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The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
Environmental health services in healthcare facilities-including water, sanitation, hygiene, waste management, cleaning, and infection control-prevent disease and strengthen healthcare delivery. Yet environmental health services are inadequate in many low- and middle-income countries (LMICs). Despite the importance of monitoring and improving services, no comprehensive evidence map exists to describe knowledge and gaps for action. The study objective was to comprehensively catalog published literature on environmental health services in healthcare facilities in LMICs by service domain, study type, and relevance to policy and practice. We conducted a systematic literature search in 2023 and updated it in 2025. After performing database searches, we used a machine learning process to prioritize studies for manual title-abstract screening. Through a title/abstract tagging process, we developed a literature inventory that categorized studies by topic, design, and relevance to policy and practice objectives. The literature inventory included 4381 studies. Fifty-eight percent of the studies were baseline assessments of environmental health services, 36% involved formative research (e.g., qualitative methods), and 13% evaluated interventions or implementation strategies. Most studies (62%) examined hygiene at points of care, while 9% examined water and 6% sanitation. Twenty-seven percent of studies examined services during the COVID-19 pandemic. There is little evidence for effective interventions and implementation strategies to improve and sustain environmental health services, especially for water and sanitation services. Formative research on under-studied services can help policymakers set investment priorities. Findings can inform the development of research agendas and practical guidelines for improving access to safe healthcare environments.
Antimicrobial-resistant bacteria are emerging biological contaminants that threaten both ecosystems and human health. Antimicrobial resistance (AMR) in livestock waste is increasingly recognized as an environmental hazard of global concern, with implications for food safety and public health. This study examined the occurrence and environmental behavior of extended-spectrum β-lactamase (ESBL)-producting and colistin-resistant Escherichia coli under environmentally relevant conditions in livestock waste from pig, cow, goat, chicken, and duck farms in Thailand. Cefotaxime-resistant E. coli were detected in all animal types, with pig, cow, and duck farms serving as major reservoirs. Untreated pig wastewater contained the highest levels of resistant E. coli (70% prevalence; 5.13-7.55 log10 CFU/100 mL), while treatment reduced but did not eliminate contamination. Among 78 confirmed isolates, all were resistant to ampicillin and cefotaxime, 5.1% to ceftazidime, and none to carbapenems. Phenotypic colistin resistance occurred in 6.4% of isolates. All isolates carried blaCTX-M genes, mainly blaCTX-M group 1 (85.9%), while blaCTX-M group 9 (15.4%) was also detected. Plasmid-mediated mcr genes (mcr-1 to mcr-3) were identified in 5.1% of isolates, exclusively from untreated pig wastewater, confirming these effluents as localized hotspots for resistance dissemination. Multiple antibiotic resistance indices ranged 0.29-0.43, with the highest values in pig farm isolates, indicating moderate to high levels of multidrug resistance. Overall, livestock wastewater represents a significant source of microbial contaminants. This study provides field-based evidence to support risk assessment and mitigation of antimicrobial-resistant bacteria within the One Health framework, emphasizing the importance of improving waste management to protect environmental and public health.
The prenatal period and childhood are particularly vulnerable to lead toxicity. Lead battery recycling plants (LBRP) can pose a health concern due to potential community exposure. A community-based intervention using an environmental health approach was implemented in a municipality near an LBRP. A joint Clinical Action Plan was implemented in Bonmatí (Catalonia, Spain), including training for local health professionals and public information sessions. Children <15 years and pregnant women were invited to blood lead testing and an environmental clinical screening (Green Page) to identify exposure and potential sources. Municipal air, soil, and water were analysed for lead; geometric means and multivariable analyses of sociodemographic variables and environmental risks were computed. Overall, 141 blood samples were collected (139 children, 2 pregnant women). In children, the geometric mean blood lead level was 0.98 μg/dL; one child exceeded 3.5 μg/dL and was referred to the regional Paediatric Environmental Health Specialty Unit (PEHSU) for specialized assessment and follow-up. Residential distance to the LBRP was not associated with blood lead. Air and water lead levels were within legal limits, whereas soil samples within the LBRP exceeded the regulatory value. This environmental health approach supported exposure assessment, professional engagement, and community empowerment. Although elevated blood lead levels were rare, continued environmental surveillance and preventive measures were recommended. Integrating clinical, environmental, and community strategies may strengthen sustainable prevention in at-risk settings.
People with disabilities and older adults are often disproportionately excluded from public health interventions. The study explored the reach and perceptions of hygiene behaviour change messages (e.g., handwashing, mask use, social distancing) and hygiene products (e.g., soap, mask, sanitiser) delivered through multiple channels among people with disabilities and older adults than those without disabilities and younger people. A matched cross-sectional study was conducted in Indonesia, Kenya, and Zambia from December 2020 to November 2022, utilising three-stage stratified random sampling technique. Data were analysed using descriptive statistics and multivariate generalised estimating equation models. Pooled analysis found people with disabilities were 64% less likely to report receiving hygiene behaviour change messages than those without disabilities (aOR = 0.36; 95% CI: 0.24-0.55). In Indonesia and Kenya, they were 59% (aOR = 0.41; 95% CI: 0.24-0.72) and 54% (aOR = 0.46; 95% CI: 0.28-0.76) less likely to receive messages. Message reach was higher among older adults (87%) and younger people (91%) in Indonesia. People with cognitive, vision, and self-care impairments had lower message reach. No significant difference was observed in hygiene product reach across disability status. In Kenya and Zambia, rural and higher socio-economic groups were more likely to report receiving products, but older women in Zambia were less reported. Across all countries, people with disabilities and older adults were less likely to report messages actionable or effective. People with disabilities and older adults reported lower reach of hygiene behaviour change programs, with inequities based on impairment type and socio-demographic context. Inclusive and context-specific strategies are required to increase reach.
Children and adolescents are highly exposed to harmful polycyclic aromatic hydrocarbons (PAHs) that exist as mixtures of hundreds of compounds in air, soil, water, dust and food. This study investigated 21 personal, lifestyle and environmental predictors of urinary PAH metabolites from four PAHs (naphthalene, fluorene, phenanthrene and pyrene), using a dataset of 516 3-17-year-olds from 167 locations in Germany. Spearman correlation analysis showed weak to moderate associations (ρ = 0.2-0.6) between PAH metabolite concentrations. Regression analysis revealed high nicotine exposure, young age, and residence in large cities to be the most important predictors of multiple PAH burden, with estimated changes in metabolite concentrations of 124-1080%, 47-155%, and 22-57% respectively. Other notable predictors included: BMI, socioeconomic status, sex, consumption of chocolate, smoked and barbecued foods, chewing on plastic objects, road traffic, and heating type. Analysis of the ratios of 1-hydroxynaphthalene to 2-hydroxynaphthalene for subgroups with high cotinine level (3-fold increase) or moderate to high chocolate consumption (1.7-3.4-fold increase) was suggestive of exposure to carbaryl, a pesticide not permitted for use in the EU since 2007. Differences in the burden of PAH metabolites between East and West Germany was investigated using subgroup analysis. Consuming smoked food was both more prevalent (p = 0.009) and likely to contribute to a greater 1-hydroxynaphthalene burden in the East German subsample. Gaining a better understanding of exposure factors, especially using population data from a large number of locations, will guide policy makers and regulators in strengthening protective measures.
Antimicrobial resistance (AMR) is one of the main pressing global health concern that we are facing. Environmental compartments, particularly wastewater, are recognised as important reservoirs for antibiotic-resistant bacteria and antibiotic resistance genes (ARGs). Hospital wastewater (HWW) has been shown to contain higher concentrations of ARGs, especially clinically relevant ARGs, compared to domestic wastewater (DWW), raising concerns about its role in the dissemination of AMR. Here, we conducted a multi-year monitoring study comparing HWW, DWW, and mixed wastewater (MWW; i.e., DWW receiving HWW), using phenotypic and genotypic methods. Our results showed that HWW harbored significantly higher levels of resistant and multidrug-resistant bacteria than both DWW and MWW. The relative abundance of most ARGs was also higher in HWW, with β-lactamases encoding genes (blaIMP, blaKPC, blaNDM, blaVIM) appearing particularly associated with HWW exposure. Microbial community analysis further revealed that HWW was dominated by human commensal bacteria, while DWW and MWW were largely composed of environmental species. Overall, only a few differences were observed between DWW and MWW, likely due to substantial dilution of the HWW input and a shift in microbial communities. This study provided valuable insight into antibiotic resistance dynamics in urban wastewater systems and highlighted a limited effect of HWW exposure. Nevertheless, it also showed that HWW appeared to be a significant source of clinically concerning metallo-β-lactamases encoding genes in wastewater, in the context of increasing incidence of blaNDM- and blaVIM- producing Enterobacterales reported in France.
Knowledge of infectious agents, modes of transmission, and routes of spread play a central role in planning and performing infection prevention and control (IPC) procedures. The European Hygeia survey involved an online questionnaire that was administered from March 2025 to August 2025 to nurses from acute Hospitals and long-term facilities in Italy, Spain, Sweden and Turkey, to monitor their training on hygiene and related topics, in order to provide them up-to-date, reliable and easily accessible professional education and training to strengthen their knowledge on IPC procedures. A total of 438 nurses were included in the study; their median age was 42 years and 368 (84%) were women and 66 (15%) men; 4 (1%) not stated. Most nurses attended at least one hygiene course (321, 75%), 364 (84%) nurses were interested in attending a hygiene course. There were a few statistically significant differences in education level, in particular, nurses with university degree had a greater self-perceived knowledge in hygiene and prevention with adjusted Odds Ratios (aOR) = 3.77, CI: 1.38-10.30, p = 0.010 and infections (aOR = 2.96, CI: 1.09-8.01, p = 0.033) than nurses with diploma. Our study showed most nurses had a good self-perceived knowledge in hygiene prevention and protection measures and were willing to take part in future courses on this subject. Greatest knowledge deficiencies were related to disinfection and sterilization and infection control fields, future education courses should aim to address this issue.
This study investigated the association between residential greenness exposure and the prevalence of allergic diseases in four-year-old children in the Greater Tokyo Area, Japan. It was an Adjunct Study of the Japan Environment and Children's Study, an ongoing nationwide birth cohort study. Participants who resided in the Greater Tokyo Area at both three and four years of age were selected and 10,846 children were included in the analysis. Residential greenness was defined as the average normalised difference vegetation index (NDVI) within a 500 m buffer of each home, derived from Landsat satellite images. Guardians reported their children's allergy status based on a doctor's diagnosis and the International Study of Asthma and Allergies in Childhood (ISAAC). Multiple logistic regression analysis examined the association between residential NDVI and allergic outcomes, adjusting for child characteristics, maternal factors, socioeconomic indicators, and indoor environmental exposures as potential confounders. The average (standard deviation) NDVI was 0.15 (0.05). For atopic dermatitis, the adjusted odds ratios (95%CI) were 0.84 (0.72-0.97) for physician diagnosis (guardian-reported) and 0.82 (0.72-0.94) for ISAAC. For asthma, the corresponding odds ratios were 1.25 (1.10-1.42) and 1.25 (1.11-1.40). No association with NDVI was observed for any other allergies. These results were consistent regardless of the buffer size. The observed negative associations between greenness and atopic dermatitis are compatible with the biodiversity hypothesis. The positive associations between greenness and childhood asthma warrant further examination, specifically regarding the quality and composition of greenness and air quality. These findings are crucial for developing effective public health guidelines.
Reproductive health is declining globally, with growing evidence linking exposure to endocrine-disrupting chemicals during critical pregnancy stages to adverse male sexual development. This study assessed the cumulative risk of nine such chemicals-acrylamide, PCB 118, DEHP, DnBP, DiBP, BBzP, DiNP, DCHP, and DnPeP-and possible influencing factors such as age, socioeconomic status (SES), and region (former East vs. West Germany). We analyzed cross-sectional data from the German Environmental Survey for Children and Adolescents 2014-2017 (GerES V), including 1090 participants with complete urine and plasma samples. Using the Hazard Index (HI) method, which combines exposure levels with human biomonitoring guidance values, we found that 31% of participants had an HI above 1, indicating elevated risk from combined chemical exposure. Notably, 26% of these cases would have gone unnoticed in single-substance assessments. DnBP, DiBP, and acrylamide were the main contributors to overall risk. Stratified analyses revealed that younger children had higher HI levels than older ones. Children from lower SES backgrounds also showed higher risk compared to those from medium or high SES groups. Additionally, residing in former East Germany was associated with increased HI levels compared to former West Germany. These findings emphasize the importance of considering chemical mixtures in risk assessments and recognizing subgroup-specific vulnerabilities. Future assessments should expand the range of included chemicals and focus on high-risk groups-especially children, individuals with low SES, and residents of former East Germany-to better capture the scope of potential health impacts.
The early-life composition and maturation of the upper respiratory microbiome, and their associations with environmental exposures and respiratory health, remain poorly characterized. We collected nasopharyngeal (NP) and oropharyngeal (OP) samples (n = 257) from a cohort of 114 Guatemalan infants at birth and six months between February and August 2019. We analyzed their NP and OP microbiomes using 16S rRNA gene sequencing and examined associations with air pollution and respiratory outcomes during the first year of life. Results show that NP and OP microbiomes exhibited distinct developmental trajectories, with NP diversity declining and OP diversity increasing by six months, accompanied by age-related compositional restructuring. Taxonomic succession was anatomically site-specific; NP communities matured toward lower alpha diversity with facultative dominance, whereas OP communities showed anaerobic enrichment and rising alpha diversity, yielding stable, differentiated airway communities. Neither alpha nor beta diversity was consistently associated with WHO IMCI (Integrated Management of Childhood Illness) pneumonia (both severe and non-severe), cough, or hypoxemia, except for higher NP alpha diversity at birth, which predicted increased odds of fast breathing episodes (Shannon: adjusted OR = 4.81, 95% CI: 1.80, 7.46 & inverse Simpson: aOR = 1.20, 95% CI: 1.04, 1.43). Higher NP Bacteroidota relative abundance at birth was associated with lower odds of subsequent WHO IMCI pneumonia (aOR: 0.003, 95% CI 0.001-0.02; FDR = 0.10). Higher personal PM2.5 exposure at 3 months was associated with differential NP microbiome composition at 6 months, including lower Firmicutes abundance (β = -0.53; 95% CI: -0.82, -0.25; FDR = 0.17) and higher Prevotella abundance (β = 3.21; 95% CI: 1.90, 4.51; FDR = 0.08), consistent with PM2.5 acting as an ecological stressor that may predispose to airway dysbiosis. These findings reveal coordinated but site-specific patterns of microbial maturation in early infancy and suggest that predictable age-related shifts in community composition, together with both environmental exposures, shape upper airway microbial communities with implications for respiratory health.
Polycyclic aromatic hydrocarbon (PAH) exposures from agricultural and household woodburning may adversely impact kidney health, but studies are limited in Latin America where these practices are prevalent. We aimed to characterize PAH exposures and examine their associations with kidney injury biomarkers among agricultural workers in Chile. Among 43 male agricultural workers from the Maule Cohort, we quantified urinary concentrations of five kidney injury biomarkers (IL-18, KIM-1, MCP-1, NGAL, YKL-40) and nine hydroxy-PAHs. Additionally, we measured 23 parent PAHs in wristbands, worn 8-11 days. We estimated percent differences in kidney biomarker concentrations and odds ratios of subclinical kidney injury (defined by two or more kidney biomarkers in the highest tertile) per interquartile range increase in PAH exposure concentration. All urinary PAH and kidney biomarkers were frequently detected (>70%) as were 13 parent PAH compounds in wristbands. We observed consistent positive associations of urinary IL-18 with select PAH exposures. Specifically, higher urinary IL-18 concentrations were observed in association with higher urinary concentrations of 1-PHE (80.4%; 95%CI: 33.8%, 143.3%), 2&3-PHE (44.1%; 95%CI: 12.7%, 84.2%), and 4-PHE (48.8%; 95%CI: 12.9%, 96.1%). Similarly, IL-18 concentrations were positively associated with higher wristband concentrations of anthracene (46.7%; 95%CI: 9.7%, 96.2%), phenanthrene (32.3%; 95%CI: 5.5%, 65.9%), fluorene (56.9%; 95%CI: 10.2%, 123.3%), and pyrene (34.1%; 95%CI: 3.2%, 74.3%) and among participants with naphthalene detected in their wristbands (51.5%; 95%CI: 1.3%, 126.7%). Wristband concentrations of benzo[e]pyrene, benzo[a]pyrene, and chrysene were associated with higher odds of subclinical AKI but not decreased kidney function. Our findings suggest that select PAH exposures may be associated with kidney injury, addressing major knowledge gaps and informing future studies of kidney health in agricultural communities.
Water, sanitation, and hygiene (WASH) interventions have had inconsistent benefits on diarrhea. The WASH Benefits (WASH-B) Kenya randomized controlled trial evaluated a set of WASH interventions (water W, sanitation S, hygiene H, and combined WSH) targeting children under 2 and found no reduction in diarrheal prevalence. We used a compartmental model fit to WASH-B Kenya data (n = 11,856) and explored whether and how changes to intervention factors (intervention efficacy, compliance, and community coverage) and contextual factors (transmission intensity, baseline WASH conditions, completeness of transmission pathways targeted) could reduce child diarrhea by 50% compared to the control arm. We estimated that this target could not be achieved by single-intervention arms (W, S, or H). However, it could be achieved in the WSH arm if there were substantial intervention improvements (i.e., 50% intervention efficacy, 100% compliance, and 60% community coverage). High baseline transmission intensity and limited preexisting WASH infrastructure in Kenya hindered impact, so we also considered changing contextual factors could influence achievable benefits. Improvements in contextual factors coupled with more modest increases in intervention factors could achieve a 50% reduction in diarrhea in the W, H, and WSH arms. Thus, in settings like Kenya with high diarrhea prevalence, WASH interventions must be used by most of the population (>60%) and block multiple transmission routes (as in the WSH arm) to appreciably reduce burden. In settings with more favorable contextual factors, diarrhea can be reduced with moderate intervention factor targets. Applications of this approach could inform WASH policies, programs, and trial design.
Environmental phenols are endocrine-disrupting chemicals widely used in personal care products. They have been shown to affect the mammary gland, but knowledge about their impact on breastfeeding duration is limited. We aimed to explore associations between maternal phenols exposure during pregnancy and breastfeeding duration. We included 373 mother-infant pairs from the Health Outcomes and Measures of the Environment (HOME) Study (Cincinnati, Ohio, USA) enrolled from 2003 to 2006. We measured urinary concentrations of eight phenols at 16 and 26 weeks of gestation (bisphenol A, triclosan, benzophenone-3, 2,4-/2,5-dichlorophenols, methyl-/propyl-/butyl-paraben) and collected breastfeeding information until mothers reported discontinuation of exclusive and any breastfeeding. We assessed the hazard ratios (HRs) and odds ratios (ORs) of the cessation of breastfeeding in relation to the eight phenols using confounder adjusted Cox proportional hazards and logistic regression models, respectively. In adjusted Cox regression models, each doubling of urinary triclosan concentration was associated with HRs of 1.09 (95% CI: 1.00, 1.18) for any breastfeeding cessation within 6 months, and 1.08 (95% CI: 0.96, 1.21) for cessation between 6 and 12 months, with tertile-categorized analyses suggesting a dose-response relationship for cessation within 6 months. We did not observe consistent associations with breastfeeding duration for the seven other phenols, but each doubling concentrations in triclosan and BP-3 were associated with 18% (95% CI: 3, 35%) and 13% (95% CI: 1, 26%), respectively, higher odds of terminating breastfeeding earlier than intended. Considering the limited sample size and multiple testing, our findings need to be confirmed in larger studies.
Climate variability poses significant risks to Ethiopia's rainfall-dependent smallholder farming systems. Since meteorological patterns can vary widely across agro-ecological zones, understanding differences in vulnerability across these zones is essential for targeted adaptation. However, many existing vulnerability studies rely on basin-, zonal-, or inter-district analyses and apply composite indices without robustness testing, which can obscure within-district heterogeneity and limit policy relevance at the scale where adaptation decisions are implemented. This study assesses smallholder farmers' vulnerability to climate variability across three agro-ecological zones (midland, highland, and cold highland) in Legambo District, north-central Ethiopia. It examines spatial differences in vulnerability levels, identifies key biophysical and socio-economic drivers, and generates evidence to inform locally differentiated adaptation and development interventions. A mixed-methods approach was employed, combining household survey data from 347 randomly selected households with focus group discussions, key informant interviews, and long-term climate data. Forty-eight indicators were grouped into twelve major components and analyses using the Livelihood Vulnerability Index (LVI) and the LVI-IPCC framework, which conceptualise vulnerability in terms of exposure, sensitivity, and adaptive capacity. The robustness of the composite indices was assessed using a PCA-based sensitivity analysis, and household-level vulnerability distributions were examined to capture within-zone heterogeneity. The results reveal modest but consistent differences in vulnerability across agro-ecological zones. The cold highland zone was the most vulnerable (LVI = 0.370), driven by high exposure to climatic hazards, limited infrastructure, weak social networks, low innovation uptake, and constrained adaptive capacity. The highland zone exhibited moderate vulnerability, largely associated with inadequate water and health services and limited soil and water conservation practices. In contrast, the midland zone was the least vulnerable (LVI = 0.285), benefiting from greater livelihood diversification, better access to assets, and stronger adaptive capacity. The LVI-IPCC analysis confirmed these patterns, indicating higher exposure and sensitivity in the cold highlands and comparatively stronger adaptive capacity in the midlands. These findings indicate the interest of differentiated policy responses to strengthen resilience among smallholder farmers. In particular, the results indicate that improved rural roads, water supply, and health services, together with agro-ecological-zone-specific extension support and improved access to climate-resilient inputs, should strengthen adaptation planning and rural development program.
Indoor air quality, especially carbon dioxide (CO2) and volatile organic compounds (VOCs), has been linked to cognitive impairment in previous studies, even below guideline levels. Most previous studies employed small cross-over designs and varied only one indoor air factor. This study aimed to investigate the influence of various combinations of indoor air parameters at typical and elevated levels on cognitive performance. We conducted a randomized controlled trial with 398 healthy adults aged 18-69 years. Participants were randomly assigned to 11 groups and exposed to different combinations of pure CO2 (1200, 2750, 4200 ppm), atmospheric pressure (940, 755 hPa), and a VOC mixture of selected compounds at low, medium, and high concentrations. Eight different cognitive domains were assessed with established tests. Participants rated air quality as good to very good at the end of exposure in all groups. Analyses of variance with pairwise comparisons showed effects of exposure in 2 out of 8 cognitive domains (concentration and figural working memory). None of the observed differences were systematically aligned with the air quality conditions. Our study provides no evidence that short-term exposure to various combinations of CO2 (up to 4200 ppm), TVOCs (up to 2100 μg/m3), and atmospheric pressure up to 8000 ft. elevation had any systematic negative effects on the cognitive abilities of healthy adults. The TVOC results should be viewed with caution, as a specific mixture was used, and other mixtures may occur in other indoor environments. Rigorously designed studies with longer exposure times are recommended.
The COVID-19 pandemic drastically altered human behaviors alongside meteorological and environmental conditions, yet how these shifts differentially impacted respiratory versus intestinal infectious diseases remains unclear. This study investigates the evolving relationships between environmental exposures and disease transmission across pre-pandemic, pandemic, and post-pandemic phases. We analyzed surveillance data for notifiable respiratory and intestinal diseases in Sichuan Province (2006-2023), integrating meteorological and environmental pollution data via principal component analysis (PCA). A modeling framework combining PCA with generalized additive distributed lag non-linear models (PCA-GAM-DLNM) was applied to quantify the non-linear and lagged effects of composite environmental exposures on disease risks. A significant divergence emerged during the pandemic: respiratory diseases declined sharply due to non-pharmaceutical interventions (NPIs), whereas intestinal diseases (e.g., infectious diarrhea) remained stable or increased, correlating with worsened water pollution indicators despite improved air quality. We identified four distinct exposure-lag patterns, ranging from immediate effects (acute hemorrhagic conjunctivitis) to protection-risk reversal effects (mumps). Simulations indicated that using medium-to-high exposure levels as baselines yields more reliable early warnings than average levels. Respiratory and intestinal diseases exhibit differential environmental sensitivities. The persistence of intestinal diseases during the pandemic suggests that NPIs targeting airborne transmission are insufficient for waterborne risks. Future public health strategies require integrated management coordinating air and water quality control, with targeted interventions accounting for specific disease lag mechanisms and extreme weather risks.
There is a broadly acknowledged need for more robust research exploring the potential health effects of occupational radiofrequency radiation (RF) exposure. The National Register of RF Workers is a long-standing database consisting of workers that typically work outside and are occupationally exposed to RF in the telecommunication and broadcast industries in the United Kingdom. This work describes the initial preliminary analysis of the cohort comparing cancer incidence at multiple sites with that observed in the general population. Cancer registration (incidence) details from NHS Digital were used and standardised registration rates (SRR) calculated as the ratio of observed to expected numbers of registrations expressed as a percentage. In calculating P-values and confidence intervals, it was assumed that registrations occurred following a Poisson distribution. All significance tests were two-tailed. The cohort comprised 1777 employees (1744 males and 33 females) Compared with national rates, all cancers combined are slightly below expectation (Observed 39, SRR 93). The only statistically significant finding is for an excess of skin cancer (excluding melanoma) (Observed 25, SRR 177, 95% CI 117 to 258, P < 0.01). Amongst legitimate concerns over the health effects of long-term occupational exposure to RF in the telecommunication and broadcast sector it is important not to overlook the significant hazard of exposure to ultraviolet radiation in a workforce that predominantly works outside. There are several ways organisations might mitigate this impact including amending working hours during the summer months and culturally tailored education on the importance of individual preventative measures.
Urban characteristics can shape physical activity, but evidence regarding their joint role alongside individual perceptions remains limited. This study examined the combined associations of multiple environmental characteristics with physical activity across the five most populous cities in Bulgaria. A cross-sectional survey of 4640 adults was conducted in 2023. Physical activity across different intensity levels was measured with the short form of the International Physical Activity Questionnaire and linked to objective measures of neighborhood walkability, fine particulate matter, road traffic noise, area-level socioeconomic status (SES), and availability of greenspace and bluespace within 300 m and 1000 m buffers. Presence of a home garden was self-reported, along with perceived walkability, bikeability, greenspace, bluespace, and sociodemographic factors. Results showed that walkability, greenspace, area-level SES, home gardens, perceived bluespace, high/low perceived greenspace (vs. medium), and bikeability were positively associated with time spent in vigorous physical activity. Walkability, greenspace, perceived bluespace, low/high perceived greenspace, home gardens, and bluespace were positively associated with moderate-to-vigorous physical activity. Objective and perceived walkability, medium/high levels of greenspace, low/high area-level SES, and home gardens were positively associated with walking. Associations remained robust after accounting for air pollution and noise, which were unexpectedly positively associated with certain forms of physical activity. These findings appear meaningful from a preventive perspective and may provide arguments for improving urban design conducive to physical activity and urban planning initiatives.