International Journal of Environmental Research and Public Health

ObjectiveImproved diet quality is increasingly important for comorbidities management and healthy aging in people with HIV (PWH). Yet, limited data exist on dietary patterns and their correlates in this population. This study aimed to (1) characterize dietary patterns among adult PWH and (2) identify demographic, clinical, and HIV-related factors associated with diet quality. MethodsWe conducted a cross-sectional analysis of PWH enrolled in the PROSPER-HIV study across four U.S. academic medical centers. Dietary intake was assessed using three 24-hour dietary recalls and scored using the Healthy Eating Index-2015 (HEI-2015). Participants were categorized into tertiles based on total HEI-2015 scores. Between-group comparisons were performed using Kruskal-Wallis and chi-square tests. Factors independently associated with HEI-2015 scores were identified using multivariable linear regression. ResultsA total of 491 PWH were included with a median age of 54 years; 76.4% were male. Overall diet quality was low with inadequate intake of dietary protein, fiber, and micronutrients. When classified by tertiles of HEI-2015 score, higher diet quality was characterized by greater intake of fiber, protein, and key micronutrients. Older age was independently associated with higher HEI-2015 scores ({beta} = 0.119, p = 0.018), while Black race was associated with lower scores ({beta} = -3.427, p = 0.008). Full-time employment and absence of current pain were marginally associated with better diet quality. ConclusionsDiet quality among PWH varies substantially and is influenced by age, race, and social determinants. Tailored nutritional strategies are needed to support healthy aging and reduce disparities in this population.

University Students are particularly vulnerable to disordered eating behaviors (DEB) and attitudes (DEA). This study expands upon the knowledge base of DEA and DEB in university students by employing a netnography as a precursor to the main study to establish the following research questions: What is the relationship between the perceived quality of dining services and DEA? What is the relationship between the perceived availability of dining services and DEA? And lastly, how does prior experience with dining services affect eating patterns and attitudes toward food? The first study utilized a netnographic approach in order to evaluate issues with university dining services, leading to the design of the second study. Students at an upper Midwestern university (n=88) were surveyed via convenience sampling. Eating attitudes, eating behaviors, and relationships with dining services were measured. A statistically significant relationship between the availability of services and the DEA was found. A statistically significant relationship between the availability of services and risk behaviors was found. However, no statistically significant correlation existed between first-year dependence on on-campus dining services and risk behavior related to eating disorders or eating attitudes. Based on this, we know the quality of nutrition and the availability of services impacted students eating attitudes and behaviors, not inherent dependence.

PurposeThis study aimed to examine the effects of formative and summative assessments on college students tennis performance and basic psychological needs. MethodsA total of 128 undergraduate students (64 males, 64 females; Mage = 19.22, SD = 0.91) participated in this study. Participants were cluster-randomized to either a formative assessment group (n = 64) or a summative assessment group (n = 64). The formative assessment intervention involved setting personalized learning goals and success criteria, administering periodic tests, and providing process-oriented and individualized feedback. The summative assessment intervention involved setting uniform goals for all students, offering instructor feedback only on common problems, and requiring students to practice independently after class without personalized guidance. Both interventions were implemented over 10 weeks, with one 90-minute session each week. Tennis skills and basic psychological needs (i.e., autonomy, competence, and relatedness) were assessed before and after the intervention. Tennis skills were reassessed 1 week after the intervention. Two-way mixed-effects analysis of variance (ANOVA) was used to examine the impact of group, time, and their interaction on tennis skills and basic psychological needs. ResultsThe results showed that the interaction between group and time was significant for all of the outcome variables. Simple effects analyses indicated that, at pre-test, the two groups did not differ significantly in tennis performance or in satisfaction of autonomy, competence, and relatedness (p > 0.05). At post-intervention, the formative assessment group demonstrated significantly better performance than the summative assessment group in tennis skills (MD = 3.50, 95% CI = [1.303, 5.697], p = 0.002), autonomy (MD = 2.44, 95% CI = [1.816, 3.059], p < 0.001), relatedness (MD = 1.33, 95% CI = [0.679, 1.977], p < 0.001), and competence (MD = 1.75, 95% CI = [1.046, 2.454], p < 0.001). At the 1-week follow-up session, the formative assessment group also showed significantly better tennis performance than the summative assessment group (MD = 6.81, 95% CI = [4.667, 8.958], p < 0.001). ConclusionFormative assessment was more effective than summative assessment in improving college students tennis performance and satisfying their basic psychological needs. These findings suggest that incorporating personalized goals, process-oriented evaluation, and individualized feedback into tennis instruction could promote both skill development and psychological outcomes in college physical education.

BackgroundDisparities in injury and death indicate that Latinos and Hispanics are disproportionately affected by firearm violence. Understanding the factors that impact Latino and Hispanic engagement with firearm safety is integral to developing nuanced interventions, yet these factors remain largely understudied. This study explores the social ecological factors related to firearm safety engagement among Latino and Hispanic adults residing in New Mexico. MethodsThe study used a convergent mixed-methods design with quantitative and qualitative components. Data were collected from a predominantly Latino-Hispanic community experiencing high rates of firearm violence near Albuquerque, New Mexico. Quantitative data (n=303) were collected using a community-based survey with a non-random sample on firearm safety engagement, collective efficacy, and sociodemographic characteristics. Qualitative data (n=18) included semi-structured interviews from a subset of the survey population who expressed interest in participating. Quantitative data was used to explore descriptive statistics and correlations between reported levels of collective efficacy and firearm safety engagement. Qualitative data were used to explore the firearm safety experiences of Latino and Hispanic participants. AnalysesMultivariate regression analyses examined associations between collective efficacy (exposure) and engagement with firearm safety (outcome). I also explored associations across key domains: collective efficacy, neighborhood characteristics, individual characteristics, and sociodemographic factors. Interviews were analyzed using framework analysis to generate a cohesive thematic structure informed by a social ecological model. The results from the quantitative and qualitative data were then integrated to develop a robust understanding of social ecological factors related to firearm safety engagement using a mixed methods joint display. ResultsThere were 303 survey participants (40.6% male; 55.1% female; 4.3% other gender identity) and 18 interview participants in this study. 57.1% of survey participants reported engaging with at least one firearm safety practice or initiative. Results from multivariate regression indicated that higher collective efficacy ({beta} = 0.082, p = 0.002), higher informal social control ({beta} = 0.174, p = 0.001), stronger endorsement of gun safety principles ({beta} = 0.079, p < 0.001), being married vs. unmarried ({beta} = -0.334, p < 0.001), speaking Spanish in the home vs. English ({beta} = 1.048, p < 0.001), and not owning a gun ({beta} = - 0.638, p = 0.006) were significantly and positively associated with firearm safety engagement. Themes from the qualitative data included barriers (insecure environment; lack of meaningful engagement) and facilitators (location-specific contributors to safety; collective identity and pride) to firearm safety engagement, organized by social ecological domain. Mixed methods findings indicate factors associated with participants individual firearm safety engagement, while providing insights into the perceived barriers and facilitators across social ecological domains. DiscussionFindings from this mixed-methods study suggest that processes of empowerment and collective efficacy may contribute to greater firearm safety engagement within Latino and Hispanic communities. Findings expand injury prevention research by exploring the factors influencing firearm safety engagement among a marginalized and hard-to-reach population who have disproportionate experiences with firearm victimization, perpetration, and injury. ConclusionThis study offers unique methodological approaches by using concurrent mixed methods and collecting complementary data sources to understand firearm safety engagement among Latinos and Hispanics. Findings highlight the need for culturally specific and community-engaged interventions that address social ecological disparities to strengthen safety practices and reduce firearm-related harms.

BackgroundForeign bodies (FBs) can cause obstruction, infection, or injury, yet comprehensive global assessments remain limited. This study evaluated the burden of FBs from 1990-2021, projected trends to 2050, and identified high-risk populations. MethodsUsing Global Burden of Disease 2021 data, we estimated age-standardized incidence ratio (ASIR), death ratio (ASDR), and disability-adjusted life years (DALYs) by age, sex, and region. Temporal trends were assessed with estimated annual percentage change (EAPC) and Joinpoint regression; projections applied Bayesian age-period-cohort models; decomposition quantified the effects of aging, population, and epidemiological change. ResultsFrom 1990-2021, global ASIR declined from 660.75 to 561.16 per 100,000 (EAPC: -0.84), ASDR from 2.11 to 1.41 (-1.47), and DALYs from 145.14 to 77.87 (- 2.13). Males had consistently higher burden (2021: 725.96 versus 394.11 per 100,000 in females). Children under 5 and adults over 80 bore the highest risks, with intraocular FBs dominating incidence and pulmonary aspiration/airway FBs driving mortality. Western Europe had the highest ASIR, Andean Latin America the highest ASDR. Since 2019, the onset of the COVID-19 pandemic, intraocular FBs incidence has surged in East Asia, mainly China. Projections suggest ASIR will continue to rise through 2050, while ASDR and DALYs continue to decline, driven by global population growth (187.27%) and aging (46.82%) but offset by epidemiological improvements (-134.09%). ConclusionsDespite long-term declines, FB incidence is rebounding, with marked disparities across sex, age, and region. Targeted interventions, including workplace safety, pediatric and geriatric care, and region-specific policies, are needed to mitigate risks and reduce inequalities.

ObjectivesTo evaluate supply-chain vulnerabilities affecting medications essential for treating sexually transmitted infection in the United States and identify disruption mechanisms that may predispose these therapies to shortages. MethodsWe conducted a qualitative, structured supply-chain vulnerability assessment of first-line medications for five priority sexually transmitted pathogens recommended by the Centers for Disease Control and Prevention and the World Health Organization: azithromycin, doxycycline, ceftriaxone, benzathine penicillin G, metronidazole, tinidazole, acyclovir, and cefixime. Using a predefined framework derived from pharmaceutical supply-chain disruption literature, we evaluated 13 disruption categories spanning raw material sourcing, active pharmaceutical ingredient production, manufacturing, distribution, market dynamics, information systems, and post-distribution loss mechanisms. Each category was assessed using four binary indicators and classified as relevant when at least two criteria were satisfied. ResultsMultiple disruption domains applied across the drug set. Recurrent vulnerabilities included geographically concentrated active pharmaceutical ingredient production, limited manufacturing redundancy in low-margin generic markets, manufacturing constraints affecting sterile injectable products, reliance on consolidated distribution networks, and susceptibility to demand surges and information-system disruptions. All eight drugs exhibited at least one regulatory or market signal consistent with potential supply vulnerability, including documented shortages, product discontinuations, or limited manufacturer participation. ConclusionsSupply-chain vulnerabilities were identified across multiple first-line sexually transmitted infection therapies, indicating that disruption risk is not confined to a single drug. There is a need for policy interventions to strengthen supply-chain resilience, including diversification of active pharmaceutical ingredient sourcing and distribution networks, as well as incentives for sustainable generic production.

Background School stress and psychosomatic complaints are linked and increase in high-income countries, with differences between countries. Evidence of how these parameters develop in Italy, particularly through combined parental and self-reported perspectives across age and gender, is limited. Methods A population-based online survey investigated school stress and psychosomatic complaints in children and adolescents aged 6-19 years, analyzing proxy- and self-reported data based on standardized validated instruments. Data was stratified by gender and age for children (6-10), early adolescents (11-14), and late adolescents (15-19). Results For early and late adolescents, the gender gap was evident, with higher levels of stress and health complaints in late adolescent girls. In this group, 56% of the girls self-reported rather/high school stress, and 43% of the boys. Parents perceived school stress and psychosomatic problems of their children as less severe than adolescents themselves. Parents stated a higher effect of parental help with school problems, and a lower effect of physical activity and digital media use on their childrens psychosomatic problems. Physical activity was related to fewer psychosomatic complaints, especially in girls. Conclusions This study identified late adolescent girls as vulnerable group, underscoring the critical need for gender-specific early prevention strategies starting in childhood, particularly for families with lower socioeconomic status. Parental perspectives may underestimate adolescents stress levels and psychosomatic well-being. In early adolescence, less digital media use may prevent psychosomatic problems, in late adolescence, physical activity may be a preventive method. Further longitudinal investigations should put a special focus on self- and proxy-reported perspectives.

Military aviation training noise remains understudied despite its widespread impacts across urban, rural, and wilderness areas. The predominance of low-frequency noise and repetitive training can create pervasive noise pollution, yet past research often fails to capture the full range of health and quality-of-life effects. This study analyzed two complaint datasets related to Whidbey Island Naval Air Station noise: U.S. Navy records (2017-2020) and Quiet Skies Over San Juan County data (2021-2023). We analyzed and mapped sentiment intensity from noise complaints relative to modeled annual noise exposure, developed a typology to classify impacts, and modeled the environmental and operational factors influencing complaints. Findings revealed widespread negative sentiment and anger, often beyond the bounds of estimated noise contours, suggesting that annual cumulative noise models inadequately estimate community impacts. Complaints consistently highlighted sleep disturbance, hearing and health concerns, and compromised home environments due to shaking, vibration, and disruption of daily life. Residents also reported significant social, recreational, and work disruptions, along with feelings of fear, helplessness, and concern for childrens well-being. The number of complaints were strongly associated with training schedules, with late-night sessions being the strongest predictor. A delayed response pattern suggests residents reach a frustration threshold before filing complaints. Overall, our findings demonstrate persistent negative sentiment and diverse impacts from military aviation noise. Results highlight the need for improved noise metrics, modeling and operational adjustments to mitigate the most disruptive effects.

Healthcare waste (HCW) management is a critical determinant of occupational safety, infection control, and environmental protection, particularly in low- and middle-income settings. Using the knowledge-attitude-practice (KAP) framework, this study assessed cognitive, behavioral, and institutional dimensions of HCW management among healthcare workers in urban Bangladesh. A cross-sectional survey was conducted among 342 cleaners and nurses in hospitals in the Chattogram Metropolitan Area (CMA) and Cumilla City Corporation (CuCC). Marked disparities were observed across professional groups. Training coverage was significantly lower among nurses than cleaners in CMA (22.5% vs. 48.7%; p = 0.002), whereas in CuCC nurses showed higher coverage (69.0% vs. 52.3%; p < 0.01). Knowledge of color-coded waste segregation was generally inadequate, with only 39.3% of CMA cleaners correctly identifying pharmaceutical waste bins compared with 60.0% of nurses (p < 0.01); CuCC nurses demonstrated substantially higher awareness (82.8%). Attitudinal indicators favored nurses, with strong hygiene and environmental risk awareness (95-100%) compared with cleaners (66-87.3%; p < 0.001). Despite this, compliance with segregation practices remained low across both sites (<30%). Several institutional support indicators were more favorable among nurses, particularly in CuCC. These findings indicate a significant knowledge-practice gap, emphasizing that effective HCW management requires not only training but also strengthened institutional structures and enforcement mechanisms to reduce public health and environmental risks.

BackgroundWork-related stress (WRS) accounts for 52% of self-reported work-related ill-health. In 2004, the Health and Safety Executive (HSE) developed the Management Standards (MS), aimed at helping organisations reduce WRS. This work investigates WRS post implementation, with reference to six MS risk factor domains: control, support, relationships, demand, change, and role. MethodCases of WRS were extracted from The Health and Occupation Research (THOR) database and mapped to the six domains. Trends in WRS incidence rates attributed to each of the domains were split at 2004 and compared with the overall WRS trend using mixed generalised regression models. ResultsBefore 2004, annual incidence in WRS increased by 1.4%(-0.5%,3.1%), whereas after 2004, there was a decrease of -0.9%(-1.5%,-0.2%), based on 10,815 WRS cases reported between 1996 and 2019. Three of the six MS domains (demands, relationships, and change) were reported in [~]82% of cases. Pre-2004, four of the six domains were observed to be increasing per year. Post 2004, cases increasingly contained multiple precipitating events e.g. demands + another (+2.6% per year) and relationships + another (6.1%). Reports of the two most common domains decreased post 2004 (demands -0.46%, relationships -0.55% per year), whereas incidence in less common domains increased (change 1.1%, support 2.4%, control 4.8%, role 4.7%). ConclusionTrends in WRS, and their common risk factors appear to be decreasing gradually, since introduction of MS in 2004. However, less common risk factors are becoming more prominent, contributing to reporting of WRS with multiple risk factors.

Introduction: Our aim was to examine the implementation of an online community-based exercise (CBE) intervention with adults living with HIV. Methods: We conducted a 12-month community-engaged intervention study with adults living with HIV in partnership with the Toronto YMCA, Canada. We conducted a two phased intervention study involving Phase 1) Intervention: participants were asked to exercise three times/week, supervised every two weeks with online personal coaching, and attend monthly online educational sessions (6-months), and Phase 2) Follow-Up: participants were asked to continue exercising thrice weekly, independently (6-months). We assessed engagement in physical activity (PA) weekly, and body composition, strength, physical function, and flexibility outcomes every two months (bimonthly) across both phases (12-months). We used segmented regression to assess the change in outcomes within and between phases to assess adoption, effect and maintenance of the intervention. Results: Of the 32 participants who initiated, 22 (69%) completed the intervention; and 18 (56%) completed the follow-up. The majority identified as men (69%), median age was 53 years (25th, 75th percentiles: 43, 60), with a median of 3 (1,7) concurrent health conditions. Median number of coaching sessions attended was 10/13 (77%). Participant engagement in [&ge;]30min of moderate or vigorous physical activity in the past week increased from 3.24 days at baseline (95%CI:2.69, 3.79) to 3.36 days (95%CI:2.83,3.89) at the end of intervention to 3.35 days (95%CI:2.81,3.89) at end of follow-up [overall mean increase of 0.11 days (95%CI: 0.02,0.20)]. During the intervention, there were significant mean decreases for weight (-1.31kg), body mass index (BMI) (-0.40kg/m2), and waist circumference (-2.92cm); and mean increases for push-ups (+7.11 in a minute), plank time (+38.13 sec), sit-to-stand (+2.86 times in 30 sec), and sit-and-reach (+3.47 cm). There were no changes in muscle mass, body fat percent and fat free mass. During the follow-up phase, there were additional significant mean decreases in body weight (-1.52 kg), BMI (-0.50 kg/m2) and sit-to-stand (+1.52 times in 30 sec). Conclusions: Participants demonstrated increases in physical activity and improvements in strength, weight, body composition, physical function, and flexibility with the online CBE intervention, some of which were sustained at the end of the study. Future research should incorporate strategies to enhance engagement in physical activity among adults with HIV.

ObjectiveTo explore the application effect of AI agent-assisted root cause analysis in the management of quality inspection defects in the Central Sterile Supply Department (CSSD) and to systematically compare it with traditional manual analysis methods. MethodsA retrospective case simulation comparative study was conducted. Thirty typical CSSD quality inspection defect cases were selected. Root cause analysis was performed independently by an AI agent-assisted analysis group and a traditional manual analysis group. Using the consensus results of a high-level expert panel as the "gold standard," a quantitative comparison was made across four dimensions: analysis quality, efficiency, practicality, and process experience, employing t-tests and Mann-Whitney U tests. ResultsCompared with the traditional method, the AI-assisted group demonstrated a significantly higher root cause identification accuracy rate (85.6% vs. 72.3%, P<0.001), superior analysis depth (4.4 points vs. 3.6 points, P<0.001), significantly shorter time consumption per case analysis (18.5 minutes vs. 35.2 minutes, P<0.001), and generated more innovative corrective measures (1.8 items/case vs. 0.7 items/case, P<0.001). There was no statistically significant difference between the two groups regarding the feasibility of the proposed measures (4.0 points vs. 4.2 points, P>0.05). ConclusionThe AI agent-assisted root cause analysis method significantly improves the accuracy, depth, and efficiency of analyzing quality inspection defects in the CSSD and facilitates the discovery of more innovative solutions, demonstrating high application value and promotion potential. Implications for Nursing ManagementThis study provides empirical evidence that AI agent technology can be integrated into CSSD quality management to enhance defect analysis efficiency and accuracy. Nursing managers should consider adopting AI-assisted tools to standardize root cause analysis processes, reduce reliance on senior staff experience, and enable faster, data-driven decision-making. The reduced training burden and improved novice performance suggest that AI can help address workforce skill gaps. Future implementation should focus on human-AI collaboration, with managers ensuring adequate training, maintaining human oversight, and periodically updating the knowledge base to reflect local clinical contexts.

Background High body mass index (BMI) presents a serious and ongoing global health challenge. However, the difficulty of high BMI intervention has not yet been systematically evaluated. Methods We developed a Generative Artificial Intelligence Meta-Evaluation (GAME) framework, which integrated 18 indicators from 4 dimensions, including "Macro-System Level", "Socio-Cultural Level", "Community-Family Level", and "Individual Level" to evaluate the difficulty of high BMI intervention across 226 locations. The GAME framework applies 8 leading AI models to generate intervention difficulty scores (IDS) of each indicator on a scale from 1 to 5, with higher scores indicating greater difficulty. Meta-analysis was conducted to derive combined scores, evaluate the heterogeneity and sensitivity. Final intervention difficulty scores were calculated as the weighted sum of all 18 indicators. Additionally, SHapley Additive exPlanation (SHAP) values were used to evaluate the importance of each indicator in determining the intervention difficulty. Results The global difficulty of high BMI intervention shows significant imbalance. Norway (IDS = 1.48) exhibited the easiest intervention, while Yemen (IDS = 4.56) faced the greatest challenge. Regions such as Western Europe, Australasia, and High-income Asia Pacific showed lower intervention difficulty, reflecting there are mature public health frameworks, supportive social-cultural environments for healthy lifestyles, and high levels of health awareness. On the contrary, countries in North Africa and Middle East, South Asia, Oceania, and Sub-Saharan Africa faced higher intervention challenges, suggesting the need for long-term, collaborative efforts from multiple sectors. Among the 18 indicators, "Cognition and Awareness" has the most significant impact on intervention difficulty, with the SHAP value of 31.03, followed by "Family life and cognitive patterns" (18.08) and "Health Care System" (11.7). Furthermore, the IDS for high BMI was significantly correlated with Socio-Demographic Index (SDI). Higher SDI values were associated with easier interventions. Finally, the independent external empirical verification demonstrated high consistency between intervention difficulty and increase in annual prevalence of obesity, population mean BMI, and national policies. It supported the GAME framework to characterize global heterogeneity in high BMI intervention challenge. Global results were freely available at http://www.deepburden.com/high-bmi. Conclusion The difficulty of high BMI intervention varies widely across countries and regions, highlighting the need for comprehensive strategies and governance to address the growing health issue effectively.

BackgroundHigh-demand sanitary crises, such as the COVID-19 pandemic, impose a high burden on healthcare professionals, increasing their risk of burnout. Healthcare postgraduate (HCP) trainees compound the general healthcare professional workforce and may face unique risks and challenges. This study aimed to evaluate the incidence of burnout and identify its predictors among healthcare postgraduate trainees during a high-demand sanitary crisis. MethodsA longitudinal observational study was conducted during the pandemic among healthcare postgraduate trainees from 67 Brazilian healthcare institutions. Participants were assessed at baseline (July to September 2020) and after an 18-months follow-up. Individuals with burnout at baseline were excluded. Several questionnaires, including the Oldenburg Burnout Inventory (OLBI) and the depressive disorder PHQ-9 scale were applied. Associations between baseline characteristics and the development of burnout were analyzed using chi-squared and t tests, and log-binomial regression. The study received ethical approval (CAAE: 33493920.0.0000.5558). ResultsA total of 313 participants were included; mean (SD) age: 28.2 (4.6) years; 80.1% (n=250) were biological females; 58.5% (n=183) whites; 51.1% (n=160) physicians; 12.5% (n=39) nurses; 36.4% (n=114) other HCP trainees; 47.9% (n=150) had depressed symptoms at baseline. Burnout incidence rate [95% CI] was 202.9 [166.5, 239.3] cases per 1000 person-years. In bivariate analyses, depressive mood at baseline predicted future burnout (relative risk [95% CI] = 2.14 [1.49, 3.08]; p<0.001), while older age (mean difference, MD [95% CI] = 1.10 [0.16, 2.09] years; p=0.029), higher autonomy (MD [95% CI] = 0.57 [0.10, 1.04] on a 10-point visual numerical scale, VNS; p=0.018) and adequate professional training (MD [95% CI] =0.85 [0.30, 1.40] on VNS; p=0.003) showed protective effects. Sex, race and weekly workload could not predict burnout. In multivariate analyses, depressive symptoms at baseline remained independently associated with higher risk of burnout (risk ratio, RR [95% CI] = 1.84 [1.26, 2.71]; p=0.002), while having adequate professional training showed a protective effect (RR [95% CI] = 0.61 [0.43, 0.87]; p=0.007). ConclusionsVery high incidence of burnout among HCP trainees was observed under a global sanitary crisis. Depressed mood at baseline was the most relevant predictor of subsequent burnout. Providing mental health support for HCP trainees in future widespread sanitary crises seems advisable to preserve the workforce.

The rapid aging of the population in urban China has led to a significant increase in empty-nest households, necessitating a rigorous evaluation of residential environment suitability. Grounded in Person-Environment Fit theory, this study develops and validates a multidimensional Aging-Suitability Index (ASI) specifically for urban empty-nest seniors. We analyzed survey data from 753 participants across 19 provinces using Partial Least Squares Structural Equation Modeling (PLS-SEM). The comprehensive structural model demonstrated robust explanatory power (R{superscript 2} = 0.754). The results reveal a hierarchical mechanism of needs: safety features and physical design serve as the survival foundation, exerting the most substantial direct effects on overall suitability. Accessibility was found to enhance suitability primarily by fostering perceived independence, indicating a psychological mechanism of empowerment (Variance Accounted For = 67.35%). Furthermore, intelligent technology and social support function as complementary resources that improve the environment-person fit. These findings suggest that aging-in-place interventions should prioritize mandatory safety upgrades while integrating accessibility modifications to sustain functional autonomy for independent seniors.

Traditional agricultural safety assessments often rely on raw incident counts that emphasize exposure but underrepresent outcome severity. This study presents a multi-criteria impact framework to distinguish frequency-driven activity patterns from severity-driven risk across the U.S. Midwest. Agricultural incident records from 2012 to 2023 across seven states were analyzed using descriptive statistics, county-level mapping, and quartic kernel density estimation. Comparative impact indices were constructed using Analytic Hierarchy Process (AHP) and Geometric-Fuzzy AHP weighting schemes to integrate incident frequency, outcome severity, and post-incident survivability. Results indicate that while overall incident frequency is strongly concentrated in northwestern Iowa, reflecting intensive agricultural activity, fatal outcomes exhibit a broader spatial footprint extending across central and northern Iowa and into central-southern Minnesota. Severity-weighted mapping further consolidates northwestern Iowa and the Minnesota-Iowa corridor as dominant high-impact zones. At the regional scale, Geometric-Fuzzy AHP produced consistently lower mean scores and reduced dispersion than AHP, yielding smoother spatial gradients while preserving the primary hotspot structure. These findings demonstrate that frequency-based mapping alone fails to capture the multi-dimensional nature of agricultural risk. By explicitly linking incident locations with survival infrastructure, this research provides an evidence-based framework for targeting safety interventions and improving rural emergency medical service planning.

BackgroundEvidence on the long-term impact of urban green and blue spaces (UGBS) interventions remains limited. This study is a 15-year evaluation of an urban greenway development in Belfast (United Kingdom), assessing the potential effects of this UGBS intervention on physical activity (PA), mental wellbeing and co-benefits. MethodsUsing quasi-experimental design, a repeated cross-sectional survey was conducted in 2010 (baseline), 2017 (post-opening) and 2023 (long-term follow-up) with about 1,200 adults participated each wave. Outcomes included PA, mental wellbeing, general health, quality of life, social capital and environmental perception. Multilevel mixed-effect regressions were performed to examine within-group changes at long-term follow-up. Difference-in-differences analysis investigated the between-group changes that might be attributed to the greenway. Additional comparative analyses included distance-decay analysis and comparison with population trends in Northern Ireland. ResultsAt six years after completion, the greenway intervention appears to buffer a decline in duration of PA - mainly from moderate-intensity activity (decline lower by 118.6 min/week, 95%CI: 3.9-232.2) but with no significant impact on the proportion of the population meeting the recommended PA level. The intervention is associated with a smaller decline in self-rated health (4.98 units; 95%CI: 0.62-9.34) relative to control group. Intervention association with mental wellbeing was positive but not significant (p=0.30). The greenway also showed positive effects on social capital and environmental perceptions, with impacts most evident in improving safety and trust in the local area. ConclusionThis study provides evidence to support the public health impact of UGBS and its long-term health and social benefits.

The widespread adoption of energy-saving bulbs like light-emitting diodes and compact fluorescent lamps in Zambia has raised significant environmental and public health issues because some of these bulbs contain dangerous materials like mercury. This study sought to evaluate households' understanding and disposal practices of used and damaged energy-saving bulbs in Lusaka, Zambia's Mtendere Compound. A cross-sectional design was used, with structured questionnaires distributed to a randomly chosen sample of households. The research showed that, although most participants were aware of the energy efficiency advantages of these bulbs, they had little understanding of their possible health risks and safe disposal procedures. The majority of households reported throwing away broken and used bulbs with their regular household trash, while only a small percentage followed the suggested disposal procedures. Environmental contamination and heightened health risks are exacerbated by a lack of awareness and inadequate municipal waste management systems for hazardous household waste. The research advocates for improved public education initiatives, the creation of specific collection sites for dangerous waste, and the formulation of explicit national regulations and policies for the handling of discarded and damaged energy-saving bulbs. In rapidly urbanizing areas like Mtendere, tackling these issues is essential for protecting public health and advancing environmental sustainability. Key Words: Knowledge, Practices, Waste Disposal, and Mercury coated bulbs

Background: Hospital canteens provide an effective setting for improving the dietary habits of users. The study evaluates the food choices of users after an educational and environmental intervention, considering nutritional composition and environmental impact, and to compare the results with pre-intervention choices. Methods: A cross-sectional study was conducted in three hospital canteens (C1, C2, C3) in northeastern Italy, during two index weeks in September 2022 (T0) and 2023 (T1). An intervention was introduced between T0 and T1, consisting of posters on healthy eating, descriptive norm messages, and environmental changes regarding fruit and vegetables. Photos of lunch trays were collected, and choices were analyzed for nutritional composition and sustainability. Results: 2,851 trays were analyzed: 1,227 at T0 (798 in C1, 228 in C2 and 201 in C3) and 1,624 at T1 (1,005 in C1, 348 in C2, 271 in C3). In C1 and C3, there was an increase in median energy (+30 kcal; +135 kcal) compared to pre-intervention meals, while in C2 there was a decrease (-118 kcal). Despite a slight improvement in macronutrient composition, at T1 meals in all canteens were still high in lipids (30%E; 39%E; 35%E) and low in carbohydrates (44%E; 39%E; 41%E). The fibre value fell within the recommended range only in C1 and C3. The median carbon (CF) and water (WF) footprints of meals in all canteens remained high: at T1 CF ranged from 966 gCO2eq. to 1,227 gCO2eq. and WF from 1,025 L H2O to 1,207 L H2O. Conclusion: The intervention has led to partial improvements in food choices. To achieve more significant results, it may be necessary to implement a parallel intervention on food offer.

Occupational activities play a critical role in shaping patterns of infectious disease transmission, as work-related contact, exposure duration, and environmental conditions vary substantially across jobs. Evidence from infectious disease outbreaks, including tuberculosis and other respiratory infections, shows that occupations involving frequent close contact and crowded settings face elevated exposure risk, highlighting the need for systematic occupational risk assessment to inform public health action. This study adopts a data-driven approach to characterize occupational risk for infectious disease transmission in the Philippine workforce. Using job-specific indicators such as encounter frequency, work shift duration, and crowd density, unsupervised clustering methods were applied to group occupations into distinct risk profiles. Unlike predefined sector-based classifications, this approach identifies latent groupings that capture shared exposure characteristics and socioeconomic context. The resulting clusters reveal a clear gradient in exposure risk across occupations, with high-risk roles often concentrated among jobs with lower to moderate income levels, while lower-risk occupations tend to be associated with higher income and greater structural capacity for risk mitigation. These findings provide a framework for occupational risk stratification that is directly relevant for public health planning. Overall, this study demonstrates the value of integrating occupational and socioeconomic data to support targeted workplace interventions, risk-informed surveillance, and more equitable allocation of public health resources for infectious disease prevention and control in the Philippine context.