Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous combustion-derived contaminants that represent a significant cross-cutting threat to human, animal, and environmental health. Viewed through an explicit One Health lens, this review shows how the shared combustion sources, evolutionarily conserved toxicological mechanisms, and food-web linkages connecting environmental contamination to wildlife and human exposure justify an integrated, cross-domain approach to PAH risk assessment and management. PAHs are generated predominantly through incomplete combustion of organic materials and are globally distributed through atmospheric transport, aquatic runoff, and food-web transfer, persisting in soils and sediments for decades. The present review synthesizes current knowledge on PAHs through an explicit One Health lens, examining shared sources, environmental fate, and convergent health effects across species and health domains, while also highlighting the need to move beyond the classical US EPA priority PAHs to include high-molecular-weight PAHs (>302 Da), alkylated homologues, and transformation products such as oxy- and nitro-PAHs. Common pathways such as dietary intake of grilled and smoked foods, inhalation of contaminated air, and occupational exposure create parallel toxicological burdens in both human and wildlife populations, particularly through genotoxic mechanisms mediated by aryl hydrocarbon receptor (AhR) activation and CYP1A1/CYP1B1-catalyzed bioactivation to reactive diol epoxides. The resulting DNA adduct formation links environmental PAH exposure to carcinogenicity, reproductive toxicity, immunosuppression, and developmental impairment across vertebrate species with remarkable mechanistic consistency. Wildlife, especially fish, marine mammals, and seabirds, serve as critical sentinels for environmental PAH contamination, while simultaneously facing direct health impacts on immune function, reproduction, and population viability. Vulnerable human populations, including children, subsistence communities, occupational workers, and residents near combustion-intensive industries, bear disproportionate burdens reflecting underlying environmental justice concerns. Integrated intervention strategies encompassing source control, dietary exposure reduction, site remediation, and coordinated biomonitoring are urgently needed. By incorporating emerging PAH classes with distinct persistence, trophic behavior, and toxicological potency, the One Health paradigm provides a more comprehensive conceptual framework for modern environmental surveillance, food safety, and integrated risk assessment, recognizing that the health of terrestrial and aquatic ecosystems is inseparable from that of the animals and humans within them.
Eco-health is an integrative approach aimed at improving human health while preserving ecosystems, in the context of environmental and climate change with major health consequences. Part of the «One Health» framework, it's based on a systemic view of the interactions between human, animal, environmental, and social health, and promotes actions that have co-benefits for both health and the environment. Primary care plays a strategic role in the implementation of eco-health. It's an essential lever for the transition to a sustainable health system due to its long-term proximity to the population. The eco-health approach in primary care is based mainly on three areas: prevention and health promotion, the relevance of care, and the eco-design of clinical and organizational practices. These actions, based on the principle of co-benefits, simultaneously reduce the environmental footprint of care and improve its quality. Eco-health thus appears to be an operational and ethical way to strengthen the sustainability of the healthcare system in the face of contemporary public health and environmental challenges. L’Éco-santé est une approche intégrative visant à améliorer la santé humaine tout en préservant les écosystèmes, dans un contexte de dérèglement environnemental et climatique aux conséquences sanitaires majeures. Inscrite dans le cadre du «One Health», elle repose sur une vision systémique des interactions entre santé humaine, animale, environnementale et sociale, et promeut des actions à co-bénéfices pour la santé et l’environnement. Les soins primaires occupent une place stratégique dans la mise en œuvre de l’Éco-santé. Ils constituent un levier essentiel de transition vers un système de santé durable par leur proximité avec la population qui s’inscrit sur le long terme. L’approche Éco-santé en soins primaires s’appuie principalement sur trois axes : la prévention et la promotion de la santé, la pertinence des soins et l’écoconception des pratiques cliniques et organisationnelles. Ces actions, fondées sur le principe de co-bénéfice, permettent simultanément de réduire l’empreinte environnementale des soins et d’améliorer leur qualité. L’Éco-santé apparaît ainsi comme une voie opérationnelle et éthique pour renforcer la durabilité du système de santé, face aux enjeux de santé publique et environnementaux contemporains.
Community-based preventive health interventions have emerged as central strategies for improving population health and reducing preventable morbidity and mortality across diverse communities. These approaches extend beyond clinical care and incorporate behavioral, environmental, social, and structural components delivered within local settings. Despite wide implementation, knowledge remains dispersed across intervention types, with limited integration of long-term outcomes and equity-focused perspectives. This narrative review synthesizes current understanding of major categories of community-based preventive strategies, including health promotion, screening and early detection, community engagement mechanisms, workforce models such as community health workers, digital and mobile health solutions including social media-based interventions, and policy and environmental actions. A structured narrative approach was used to examine conceptual foundations, implementation characteristics, and reported impacts across varied geographic and socioeconomic contexts. Integrated, multicomponent initiatives that combine behavioral modification, participatory engagement, decentralized screening, and supportive structural measures are associated with improvements in risk factor management, service accessibility, and early identification of chronic conditions. Variations in contextual adaptation, governance arrangements, financing stability, and workforce capacity influence the magnitude and sustainability of outcomes. Stronger coordination across sectors, standardized monitoring indicators, and closer alignment with primary healthcare systems are necessary to enhance scalability and long-term impact. Community-based prevention provides a viable pathway for advancing equitable improvements in population health when designed and locally responsive.
The pervasive global dispersion of organophosphorus pesticides (OPs) as a primary insecticidal agent for enhanced agricultural productivity presents an enduring ecological and human health exigency. Unfettered field-scale applications result in the ubiquitous contamination of diverse ecosystems, precipitating deleterious effects extending from the disruption of soil microbiome homeostasis and attendant biogeochemical cycles to significant morbidity in non-target biota and human populations. The pronounced hazards associated with specific OPs, including methamidophos, methyl parathion, and parathion, categorized as highly hazardous by the World Health Organization (WHO) and consequently restricted in numerous countries - underscore the imperative for effective remediation strategies. This review critically examines the natural attenuation of OPs, accentuating the burgeoning field of bioremediation and biodegradation as environmentally sustainable and efficacious approaches for decontaminating affected niches. We provide a comprehensive synthesis of the current understanding of the remarkable metabolic versatility exhibited by a phylogenetically diverse consortium of fungal and bacterial genera, exemplified by genera such as Pseudomonas, Bacillus, Acinetobacter, and Aspergillus, capable of catabolizing a broad repertoire of OP compounds in both soil and aqueous matrices. Furthermore, this analysis elucidates the central role of specific microbial organophosphorus hydrolase genes (oph, opd, mph, hocA, and opaA) in the evolutionary adaptation of novel metabolic pathways and the expression of cognate hydrolase enzymes that catalyze the crucial initial steps in OP degradation. This focused synthesis highlights recent advances in deciphering the intricate molecular mechanisms governing microbial OP biodegradation and critically evaluates the potential of these biological systems as robust and scalable bioremediation interventions for the effective restoration of OP-contaminated water and soil environments.
The assessment and regulation of soil health based on soil micro-food web represents a cutting-edge field in soil ecological research. Indicators of soil micro-food web are highly indicative in reflecting the state of soil ecosystems and revealing the underlying mechanisms of soil degradation. We systematically sorted out the relevant indicators of soil micro-food web that can be used for soil health assessment from the perspectives of community structure and ecological function, summarized the soil health assessment methods based on soil micro-food web, the selection and application of core micro-food web assessment indicators under different ecological scenarios, and its role in regulating soil health. Furthermore, we proposed that future efforts should focus on integrating micro-food web based regulation methods into precision agricultural practices, actively stimulating the role of soil micro-food web in the "One Health" framework, and constructing soil health evaluation system centered on multi-indicator integration and soil food web, to advance the application of soil micro-food web in the precise assessment and management of soil health. 基于微食物网的土壤健康评价和调控是土壤生态学研究的热点和前沿,土壤微食物网指标能够灵敏地反映土壤生态系统的健康状态,揭示土壤退化的内在机制。本文从群落结构和生态功能两个角度,系统梳理了用于土壤健康评价的土壤微食物网相关指标,总结了基于土壤微食物网的土壤健康评价方法、不同生态场景核心微食物网评价指标的选择与应用,及其在农业土壤健康调控中的作用,并提出未来应将基于微食物网的调控方法纳入精准农业实践,积极发挥土壤微食物网在同一健康(One Health)中的重要作用,构建以多指标融合、大食物网为框架的土壤健康评价体系,促进土壤健康的精准评价与农业生态系统的可持续管理。.
The current kidney care model-focused on late-stage disease and in-center haemodialysis-is unsustainable because of costs, environmental burden, poor outcomes, and reduced quality of life. The 78th World Health Assembly's recognition of kidney disease as a serious health threat presents a critical opportunity to reshape kidney care. Aligned with this, the 2026 World Kidney Day theme, "Kidney Health for All: Caring for People, Protecting the Planet", calls for a systematic change. A sustainable model must prioritize early detection and prevention, reducing the need for kidney replacement therapy. Transplantation and home dialysis benefit people with kidney failure, environment and society. Dialysis itself must become more eco-friendly without compromising care quality, recognizing that planetary perturbations in turn affect kidney health. Conservative care should also be considered, particularly for elderly and frail patients, if the quality-of-life benefits outweigh the perspectives offered by dialysis. Achieving this shift requires coordinated action across all stakeholders: education and engagement of the public, policy makers and health professionals to raise awareness about the threat of kidney disease; and an urgent move toward patient-centered care.
Hantaviruses are enveloped, negative-sense RNA viruses. Rodents serve as natural reservoirs, and spillover into humans causes hemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome. While transmission typically occurs by inhaling aerosolized rodent excreta, the Andes virus variant is capable of human-to-human transmission. A recent outbreak involving a person-to-person transmission cluster aboard the cruise ship MV Hondius has underscored the urgency of hantavirus preparedness. Immediate global pandemic risk remains low because sustained transmission requires prolonged close contact, and hantavirus has low environmental stability compared to other RNA viruses with pandemic potential. However, climate change, deforestation, and urbanization increase human-rodent interactions and spillover risks. Additionally, prolonged incubation in immunocompromised individuals, including people with Human Immunodeficiency Virus (PWH) and other chronic conditions, may facilitate viral adaptation, potentially leading to strains with enhanced transmissibility. We review hantavirus classification, epidemiology, transmission dynamics, immunopathology, treatment strategies, the urgent need for global surveillance, and accelerated vaccines and prophylactic development.
Diet is a major determinant of health and an essential lever for preventing non communicable diseases. However, it cannot be understood independently from the food systems that shape food supply, prices, accessibility, and attractiveness, and that simultaneously contribute to environmental pressures. Recent research highlights a growing convergence between public health objectives and ecological sustainability, prompting an expanded analysis of the role of food environments in structuring individual choices. In this context, nutritional guidelines are evolving and now promote a predominantly plant based, minimally processed diet that is compatible with sustainable production methods. Nevertheless, the social sciences remind us that eating practices remain shaped by cultural, economic, and social determinants, and that inequalities in access to healthy and sustainable food persist. For medical practice, these perspectives call for embedding nutritional support within the material and cultural realities of patients and for recognizing food environments as full fledged determinants of health. Understanding these interdependencies strengthens the coherence, effectiveness, and equity of nutritional prevention strategies. L’alimentation constitue un déterminant majeur de la santé et un levier essentiel de prévention des maladies non transmissibles. Toutefois, elle ne peut être appréhendée indépendamment des systèmes alimentaires qui en organisent l’offre, les prix, l’accessibilité et l’attractivité, et qui contribuent parallèlement aux pressions environnementales. Les travaux récents mettent en évidence une convergence croissante entre objectifs de santé publique et soutenabilité écologique, invitant à élargir l’analyse au rôle des environnements alimentaires dans la structuration des choix individuels. Dans ce contexte, les référentiels nutritionnels évoluent et promeuvent, désormais, une alimentation majoritairement végétale, peu transformée et compatible avec des modes de production durables. Les sciences sociales rappellent, cependant, que les pratiques alimentaires demeurent façonnées par des déterminants culturels, économiques et sociaux, et que les inégalités d’accès à une alimentation saine et durable restent marquées. Pour la pratique médicale, ces perspectives invitent à inscrire l’accompagnement nutritionnel dans les réalités matérielles et culturelles des patients et à reconnaitre les environnements alimentaires comme des déterminants à part entière de la santé. Comprendre ces interdépendances renforce la cohérence, l’efficacité et l’équité des stratégies de la prévention nutritionnelle.
Social determinants play a critical role in shaping mental health (MH) outcomes. The World Health Organization emphasizes the importance of addressing such factors to reduce MH disparities. This scoping review aims to assess the landscape of research on social determinants of MH in Germany, focusing on frequently studied social determinants, MH outcomes, and underlying theoretical frameworks and explanatory mechanisms, particularly the consideration of the framework of intersectionality. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, a systematic literature search was conducted in PubMed and Web of Science. Studies that specifically addressed social determinants of MH in Germany were targeted, and data were charted to map key research trends. A total of 73 studies were included in the data analysis and synthesis, and outcomes were grouped into eight social determinants of health domains. The most frequently examined domains were demographics (in 96.0% of included studies), interpersonal/community/cultural influences (89.3%), economic stability (72.0%), and education (57.3%). Less frequently addressed domains included neighborhood and built environment (25.3%), environmental events (16.0%), other health-related determinants (16.0%), and healthcare access and quality (5.3%). We observed substantial heterogeneity within and between domains. MH outcomes were more often studied in terms of mental illness than positively defined MH, with depression and anxiety being the most frequently assessed outcomes. Theoretical frameworks such as the biopsychosocial model, social-ecological perspectives, and resilience theory were commonly applied, while intersectionality was rarely explicitly analyzed. This scoping review delineates the research landscape on social determinants of MH in Germany. The findings point towards a predominant focus on individual-level determinants, with comparatively limited attention to systemic and structural factors. Moreover, an emphasis on mental illness rather than MH, alongside substantial heterogeneity in measured constructs, may constrain the understanding of MH disparities. These gaps highlight the need for more comprehensive, intersectional approaches that account for the diversity of individuals, contexts, and outcomes.
The COVID-19 pandemic has significantly affected global respiratory health, with a notable rise in severe and recurrent respiratory infections. Irrational antibiotic use and limited public health measures during the pandemic were perceived by Physicians to have worsened post-COVID respiratory morbidity and to have contributed to the emergence of antimicrobial resistance (AMR). To explore physicians' experiences and perspectives on the rise in post-COVID respiratory infections in Pakistan, with a focus on contributing factors, treatment challenges, and the impact of irrational antibiotic use and antimicrobial resistance on respiratory disease management. A qualitative explorative study was conducted from September to December 2025 with 20 physicians in public and private healthcare settings in Islamabad and Rawalpindi. In-depth interviews using a semi-structured guide explored post-COVID respiratory trends, contributing factors, treatment challenges, and AMR. Data were transcribed, translated, and analyzed through inductive thematic analysis until saturation, following the COREQ reporting guidelines. Physicians reported increased frequency and severity of upper and lower respiratory tract infections including asthma, COPD, and pneumonia, physicians characterized them as often severe, recurrent, and prolonged. Key contributing factors cited by physicians included perceived post-viral immune compromise, comorbidities, environmental factors, behavioral changes, and reduced adherence to preventive measures. Challenges such as irrational antibiotic prescribing, over-the-counter use, and self-medication were cited by physicians as drivers of AMR. Respondents emphasized the need for strengthened diagnostics, antimicrobial stewardship, vaccination, public awareness, and systemic interventions. The increase and severity of post-COVID respiratory infections in Pakistan is due to a combination of factors including lack of immune compromise, socio-environmental and behavioral factors, and irrational antibiotics prescriptions fueling the rising antimicrobial resistance (AMR) perceived by Physicians. It is crucial to integrate public health measures, vaccination, and antimicrobial stewardship to strengthen diagnostics and mitigate the long-term respiratory morbidity and potential future crises of infectious disease. Not applicable.
Humans encounter a wide range of natural and synthetic chemicals throughout their lifespan and these exposures have a complex impact on health outcomes. Epidemiological studies provide compelling evidence linking chemical exposure to neurological disorders and various cancers. However, establishing causality between specific pollutants, or their mixtures, and health outcomes is challenging due to long disease latencies. Functional biomarkers in exposed subjects provide rapid predictions of the impact of environmental exposures. Notably, genome alterations, including DNA breaks and epigenetic modifications, are hallmark features of cancers, premature aging, and neurological diseases. Biomonitoring studies show that individual chemical exposures are specific. These differences highlight disparities across socioeconomic groups. They also present opportunities to associate specific environmental factors and disease development, as well as socioeconomic determinants of exposures and their consequences. This review focuses on biomonitoring environmental chemical exposures and their effects with hair and hair follicles. Pollutants detected in the hair matrix reflect cumulative internal exposures over specific time periods, while biomarkers can be analyzed in plucked hair follicles. These mini organs contain proliferating and stem/progenitor cells, which are critical to understanding the onset of various diseases. We propose an integrated approach that combines socioeconomic indicators, chemical analyses in hair, and biological assessments of matching hair follicles to evaluate the exposome and its effects on the genome. We discuss the state of the art of these approaches, their current limitations, and the perspectives they offer.
The objective of this study is to explore public sector clinicians' perspectives on factors associated with relapse in schizophrenia within a South African context, focusing on structural, social and environmental contributors beyond treatment non-adherence. Three focus groups were conducted with 14 public-sector clinicians (psychiatrists, medical officers, psychiatric registrars and psychiatric nurses) with ≥5 years' experience in schizophrenia care. Data were analysed using reflexive thematic analysis to identify themes relating to relapse risk. Clinicians consistently described medication non-adherence, often the immediate trigger for relapse, as emerging from interrelated health system and socio-structural constraints, including poverty, unemployment, unsafe communities, fragmented services and stigma. Limited access to newer-generation antipsychotics, medication stockouts, early discharges due to bed shortages and scarce post-discharge rehabilitation compounded relapse risk. Family support was frequently undermined by financial strain and competing demands, while crime and gang violence discouraged clinic attendance. Stigma within both communities and healthcare settings reduced trust and engagement. In this lower-middle-income country context, relapse prevention depends on integrated strategies that combine clinical management with interventions addressing structural and social determinants. Policy priorities include strengthening primary-level mental healthcare, ensuring medication supply continuity, expanding supervised care and vocational programmes, implementing stigma-reduction initiatives and fostering intersectoral collaboration to address safety and spatial inequities in service provision.
The management of risk associated with clinical processes is gaining increasing importance in both health policy and medical research. Data show that among mental health professionals, cases of violence and burnout are on the rise. Implementing appropriate risk management strategies in psychiatry should be considered a key objective. This study aims to provide an overview of the current state of psychiatric risk management, with particular focus on Italian community-based mental health services. Through a non-systematic review of international and national literature, we identify the main areas of risk in psychiatry, which can be summarized as: interpersonal violence, coercive interventions, environmental safety, adverse drug events, clinical errors, and professional burnout. In the Italian context, critical issues mainly concern the protection of staff well-being and safety, the management of forensic patients according to Law 81/2014, and the acquisition of informed consent. The National Action Plan for Mental Health 2025-2030 formally recognizes risk management as a field of action, outlining related priorities and operational strategies. For the effective implementation of risk management in community-based psychiatry, it appears to be necessary the dissemination of standardized assessment and monitoring tools, promote workforce continuous training, and strengthen the culture of consent and shared decision-making.
The theory to practice gap (TPG) is a significant challenge in undergraduate community nursing education. Although TPG has been extensively studied in nursing education, research specifically examining these gaps in community nursing remains limited. The aim of this study is to explore the manifestations, contributing factors, and bridging strategies of the TPG in community nursing education from undergraduate nursing interns' perspectives. A qualitative study guided by the knowledge-to-action (KTA) framework. This study was conducted at a medical university in China. Fifteen undergraduate nursing interns (12 females, 3 males) who had completed their 2-3-week community practicum were recruited using purposive sampling. Data were collected through face-to-face in-depth interviews conducted from October to December 2024. All interviews were audio-recorded and analyzed using Braun and Clarke's thematic analysis method. The analysis identified three core themes: (1) gaps, manifesting in individual competencies, pedagogical aspects, and healthcare system; (2) factors, including individual aspects, environmental aspects, and systemic issues; (3) strategies, focusing on enhancing talent development, adjusting teaching plans, and building collaborative mechanisms. Notably, a majority of the respondents believe that adjusting the ratio of theoretical and practical courses, enhancing students' hands-on learning, and strengthening school-community collaborative education can quickly narrow the gap. This study found that the TPG in community nursing involves three dimensions including individual, environmental, and healthcare system, primarily influenced by factors such as the disconnect between theoretical and practical curricula, uneven teaching quality, and insufficient support from community institutions. It is recommended to increase the arrangement of practical courses in the curriculum design process and implement corresponding synchronization, and to improve educational quality through regular exchanges between teachers from both schools and communities.
Background music is commonly played in operating theatres and is perceived by many health care professionals (HCP) to reduce stress and fatigue. However, objective psychological and physiological evidence supporting these benefits remains limited, leaving a gap between HCPs' perceptions and the measured experience. The Background Auditory Conditions in Healthcare (BACH) study aims to qualitatively explore HCPs' experiences, beliefs and perspectives regarding the use of background music in the operating theatre. Semi-structured interviews were conducted with seven HCPs including surgeons, anaesthetists, and theatre nurses recruited via purposive and snowball sampling between February and November 2024. Data were analysed using qualitative content analysis, with themes developed through open coding, collaborative review, and iterative refinement using a critical realist epistemology. Three surgeons, two anaesthetists, and two nurses from general, vascular, and ENT specialties participated in interviews. Five major themes were identified: (1) Team cohesion reflected in music (2) Music contributes to therapeutic space, (3) Music is not a panacea, (4) Power and protection play out through music and (5) Music as an environmental cue, encompassing nine subthemes. This study highlights the multifaceted role of music in the operating theatre, as perceived by HCPs. While music promoted team cohesion, elevated shared mood and was identified to have therapeutic value for patients and staff, it was also perceived to create or exacerbate interpersonal tension, reinforce hierarchy and disproportionately impact some individuals negatively. Background music also functioned as a situational cue, helping HCPs interpret the immediate OT environment.
Ginseng polysaccharide (GPS), the principal bioactive component of Panax ginseng, has attracted considerable interest for its health-promoting properties, including immunomodulation, neuroprotection, antioxidative effects, and gut microbiota regulation. However, the intricate chemical structures, complex in vivo dynamics, and poorly defined structure-activity relationships limit its application in health products. This review summarizes recent progress in GPS research, covering extraction, isolation, purification, structural characterization, and bioactivities. Furthermore, it elucidates the in vivo fate of GPS, including gut microbiota-mediated degradation, intestinal uptake, and tracking techniques, as well as GPS-based delivery systems and structural modifications to enhance bioavailability. We also discuss its potential in functional food development and outline future perspectives, including structure-activity relationships, microbial metabolism networks, and delivery challenges. This review aims to provide a solid theoretical foundation for the further utilization of GPS as a promising natural macromolecule for health applications.
Ecological risk assessment (ERA) and health risk assessment (HRA) of metal(loid)-contaminated soils are essential for the achievement of risk mitigation and sustainable soil management. While conventional risk assessment methodologies are constrained by static modeling and a lack of multivariate considerations, machine learning (ML) has demonstrated significant potential in soil metal(loid) ERA and HRA by leveraging robust data mining and pattern recognition capabilities. Following the PRISMA guidelines, the review included 54 peer-reviewed studies regarding ML-based ERA and HRA in metal(loid)-contaminated soils from the Web of Science and Scopus databases. The analysis of 54 reviewed studies reveals an upward trend in research within this field from 2021 to 2025, focusing on Cd, Pb, As, Cr, Cu, Zn, Ni, and Hg. Input data for ML approaches include environmental covariates (94.44%) and hyperspectral data (5.56%). ML applications in risk assessment comprise four distinct pathways: risk assessment based on direct modeling of risk indicators (29.23%), risk assessment based on predicted concentrations (32.31%), source-oriented risk assessments (32.31%), and risk assessments improved by environmental factors (6.15%). Specifically, ERA is mainly applied through direct modeling of risk indicators (42.86%), whereas source-oriented risk assessment (46.67%) is the primary pathway for HRA. This review provides a comprehensive synthesis of the current status and developmental trends, an overview and selection guidelines for ML approaches, a summary of common input variables, and a detailed analysis of application pathways, while addressing existing challenges and future perspectives.
With over 300 million surgeries performed under general anaesthesia annually, optimising perioperative brain health has become a critical public health priority. Electroencephalogram (EEG) monitoring, initially conceived to prevent awareness during anaesthesia, is now emerging as a tool for assessing cognitive vulnerability and predicting neurocognitive outcomes. This narrative review synthesises the evolution of intraoperative EEG monitoring across three conceptual stages: from a depth-of-anaesthesia measure to a tool for optimising anaesthetic exposure, and to an emerging biomarker of brain frailty and long-term perioperative risk. We review the technical foundations of EEG signal analysis and the distinctive patterns produced by GABAergic anaesthetics, characterised by frontal alpha anteriorization and slow-wave oscillations. EEG-guided anaesthetic titration reduces drug consumption, accelerates recovery, and minimises environmental impact, while maintaining equivalent safety. Specific intraoperative EEG patterns, including burst suppression and diminished alpha power, are robustly associated with postoperative delirium and cognitive decline, especially in vulnerable populations. However, trials targeting these patterns have not consistently prevented delirium, revealing that baseline cognitive impairment mediates most of the risk. Age-dependent EEG changes under anaesthesia, including reduced oscillatory power and altered spectral characteristics, may serve as markers of latent brain vulnerability. Intraoperative EEG monitoring should be viewed not merely as a tool for titrating hypnotic agents, but as a window into perioperative brain health. Future integration of machine learning algorithms and longitudinal cognitive follow-up may enable EEG-based preoperative risk stratification and individualised perioperative management strategies, transforming perioperative care for cognitively vulnerable patients.
Latin America and the Caribbean host one of the world's most complex intersections of ancestry, pathogen exposure, and environmental change, generating an immunological landscape that cannot be fully understood through frameworks derived from high-income regions. The region's immune profiles reflect the legacy of colonization, population collapse, forced migration and admixture, together with more recent transformations driven by urbanization, dietary change, pollution and shifts in microbial exposure. These factors contribute to variability in immune responsiveness, susceptibility to infection and immune mediated and metabolic diseases. In this review, we aim to integrate insights from population genomics, infectious disease epidemiology, environmental immunology and social determinants of health to examine how these processes contribute to immune variation across LAC. We highlight how ancestry associated immunogenetic variation, in interaction with environmental and socioeconomic context, may contribute to heterogeneity in host-pathogen interactions, inflammation regulation and vaccine responses. We further discuss how persistent infectious exposures coexist with rising non-communicable diseases, generating distinct immunological trajectories. Understanding immunity in LAC may provide a framework for developing context specific interventions while offering broader insight into how ancestry, environment and social conditions shape human immune adaptation.
Dark kitchens - technology-enabled commercial kitchen(s) operating primarily for delivery, to fulfil remote, on-demand, consumer online orders of food for immediate consumption - are a contemporary addition to the food environment. There are growing concerns around the impact of these food businesses on wider determinants of health, with a paucity of guidelines, regulations and oversight of the dark kitchen sector. This work explored the perceptions of dark kitchens from multiple stakeholder perspectives. This study recruited key stakeholders (consumers, those working in local authorities and dark kitchens) and applied mixed-methods approaches to explore the definition, identification and regulation of dark kitchens. Results show confusion and inconsistencies in the way that consumers, local authority departments and other stakeholders define, identify and regulate dark kitchens, resulting in current regulation being difficult to implement. Where local authorities worked cross-departmentally, a more consistent approach to regulating dark kitchens was observed. The potential risks of dark kitchens to food safety, food hypersensitivities and public health agendas are not fully known and warrant further research and policy development. Defining, identifying and regulating dark kitchens in the North of EnglandThis research explored the perceptions of dark kitchens held by consumers, people working in local authorities and those working in food businesses. Dark kitchens are food businesses that offer food for delivery through online orders made via mobile or web applications. Participants had different opinions on what dark kitchens were. Participants working in local authorities applied different approaches to identifying and regulating dark kitchens, and found it difficult to do this within current regulation frameworks. Dark kitchens may pose a risk to food safety, food hypersensitivities and allergies, and public health, which requires further research and policy development.