International Journal of Environmental Research and Public Health

Background: Guanica, Puerto Rico, has one of the highest concentrations of environmental polychlorinated biphenyls (PCBs). This PCB contamination coupled with persistent poverty, population loss, and repeated environmental disasters has taken a heavier toll on Guanica community. Our environmental sampling has documented high levels of PCBs in sediment, air and fish, but far less is known about how residents themselves understand exposure, interpret health risk, and weigh contamination against the other pressures of daily life. Methods: We used a qualitative descriptive design nested within the larger HELP Study. This paper presents the final analysis of all qualitative data collected in Guanica: ten sessions comprising five focus groups and five interviews with fishermen (N = 31), conducted between November 2024 and October 2025 in familiar community settings. Sessions followed a semi-structured guide translated from English to Spanish and back-translated for accuracy. Recordings were transcribed in Spanish, verified against the audio, and analyzed in NVivo using codebook-style thematic analysis; three bilingual researchers coded collaboratively and resolved disagreements by consensus. Results: Five themes emerged from our analysis concerning how residents and fishermen understand and navigate PCB contamination: (1) perceived community decline shapes how residents prioritize environmental risks; (2) limited knowledge, misinformation, and communication gaps affect understanding of PCB contamination; (3) cancer concerns are high, but links to PCB exposure remain unclear; (4) PCB contamination is seen as a threat to livelihoods, especially fishing and tourism; and (5) deep mistrust and a desire for accountability influence perceptions of environmental interventions. Participants described contamination not as an isolated hazard but as one strand of a longer history of economic decline, disaster, and institutional neglect. Conclusions: Social, economic, and environmental conditions together shape how Guanica residents perceive contamination of their environment. Meaningful progress requires sustained community involvement, support for local initiatives, development of a Community Health Worker program, and expanded partnerships with local institutions and schools to close communication gaps and promote long-term resilience to address the health effects of PCB contamination in Guanica.

Background: Children spend more than 90% of their time indoors, and early childhood education settings (ECEs) are an understudied, high-occupant-density indoor microenvironment where exposure to volatile organic compounds, particulate matter, and other toxicants has been documented. Limited knowledge exists on ECE-specific exposures affecting young children and how they compare to exposures in the home. Methods: This prospective, repeated-measures pilot study targeted enrollment of 44 preschool-aged children and 8 ECE staff across two geographically and sociodemographically distinct ECEs in metropolitan Atlanta, Georgia. Paired silicone wristbands, one home-designated and one ECE-designated, were exchanged between settings across three consecutive days and nights beginning at enrollment to characterize microenvironment-specific exposure. A single spot urine sample was also collected from each child. Continuous indoor air quality monitoring was conducted in two classrooms per site. Caregivers and ECE staff completed structured questionnaires assessing home and ECE environmental characteristics, child respiratory risk, and protocol feasibility and acceptability. Feasibility was evaluated using eight pre-specified indicators spanning recruitment and enrollment, wristband wear duration and loss by microenvironment, urine sample collection completeness, and survey completion by instrument and respondent group. Conclusion: This pilot will establish feasibility and acceptability parameters for a paired, multi-matrix silicone wristband protocol across home and ECE microenvironments. Findings will inform the design, sample size, and power calculations for a subsequent study testing indoor air interventions and pediatric respiratory outcomes in ECEs. Feasibility outcomes are reported in a companion manuscript.

Socioeconomic inequality in exposure to air pollution possess a significant public health challenge, yet little is known about how the disparities vary across the various economic status areas in Nairobi. Globally, studies have shown that exposure to air pollution is unequal across communities hence disparities in harm to human health. This study examined the association between socioeconomic characteristics and perceived air quality among residents of low- and high-socioeconomic status areas in Nairobi, Kenya. Two regions within Nairobi County were selected for this study: Mukuru kwa Njenga (representing the Low Socioeconomic Status) and Langata (representing the High Socioeconomic Status) with a sample size of 384 in HSES areas and 368 in LSES areas. A cross-sectional study was conducted among 752 respondents residing in selected LSES and HSES areas of Nairobi. Data was collected using a structured questionnaire assessing sociodemographic characteristics, income, education, employment, perceived air quality, and self-reported health outcomes associated with air pollution exposure. Descriptive statistics were used to summarize participant characteristics and perceived air quality. Chi-square tests were used to examine associations between residential area and categorical health outcomes, while ordinal logistic regression was used to assess the association between socioeconomic characteristics and perceived air-quality ratings. Perceived air quality differed significantly between residential socioeconomic groups. Respondents in LSES areas were more likely to rate air quality as poor or very poor, with 45.4% rating it as very poor, compared with only 1.6% of respondents in HSES areas. In contrast, 12.2% of HSES respondents rated air quality as good compared with 0.3% in LSES areas. The association between area of residence and perceived air-quality rating was statistically significant, {chi}2(3) = 282.672, p < 0.001. In the ordinal logistic regression model, HSES residence was associated with significantly lower odds of reporting poorer perceived air quality compared with LSES residence (OR = 0.135, 95% CI: 0.095-0.190, p < 0.001). Income was also significantly associated with perceived air quality, while respondents with no formal education had higher odds of reporting poorer perceived air quality compared with those with secondary education (OR = 3.254, 95% CI: 1.388-7.638, p = 0.007). Significant differences were also observed for several self-reported health outcomes. Respiratory problems were more prevalent among respondents in LSES areas than HSES areas (72.7% versus 50.4%; {chi}2(1) = 29.081, p < 0.001; Cramer's V = 0.224). However, allergies, eye irritation, and headaches were reported more frequently in HSES areas than in LSES areas, with significant associations observed for allergies ({chi}2(1) = 106.479, p < 0.001; Cramer's V = 0.429), eye irritation ({chi}2(1) = 136.577, p < 0.001; Cramer's V = 0.486), and headaches ({chi}2(1) = 149.180, p < 0.001; Cramer's V = 0.508). No statistically significant association was observed for cardiovascular problems, likely reflecting the very low number of reported cases. Substantial socioeconomic disparities in perceived air quality and self-reported respiratory health outcomes were observed. Residents of low-socioeconomic status areas consistently perceived poorer air quality and reported a higher burden of respiratory problems, highlighting the need for targeted interventions to reduce environmental health inequalities.

Background: Long-term mortality data among Brazilian police officers and firefighters are scarce. This study investigated the leading causes of death in Brazilian male military police officers and firefighters over three decades, comparing their mortality and mean age at death with those of the male population. Methods: We retrospectively analyzed death records of male military police officers and firefighters from Espirito Santo (ES), Brazil, from 1988 to 2019. Mortality was analyzed across three decades and the standardized mortality ratios (SMRs) for the three leading causes were calculated using the male populations of ES and Brazil as references. Results: Overall, 2,198 deaths were identified, with a mean age at death of 59 {+/-} 18.5 years, compared with 60.5 {+/-} 23.9 years among men in ES and 63.4 {+/-} 23.7 years among Brazilian men. Mean age at death was 36 {+/-} 9 years among active-duty and 68 {+/-} 13 years among inactive personnel. Across the study population, the leading causes of death were circulatory system diseases (32%), external causes (26%) and neoplasms (15%). Circulatory disease mortality was higher in the second and third decades compared with both reference populations, whereas external-cause mortality shifted from higher, in the first two decades, to lower than expected in the last decade. Neoplasm mortality was higher relative to Brazil only in the last decade. Conclusion: Mortality patterns differed by cause and over time. The younger mean age at death among active-duty personnel, together with cause-specific excess mortality, highlights the importance of long-term occupational health surveillance and preventive strategies.

Background Sports apps are increasingly used to promote physical activity and support physical education among students. However, their effects on different dimensions of physical fitness and the factors influencing intervention effectiveness remain unclear. Objective This study aims to evaluate the effects of sports app-based interventions on multiple dimensions of physical fitness among adolescents and students and to examine whether intervention duration, exercise frequency, intensity, and session duration influence intervention effects. Methods Following PRISMA guidelines, six databases were systematically searched through June 20, 2026. Randomized controlled trials and quasi-experimental studies were included. Risk of bias was assessed, and meta-analyses and subgroup analyses were performed. Results Twenty moderate-quality studies involving 3,268 adolescents and University students were included. Interventions lasted 6-24 weeks, with 2-7 sessions per week and 20-80 minutes per session. Sports app interventions significantly reduced BMI (MD = -0.41, 95% CI -0.76 to -0.07) and improved cardiorespiratory endurance (SMD = 0.85, 95% CI: 0.35 to 1.35), male pull-ups (MD = 0.74, 95% CI 0.19 to 1.28), female sit-ups (MD = 1.99, 95% CI 1.13 to 2.86), male 1000-m run time (MD = -13.44 s, 95% CI -25.14 to -1.74), female 800-m run time (MD = -9.02 s, 95% CI -13.40 to -4.64), and sit-and-reach performance (MD = 2.01 cm, 95% CI 0.91 to 3.10). Significant subgroup differences by intervention duration were found for cardiorespiratory endurance (P = 0.03) and flexibility (P = 0.01), but no subgroup differences in body mass index were found across the intervention characteristics examined. Conclusions Sports app interventions can improve multiple dimensions of students physical fitness, although current evidence is insufficient to establish an optimal intervention dose. Further high-quality studies need to clarify dose-response relationships and optimize intervention procedures.

Background: Physical inactivity remains a major public health challenge, and policy action across sectors is needed to create environments that enable active lifestyles. Several tools have been developed to evaluate national physical activity policies, but it remains unclear whether they assess similar policy aspects or produce comparable results. This study compared evaluation results across the 27 EU member states and examined the indicators used by these tools. Methods: Eight physical activity policy evaluation tools were included that (a) assess national physical activity policies and (b) had been applied in multiple countries. For five tools covering at least half of the EU member states, aggregate scores were extracted or calculated and converted into country rankings. A total of 202 indicators were coded and mapped by category (policy content, process, structure), and data type (audit, content, implementation, impact assessment). Results: Country rankings varied considerably, with a mean difference of 13.0 positions between highest and lowest ranks. Some countries displayed consistent results (e.g., Austria, France, Germany), while others showed large discrepancies (e.g., Hungary, Spain). Indicator mapping revealed a focus on policy content (47.6%), followed by structure (21.6%) and process (13.7%) (6.2% other). Across tools, 20.3% of indicators audited policies, 26.0% assessed policy content, and 26.4% assessed policy implementation (16.3% other). Conclusion: The systematic comparison of indicators across physical activity policy evaluation tools provided insights into differences in country rankings. Future evaluations should clearly communicate their purpose, identify synergies between tools, address gaps in policy evaluation, and strengthen the reproducibility of evaluation processes.

Purpose: The internship period is a critical stage for nursing students to develop professional values. This study aimed to investigate the current status of professional identity among nursing interns, analyze the effects of social support, perceived stress, psychological resilience, and career adaptability on professional identity, and explore the mediating role of career adaptability between social support and professional identity, so as to provide empirical evidence for enhancing professional identity and optimizing nursing talent training systems. Methods: Using convenience sampling, 407 nursing interns from a tertiary hospital in Quanzhou were selected as participants from May to July 2025. Data were collected using a general information questionnaire, the Social Support Scale, the Perceived Stress Scale, the Psychological Resilience Scale, the Professional Identity Questionnaire for Nursing Students, the Career Adaptability Scale, and the Questionnaire for Nurse Intention to Retention Employed. SPSS 26.0 was used for reliability analysis, descriptive analysis, independent samples t-test, one-way ANOVA, Pearson correlation analysis, and multiple linear regression analysis. The PROCESS macro was employed to test the mediating effect. Results: The total score of professional identity among nursing interns was (61.74{+/-}11.08), with 73.5% showing moderate professional identity. Parents' attitude toward nursing, reasons for choosing the profession, personal attitude toward the major, and employment intention showed statistically significant differences in professional identity scores (p<0.05). Pearson correlation analysis revealed that professional identity was significantly positively correlated with social support (r=0.474), psychological resilience (r=0.389), and career adaptability (r=0.609) (p<0.01), and significantly negatively correlated with perceived stress (r=-0.378) (p<0.01). Multiple linear regression analysis indicated that career adaptability ({beta}=0.309, p<0.001) and social support ({beta}=0.383, p<0.001) were significant positive predictors of professional identity, whereas reasons for choosing the profession ({beta}=-3.603, p=0.001) and employment intention ({beta}=-7.116, p<0.001) were significant negative predictors. The model explained 49.2% of the variance in professional identity. Mediation effect analysis showed that career adaptability played a partial mediating role between social support and professional identity, with a mediation effect value of 0.288 (95% CI: 0.221-0.363), accounting for 40.2% of the total effect. Conclusions: Nursing interns' professional identity is at a moderately high level. Social support and career adaptability are positive influencing factors. Career adaptability plays a partial mediating role between social support and professional identity; social support indirectly enhances professional identity by strengthening career adaptability.

Social media influencers serve as a key source of health information for adolescents but often lack expertise, have commercial motives, and may spread misleading or harmful content. This study examines the health-related content shared by influencers, the prevalence of advertising, and how adolescents evaluate potential benefits and risks. Using a mixed-methods approach, we employed a quantitative descriptive method involving citizen science (Study 1) and a qualitative content analysis (Study 2). In Study 1, 336 adolescents from 16 Austrian schools documented and categorized 2,147 posts from 255 influencers. The most common topics included sports and fitness (50.5%), beauty ideals (29.6%), food and nutrition (27.6%), and cooking (19.1%). Although advertisements appeared in 41.5% of posts, adolescents rated 60.4% of them as beneficial and only 4.5% as harmful. The qualitative analysis of a subsample of the 90 most prominent posts showed that adolescents appreciated motivational aspects (e.g., healthy eating) but often overlooked problematic elements such as misleading claims, sexualized body ideals, and the linking of health messages to commercial products. Enhancing persuasion knowledge and critical thinking through education, along with stricter regulation of harmful products, is crucial to safeguarding youth online.

Handgrip strength (HGS) is a practical measure of muscular strength, but the factors associated with relative HGS among young adults remain insufficiently understood. This exploratory cross-sectional study examined demographic and anthropometric characteristics, total physical activity (PA), and depressive symptoms in relation to relative HGS among medical students in Serbia. A total of 424 students from the Faculty of Medicine, University of Belgrade, completed HGS testing and study questionnaires. HGS was measured using a VALD DynaMo Lite dynamometer and expressed relative to body weight (N/kg). Participants were categorized according to sample-specific relative HGS percentiles: <25th, 25th to 75th, and >75th percentile. PA was assessed using the IPAQ-SF and depressive symptoms using the PHQ-9. Three pairwise multivariable logistic regression models were used to examine factors associated with relative HGS categories. Sex and BMI were the most consistent correlates of relative HGS. Female students had lower odds of belonging to higher relative HGS categories, while higher BMI was consistently associated with lower odds of belonging to higher categories. Age was associated only with the 25th to 75th percentile group compared with the <25th percentile group. Total PA volume and PHQ-9 score were not independently associated with relative HGS categories. These findings suggest that relative HGS in this population was more strongly associated with demographic and anthropometric characteristics than with total self-reported PA or depressive symptom severity. Keywords: handgrip strength; relative handgrip strength; muscular strength; medical students; physical activity; depressive symptoms; body mass index

Work-related musculoskeletal disorders (WRMSDs) constitute the primary occupational health burden among healthcare professionals (HCPs) globally and directly threaten health workforce sustainability, a critical concern for Sustainable Development Goal 3 (Good Health and Well-being) and SDG 8 (Decent Work and Economic Growth). Despite high prevalence in Cameroon, downstream occupational effects and management strategies across hospital levels remain undocumented. A hospital-based, analytical cross-sectional study was conducted across five referral hospitals in Douala, Cameroon (2019-2022). A total of 561 HCPs were enrolled by stratified random sampling. The Modified Nordic Musculoskeletal Questionnaire and structured interviews assessed WRMSD occupational effects and management strategies. Data were analysed using IBM SPSS v26; chi-square tests and logistic regression assessed associations (p < 0.05). The 12-month WRMSD prevalence was 83.4% (468/561). WRMSDs caused absenteeism in 83.4% of affected HCPs ({chi}2 = 14.414; p < 0.001), reduced daily activity capacity in 55.6%, and job dissatisfaction in 60.4%; 38.9% were considering a career change. Management was predominantly reactive: fitness training (76.3%), rest (41.4%), and non-steroidal anti-inflammatory drugs (NSAIDs; 37.3%). Only 15.0% received physiotherapy referral, and no hospital had a formal WRMSD protocol. WRMSDs impose a substantial and measurable occupational burden on HCPs in Douala. Current management is reactive, non-standardised, and under-integrated with physiotherapy. Evidence-based, multicomponent prevention programmes, physiotherapy integration, and a national occupational health policy are urgently required to protect the healthcare workforce and advance SDG 3 and SDG 8 targets in Cameroon.

Indiana still faces significant health challenges, ranking among the least healthy U.S. states due to high obesity rates, mental health issues, and other chronic conditions. These disparities are closely linked to inequities in healthcare access, which are largely shaped by social determinants of health. Using data from the Social Vulnerability Index and County Health Rankings and Roadmaps, this study analyzes trends in obesity, mental health, and premature death across Indiana counties before, during, and after the COVID-19 pandemic. Descriptive statistics, correlation analyses, and Negative Binomial regression models were used to evaluate county-level disparities. In 2018, higher rates of uninsured, obese, and physically inactive populations were associated with increased premature death. In 2020, diabetes, smoking, and alcohol consumption were significant factors. By 2022, unemployment, education, obesity, insurance, exercise access, and mental health provider availability were associated with premature death. Findings indicate that socially vulnerable counties experienced amplified health impacts, with obesity rising most sharply where exercise infrastructure was limited and poor mental health days increasing across all counties. These results highlight persistent service gaps and the critical need for targeted investments in recreational infrastructure and mental healthcare. Future research should examine policy influences and causal relationships to inform equity-focused interventions.

Current health risk assessments from thirdhand exposure to methamphetamine (meth) to occupants of contaminated residences when no cooking or use is still occurring assume that inhalation exposure is insignificant. After Wright et al. (2021) reported substantial meth concentrations in a contaminated residence, the present study was conducted to further test the hypothesis that concentrations were high enough to contribute to total occupant dose. Air sampling was conducted in contaminated residences that had been previously sampled for surface contamination. Samples were collected on personal sampling pumps in fixed locations on treated glass fiber filters is cassettes and analyzed by gas or liquid chromatography with mass spectroscopy. Sixty-nine samples were collected from eighteen residences for the study. Meth concentrations ranged from 0.02 to 15 ug/m3. Concentrations in supply air vents were significantly higher than in return vents or in ambient air. Residences with no HVAC systems (baseboard heat) had airborne concentrations similar to residences with HVAC systems turned off, and lower than when HVAC was on. Whether a residence was occupied or not did not show differences. All data from residences with HVAC had a significant correlation with surface concentrations (R2 = 0.61) but some factors that affected results were not determined in the study. In the context of the risk assessment and regulatory standard established by California and adopted in several other states, the inhalation exposure would approximately double total occupant dose for infants, and this population would exceed the California reference dose by approximately 100%. Further studies should be conducted to refine these estimates and determine the factors that influence airborne concentrations.

Lifestyle behaviors influence cardiometabolic and cognitive health through multiple interconnected processes, involving metabolic, cardiovascular, behavioral and cognitive factors. This study aimed to assess associations between multivariate plasma and physiological profiles, and behavioral parameters, and their potential association with reaction time (RT) in active young adults. Data on physical activity levels were collected from wearable devices and GPAQ questionnaire, along with anthropometric and clinical assessments, cognitive tests, and blood analyses. Principal component analysis was performed separately for physiological and plasma parameters, retaining the first two principal components (PCs) from each analysis. Multiple linear regression models were used to evaluate the associations between plasma, sex, physical activity levels (METs), daily step count, and alcohol/marijuana use on physiological PC1/PC2 scores, as well as RT. Continuous independent variables were previously categorized, and combined variables were created to represent specific combinations between plasma/physiological PC1 categories and sex. Physiological PC1 (blood pressure) was associated with combined plasma PC1 (insulin/HOMA-IR)-sex variable, total METs and alcohol consumption (adjusted R2 = 0.30). Physiological PC2 (handgrip strength) was mainly explained by combined plasma PC1-sex variable (adjusted R2 = 0.54), with minimal contribution from behavioral factors. RT was associated with physiological PC1 variable and sex (adjusted R2 = 0.35), with slower responses observed among women with lower physiological PC1 scores or hypotension; these associations were supported by RT-physiological PC1 and RT-blood pressure correlations. These exploratory findings suggest sex-dependent associations between physiological, metabolic and lifestyle-related factors, supporting a holistic approach in future research, particularly among young adults.

Individuals of Vietnamese descent comprise a majority of the United States nail salon workforce. Whereas prior research has centered on chemical exposures, thematic analysis of interviews with Vietnamese nail salon workers around Baltimore, Maryland examined the lived experiences of nail salon workers. Six themes were identified: (1) nail work as a familial livelihood and a sacrifice-oriented pathway towards intergenerational mobility; (2) perceived flexibility within the workplace with low control; (3) professional pride grounded in artistry, detail, and customer care; (4) cumulative occupational risks; (5) emotional labor as an expected and core component of nail salon work; and (6) limited perceived capacity to change working conditions. These findings suggest that the occupational pressures in nail salon work cannot be solely framed as a lack of worker knowledge or motivation towards adopting safer practices. Intervention success depends on a holistic view of workers' lives, whose choices are shaped by family obligations, customer demands, and conditions largely outside their control. Therefore, efforts to improve nail salon health may benefit from shifting the burden of risk management away from individual workers and engaging the wider community.

This article critically considers how exhibition, as a modality for research evidence delivery, can be mobilised in the largely positivist and biomedical world of elite sport for the purpose of system change. Our interdisciplinary team composed of a health geographer and rehabilitation scientist together with non-academic specialists in athlete health and performance innovation, conceptualised an exhibition-as-intervention to reframe gender disparities in sports injury from being biologically induced to also socially influenced. Here, we reflect on our experience creating and implementing More Than Medals: Gendered Environments of Sports Injury Uncovered - a research-based, online, multimedia exhibition exploring the gendered environments of sports injury through the first-hand experiences of female athletes. Using evaluation interviews with both sports staff and athletes, we assess the impacts of our exhibition-as-intervention. We conclude that exhibition offers a novel way to bridge social and biomedical paradigms, innovate on evidence delivery in elite sport, and close the gap between social sciences research and practice.

Background: Sweeping sliders with large horizontal break are hypothesized to be associated with arm injury, and prior work suggests a link between slider usage, arm angle, and injury. Purpose: To evaluate whether arm angle and slider horizontal movement are associated with elbow or forearm injury risk in MLB pitchers. Study Design: Retrospective cohort study; Level of evidence, 3 Methods: Statcast data from 2020-2025 and injury data were used to study the relationship between sliders and arm injuries. Pitchers with at least 30 innings pitched (IP) were evaluated for same- and next-season injury incidence to the Elbow, Forearm, or Elbow/Forearm. A generalized additive model (GAM) related pitch-level variables to injury incidence, and average marginal effect (AME) odds ratios are reported for main effects. Results: All fits were significant at p<.01. Fits for same-season (N=1,957, p=.00008, R2=.066) and next-season (N=2,511, p=.00005, R2=.053) Elbow/Forearm injury were significant at p<.001. Same-season (R2=.061) and next-season (R2=.055) Forearm injury fits had p=.001. Main effects for slider glove-side movement and fastball usage, their interactions with arm angle, and arm angle main effects were the most predictive features. Across the three fits where the slider glove-side movement main effect was significant, odds ratios ranged from 1.03 to 1.07, meaning that each additional inch of slider glove-side movement was associated with a 3% to 7% increase in the observed injury incidence. Furthermore, this effect was magnified at high arm angle and muted at low arm angle. Conclusion: We observed that slider horizontal movement, arm angle, and their interaction were significantly associated with incidence of Forearm and combined Elbow/Forearm injury. This effect was weak or non-existent at low arm angles and strong at high arm angles, suggesting that arm angle moderates the risk of slider horizontal movement, and providing evidence that sliders with large horizontal break (e.g. sweepers) may pose an injury risk. Keywords: baseball; sweeper; slider; arm angle; horizontal movement; elbow injury; forearm injury

Abstract Objective To estimate the burden and patterns of multimorbidity and cardiometabolic multimorbidity among university employees undergoing a comprehensive health assessment programme, and to examine demographic and behavioural factors associated with multimorbidity. Design Cross-sectional study. Setting A public university in Maharashtra, India. Participants A total of 266 university employees who underwent a comprehensive health assessment were included. Main outcome measures Multimorbidity was defined as the presence of two or more of nine chronic conditions: hypertension, diabetes mellitus, dyslipidaemia, ischaemic heart disease, chronic kidney disease, thyroid disease, stroke, chronic obstructive pulmonary disease and cancer. Cardiometabolic multimorbidity was defined as the presence of two or more of hypertension, diabetes mellitus, dyslipidaemia, ischaemic heart disease and chronic kidney disease. Results Hypertension was identified in 119 participants (44.7%), comprising 50 participants with pre-existing hypertension and 69 newly identified during the assessment. Dyslipidaemia was present in 189 (71.1%) and diabetes mellitus in 45 (16.9%). Overall, 108 participants (40.6%) had multimorbidity and 103 (38.7%) had cardiometabolic multimorbidity. The prevalence of multimorbidity increased progressively with age, from 17.5% among participants aged <30 years to 83.3% among those aged [&ge;]60 years. The predominant exact multimorbidity patterns were hypertension with dyslipidaemia alone (49 participants) and hypertension, diabetes mellitus and dyslipidaemia (27 participants). Overall, 173 participants (65.0%) had at least one newly identified hypertension, diabetes mellitus or dyslipidaemia diagnosis. In multivariable logistic regression, age (adjusted OR [aOR] 1.058 per year, 95% CI 1.027 to 1.091), BMI (aOR 1.163 per kg/m2, 95% CI 1.076 to 1.257) and tobacco use (aOR 3.296, 95% CI 1.377 to 7.888) were independently associated with multimorbidity. The model had an area under the receiver operating characteristic curve of 0.731. Conclusion Multimorbidity affected approximately two in five university employees, with cardiometabolic conditions accounting for most of the observed disease clustering. Comprehensive health assessment identified a substantial burden of previously unrecognised chronic disease. Integrating institutional or occupational health assessment with longitudinal primary care follow-up may provide an opportunity for earlier detection, risk-factor modification and coordinated management of multimorbidity. Keywords: Multimorbidity; cardiovascular diseases; hypertension; diabetes mellitus; dyslipidaemia; occupational health; university employees; India

Wildfire smoke has increasingly affected air quality across North America, raising concerns about the health effects of fine particulate matter (PM2.5) exposure, including potential impacts on brain health. However, relatively few studies have characterized personal PM2.5 exposure during these events using wearable monitoring. We examined daily personal PM2.5 concentrations during wildfire smoke episodes in southeast Michigan alongside neighborhood outdoor PM2.5 estimates. Four participants (one adolescent and three adults) wore AirBeam3 personal monitors during ongoing studies. Neighborhood outdoor PM2.5 was estimated using the average of three nearest PurpleAir outdoor air quality sensors, and wildfire smoke days were identified using state air quality advisories. Group-level descriptive statistics summarized personal and neighborhood outdoor PM2.5 and self-reported time spent outdoors. Exploratory within-participant analyses quantified associations between neighborhood outdoor and personal PM2.5 concentrations on smoke and non-smoke days. Neighborhood outdoor daily PM2.5 concentrations were higher during wildfire smoke days than non-smoke days (87.6 + 80.2 vs. 12.3 + 7.0 {micro}g/m3). Personal PM2.5 concentrations were more than five times higher during wildfire smoke days (28.2 + 20.0 vs. 5.1 + 4.7 {micro}g/m3) than non-smoke days. Within participants, every 10 {micro}g/m3 increase in neighborhood PM2.5 was associated with 2.3 {micro}g/m3 increase in personal PM2.5 concentrations. Wearable PM2.5 monitoring captured elevated personal exposures while providing individual-level exposure information beyond neighborhood outdoor air quality estimates. These findings demonstrate that wearable monitoring complements neighborhood air quality measurements by capturing individual-level exposure, providing a more comprehensive assessment of real-world wildfire smoke exposure for future studies examining the effects on brain health.

Objectives: Collaboration among health care professionals and the services they provide can be strengthen by interprofessional education (IPE). IPE can be implemented at the undergraduate level. Accordingly, the objective of the present study was to evaluate senior students' understanding of the terms interdisciplinarity and multidisciplinarity within the context of IPE. Methods: A retrospective cross-sectional study design was used. Students understanding of interdisciplinarity and multidisciplinarity was assessed through an assessment question completed by three consecutive cohorts of senior undergraduate dental students at the UBC Faculty of Dentistry between 2021/22 and 2023/24 (N = 177). Responses had a maximum of 100 words and were categorized into one of four predetermined themes: concordant knowledge (when both definitions were correct), discordant rhetoric (when both definitions were incorrect), switched ideas (when the definitions were reversed), and altered discourse (when the concepts of discipline and specialty were conflated). Descriptive and inferential statistical analyses were performed using SPSS Version 31. Results: Of the 177 students enrolled, 164 provided responses to the question on multidisciplinarity and interdisciplinarity: 60 students in 2021/22, 51 students in 2022/23, and 53 students in 2023/24; the mean age was 25 years and 88 were female. Of the four predetermined themes, 45.7% of responses reflected concordant knowledge, 15.9% discordant rhetoric, 18.3% switched ideas, and 20.1% altered discourse. The logistic regression analysis showed age associated with a higher probability of providing the correct definitions (adjusted OR = 1.39; 95% CI: 1.06 - 1.83; p = 0.017). Conclusions: Knowledge of interdisciplinary and multidisciplinary appeared to be retained by the majority of students. However, dental education programs, alongside other health professional training programs, should continue to incorporate interprofessional education through both didactic and experiential learning opportunities to equip students with the skills necessary to provide collaborative care in future practice.

Perioperative safety checklists standardize critical actions, but reliable completion depends on the surrounding work system and team behavior. We conducted a prospective observational analytic study from April to May 2026 in the central surgical unit of a high-volume public teaching referral hospital in Indonesia to examine whether patient safety culture and teamwork were associated with directly observed perioperative safety compliance and whether teamwork mediated the culture-compliance relationship. Patient safety culture was measured with the Hospital Survey on Patient Safety Culture 2.0, teamwork with a 35-item TeamSTEPPS Teamwork Perceptions Questionnaire research adaptation, and compliance by direct role-based observation using a 45-item checklist derived from the AORN Comprehensive Surgical Checklist. Eighty of 92 recruited professionals contributed 240 person-operation observations across 50 operations. Overall compliance was 74.75%, with sign-out lowest at 70.68%. Patient safety culture was associated with teamwork ({beta} = 0.590; 95% CI 0.510-0.770) and directly with compliance ({beta} = 0.407; 95% CI 0.187-0.712). The teamwork-compliance coefficient was positive ({beta} = 0.285; p = 0.046), but the prespecified percentile 95% CI included zero (-0.045 to 0.517). The indirect effect through teamwork was not supported ({beta} = 0.168; p = 0.079). These findings support a system-level interpretation of perioperative safety and identify learning-oriented responses to error, situation monitoring, and sign-out fidelity as measurable targets for future improvement efforts.