory frameworks remain fragmented, with marketing restrictions and school food policies emerging in Ghana and Nigeria. Conclusions: Addressing the growing NCD burden among West African youth requires context-specific longitudinal research, strengthened food-environment governance, and preservation of traditional food systems. Priority actions include restricting UPF marketing to youth, taxing SSBs, implementing front-of-pack labeling, and integrating traditional food systems into public-health strategies.

Abstract: Background/Objectives: The Mediterranean diet (MD) is a set of customs and eating habits developed in countries bordering the Mediterranean sea thousands of years ago. These habits are frequently proposed as a complement to pharmacological therapies for chronic diseases and could also counteract their onset. This study aimed to investigate adherence to the MD in workers from 22 companies in Latium (Italy) and to evaluate the association of diet with workers' health. Methods: Workers undergoing their health surveillance examination and routine blood tests (total cholesterol, HDL cholesterol, triglycerides, glucose) were invited to fill in the Mediterranean Diet Adherence Screener (MEDAS), the Effort-Reward Imbalance (ERI) questionnaire for work-related stress, the Sleep Condition Indicator (SCI) for sleep quality, the STOP-Bang questionnaire for obstructive sleep apnea (OSA) risk, the General Health Questionnaire (GHQ12) for low mental health, and the Abdel-Khalek questionnaire (AKQ) for happiness. 1,475 out of 1,608 workers (91.7%) participated in the study. Results: The prevalence of high adherence to the MD was 53.8% (95%CI 51.3; 56.4). Female workers reported greater adherence to the MD than males (Mann-Whitney U, p< 0.001). MD adherence was positively correlated with age (Spearman’s rho = 0.071, p< 0.01). In multiple logistic regression models adjusted for age and gender, the MEDAS score was inversely associated with hypertension [aOR=0.923 (95%CI=0.861; 0.990)], hypercholesterolemia [aOR=0.939 (95%CI=0.882; 0.999)], hypertriglyceridemia [aOR= 0.909 (95%CI=0.838; 0.985)], and metabolic syndrome [aOR =0.900 (95%CI=0.824; 0.982)]. The MEDAS score was inversely related to low mental health [aOR=0.943 (95%CI=0.893; 0.996) p=0.036] and positively related to happiness [aOR =1.094 (95%CI= 1.038; 1.154) p< 0.001]. Conclusions: Although the association between diet adherence and health is weak, the MD remains a useful measure for promoting health in the workplace.

Abstract: Background: Climate change poses increasing environmental and public health risk, particularly in arid regions, understanding how population perceives this risk and translating awareness into adoptive behavior is essential for effective climate resilience strategies. This study examined climate change risk perception and adoptive behavior among Hail region population in Saudi Araba using Health Belief Model (HBM). Methods: Cross-Sectional study was conducted among 460 participants using structured questionnaire based on HBM constructs. Data was analyzed by applying descriptive statistics, superman's correlation, logistic regression, and structural equation modeling to assess the predictors and pathways influencing adoptive behavior. Results: About half of participants stated high climate change risk perception (50.7%) and adoptive behavior (53.9%). Education, gender, and employment sector were significant predictors of risk perception, however adoptive behavior displayed constrained sociodemographic associations. Correlation analysis revealed strong relationships adoptive behavior and enabling constructs, particulary perceived benefits and self-efficacy than with susceptibility and severity. Path analysis demonstrated that risk perception significantly influenced adoptive behavior (β=1.00, p < 0.001) however, perceived barrier exerted strongest effect (β=0.70), followed by benefits, cues to action, and self-efficacy. The model displayed satisfactory fit and illuminated a substantial proportion of variance in adoptive behavior.Conclusion: The results confirm a perception- behaviors gap, indicate that climate change awearness alone does not ensure adoptive action. Enabling and related factors play a decisive role in behavioral adoption. Interventions should therefore be more beyond risk communication toward barrier reduction, capacity building, and supportive policy measures to enhance climate adaptation and public health resilience in arid sitting areas.

Abstract: Population aging is a defining demographic transformation in Latin America, but its subnational spatial dynamics remain insufficiently understood. This study examines how population aging becomes spatially differentiated during an advanced stage of demographic transition, using the Maule Region of Chile as a case study between 1992 and 2024. We conducted a longitudinal ecological analysis using official Population and Housing Census data from 1992, 2002, 2017, and 2024 at provincial and commune levels. The Aging Index, defined as the number of people aged 65 years and over per 100 people younger than 15 years, was used as the main demographic indicator. To assess demographic acceleration and territorial differentiation, we calculated absolute change, multiplication indices, average annual growth rates, and intercensal growth rates. Spatial dependence was evaluated using Global Moran’s I and Local Indicators of Spatial Association based on a first-order queen contiguity matrix, with robustness checks using alternative spatial weights. Territorial inequality was assessed through dispersion measures, the Gini coefficient, and β-convergence analysis. Sex-specific Aging Indices, old-age and youth dependency ratios, and the share of the oldest-old population were also examined. By 2024, the Maule Region reached an Aging Index of 83.9, exceeding the national value of 79.0. Aging levels were highest in Cauquenes and in predominantly rural communes such as Curepto, Vichuquén, Hualañé, and Licantén. Intercensal growth rates increased over successive periods, indicating acceleration of population aging. Spatial clustering intensified, with Global Moran’s I increasing from 0.188 in 1992 to 0.298 in 2024, and significant High-High clusters emerging in coastal dryland communes. Territorial dispersion widened, while β-convergence was not statistically significant, indicating persistent local divergence rather than convergence toward similar aging profiles. Aging was consistently higher among women, old-age dependency exceeded youth dependency in nine communes, and the oldest-old represented more than one-quarter of older adults in the most aged territories. These findings show that subnational population aging may combine regional demographic aging with local divergence, spatial concentration, and territorial inequality. Integrating demographic and spatial indicators can support comparative population studies and geographically targeted planning for rapidly aging regions in Latin America and comparable contexts.

Abstract: Background: Employee well-being is increasingly understood as the result of the inter-action between individual vulnerabilities and organizational resources. However, limited evidence has examined how employees’ emotion regulation difficulties, workplace bullying, and leaders’ emotional intelligence (EI) jointly contribute to psychological well-being within a multilevel organizational context. Drawing on the Job Demands–Resources (JD-R) theory, this study conceptualizes emotion regulation difficulties as indicators of deficits in personal emotional resources, workplace bullying as a psycho-social job demand, and leaders’ EI as a team-level organizational resource. Methods: A multilevel design was adopted involving 287 employees nested within 41 work teams of an Italian communication company. Employees completed measures of emotion regulation difficulties, workplace bullying, and psychological well-being (level 1), whereas team leaders (level 2) completed the Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT). Random-intercept multilevel models were estimated to examine direct and cross-level relationships. Results: Greater emotion regulation difficulties and higher exposure to workplace bullying were associated with poorer psychological well-being. Although leaders’ EI showed limited direct effects on well-being, specific emotional abilities—particularly understanding emotions —buffered the negative association between workplace bullying and psychological well-being. These findings suggest that emotionally intelligent leaders can provide a supportive interpersonal context that mitigates the impact of employees’ emotional vulnerabilities. Conclusions: The findings support a multilevel JD-R perspective in which employee well-being emerges from the interaction between deficits in personal emotional re-sources, psychosocial job demands, and organizational resources. By providing partial evidence for the buffering role of specific leader EI abilities, this study extends current knowledge on emotionally intelligent leadership and highlights its value for promoting psychologically healthy and sustainable workplaces.

Abstract: Worldwide increases in noncommunicative diseases (NCDs) are a threat to the ongoing human existence. Total oxidative stress (OS) is well known to be a direct cause of non-communicable disease (NCD) onset. The Oxidative Stress Index (OSI), obtained from a non-invasive eight item questionnaire, has been shown to be indicative of total OS level in the human body and a predictor of the likelihood of NCD onset. The eight OSI parameters are: age, weight, genetics, socioeconomic status, environmental pollution, pre-existing chronic illness, numbers of medications regularly taken and chronic psychological stress. This review paper presents the evolution of the OSI, its applications, justifications for the use of each of its eight parameters in measuring total OS and how the inter-relationships of these parameters contribute to NCD onset. Also discussed are the implications of ever-increasing OS on the human existence.

Abstract: Physician career sustainability depends on adequate and relevant prevention of negative psychological states. Burnout is one. Recent research modifying Csikszentmihalyi’s four-quadrant model identifies the inverse relationship between achieving psychological flow and burnout. The burned out are those who can also achieve psychological flow. As such, the term “burnout” has inappropriately classified other negative states as burned out. Physicians as a profession have one of the highest rates of burnout. Thus, this finding is significant for them. Psychological states erroneously identified as burnout regarding the model of work engagement include apathy, anxiety, and boredom. Achieving appropriate work engagement promotes career sustainability. It can be achieved when a differentiation is made among treatments into the four types of negative work engagement. This study will utilize the modified four-quadrant model specifically for physicians. Successful methods in reducing the four negative psychological states in physicians will be considered and evaluated for their ability to reduce work exhaustion and promote work engagement. The conclusion is that when there is a division of physicians’ negative psychological factors into the four regarding work engagement, avoiding each of burnout, apathy, anxiety, and boredom is possible to sustain physician careers in a way that previously has not been identified.

Abstract: Wildfires are an escalating natural hazard in Australia and a growing public health concern. Exposure to wildfire smoke is associated with acute and chronic adverse health effects, placing wildland firefighters at elevated risk due to recurrent occupational exposure. Although protective behaviours and personal protective equipment (PPE) are recommended, uptake remains inconsistent due to operational and behavioural barriers. This descriptive qualitative study applied the Health Belief Model to explore firefighters’ risk awareness, protective practices, motivators, and barriers. Semi-structured interviews were conducted with eleven wildland firefighters in Southeast Queensland, Australia. Participants demonstrated strong awareness of short-term health effects, informed by personal experience, but limited understanding of long-term health risks. Compliance with mandatory PPE (clothing, gloves, boots, helmets) was high and motivated by prevention of immediate injury. However, respiratory protective equipment use was inconsistent due to discomfort, poor fit, communication difficulties, and operational constraints. Additional barriers to health protective behaviours included limited decontamination access and inequities in PPE design, particularly for women. Participants identified improved health education, practical PPE options, and further research as priorities for strengthening occupational health protection. Addressing these barriers through improved knowledge translation, organisational support, and approaches such as cultural burning may reduce exposure and improve workforce health.

Abstract: Influenza A(H3N2) viruses show continuous antigenic and genetic evolution, requiring sustained molecular surveillance to understand their circulation and geographic spread. This study investigated the epidemiological, evolutionary, and phylogeographic dynamics of A(H3N2) viruses circulating in Brazil between 2011 and 2019. Epidemiological surveillance data from Northern and Northeastern Brazil were analyzed together with hemagglutinin (HA) gene sequences generated in this study and sequences retrieved from GISAID EpiFlu database. Phylogenetic and Bayesian phylogeographic analyses were performed to characterize genetic diversity and viral dispersal. Among 23,278 respiratory samples, 1,003 (4.31%) were positive for A(H3N2), with seasonal peaks occurring mainly between epidemiological weeks 13 and 16. Phylogenetic analyses revealed successive lineage replacement, with predominance of 3C.2a-derived clades after 2015. Phylogeographic reconstruction identified multiple international introductions into Brazil and extensive viral movement among Brazilian regions, with Southeastern Brazil acting as the main hub of national connectivity. Northern and Northeastern Brazil participated predominantly as recipient regions while also contributing to onward viral dissemination. These findings highlight the interconnected nature of A(H3N2) circulation in Brazil and reinforce the importance of integrating genomic and epidemiological surveillance to understand influenza dynamics.

Abstract: Background. Long-term exposure to ambient ozone is an established cause of chronic obstructive pulmonary disease (COPD) mortality. Absolute ozone-attributable COPD deaths have risen sharply since 1990, but the separate contributions of changing ozone exposure, changing population size, and changing background COPD mortality have not been quantified.Methods. Using Global Burden of Disease Study 2023 estimates for 204 countries, we expressed ozone-attributable COPD deaths as the product of the population-attributable fraction, the background COPD death rate, and population size, and decomposed the 1990–2023 change into three exactly additive components using the Das Gupta (1993) three-factor method. We additionally estimated a counterfactual in which the population-attributable fraction remained at its 1990 value. Reconstructed totals were validated against the published GBD global estimate before analysis.Results. Global ozone-attributable COPD deaths rose from 172,584 (95% uncertainty interval 39,323–329,062) in 1990 to 468,719 (108,209–854,387) in 2023, an increase of 171.6%. The three drivers contributed almost equally: population size +113,103 deaths (38.2% of the change), exposure +93,059 (31.4%), and rising background COPD death rates +89,973 (30.4%). Country-level patterns diverged sharply from this global average: countries in which exposure was the leading driver of the increase accounted for 62.6% of the 2023 global burden, against 27.7% for population size and 8.2% for the background COPD rate. Had ozone exposure remained at 1990 levels, an estimated 326,192 deaths would have occurred in 2023, implying 142,526 deaths (30.4% of the 2023 burden) attributable to the change in exposure. South Asia accounted for 285,164 deaths in 2023, with exposure the single largest driver there (39.9%). In high-income countries and in Central and Eastern Europe the exposure component was negative, averting an estimated 7,054 and 3,865 deaths respectively.Conclusions. Rising ozone-attributable COPD mortality is not driven predominantly by demography. Exposure change accounts for 31.4% of the global increase and is the leading driver across the countries carrying 62.6% of the current burden. Precursor emission controls have measurably reduced burden where they have been applied. These results are based on all-age data and therefore cannot separate population growth from population ageing.

Abstract: Plastic pollution is disproportionately affecting low- and middle-income countries, where evidence-based interventions suited to local needs, cultural practices and available resources are needed. We conducted a systematic review of literature to identify interventions that have been implemented in these settings to reduce the use of plastic and improve plastic waste management. Three databases were searched, supplemented by manual citation searching. Of 4,631 records screened, 17 studies were included after assessing 144 full texts. Studies were conducted in Asia (n=16) and Sub-Saharan Africa (n=1). Interventions fell into four categories: regulations targeting single-use plastics and open waste burning (n=7), integrated solid waste management (n=4), community-based initiatives (n=3), and technological solutions (n=3). Despite initial positive effects, single use plastic ban policies often caused an overall increase in plastic use due to absence of viable alternatives and weak policy enforcement. Adequate policy-level support and community awareness were effective for integrated solid waste management and community-based initiatives. Additionally, technological solutions were reported as potentially effective measures to complement policy and infrastructure. While multisectoral efforts and interventions are needed to effectively address this issue, future studies should also consider the human health impacts of implementing such solutions.

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.