International Journal of Hygiene and Environmental Health

Enteric pathogen infections are a major global health challenge, influenced by a variety of host and environmental factors, and their clinical presentation and treatment can be complicated by the presence of co-infections. The prevalence of enteric infections and co-infections tend to vary between rural and urban contexts, likely driven by underlying environmental, geographic, and demographic characteristics. To improve understanding of urbanicity and age on enteric pathogen prevalence and on co-infection risk, we measured 22 enteric pathogens in fecal samples collected from children aged 6, 12, and 18 months across a rural-urban gradient within the ECoMiD birth cohort study (n=473). Enteric pathogen burden was high and increased with age, with at least one pathogen detected in 91% of children at 6 months, 97% at 12 months, and 98% at 18 months. However, prevalence of some pathogens-- notably Salmonella enterica, enterovirus, and rotavirus-- decreased with age. Co-infections were also common (88%), and children were infected with as many as 11 pathogens simultaneously. The most frequently observed co-infection profiles included enteroaggregative E. coli and atypical enteropathogenic E. coli, followed by combinations with diffusely adherent E. coli, enterovirus, enterotoxigenic E. coli, and/or adenovirus. Enteric pathogen detection generally was higher in more rural settings, though patterns varied by pathogen. These results provide useful information for future examination of pathogen dynamics of co-occurrence. Given the ubiquity of enteric infections in high transmission settings, strategies that aim to reduce overall microbial exposure may be needed to supplement interventions targeting control of individual pathogens.

Background: Men with prostate cancer (PCa) may be especially vulnerable to per- and polyfluoroalkyl substances (PFAS) exposure due to their endocrine-disrupting and cardiometabolic impacts and cardiotoxicity and immune suppression of treatments. Objective: A pilot study was launched to measure serum and tap water PFAS concentrations in PCa survivors. Methods: Men with PCa were recruited from Rutgers Cancer Institute between February 2025 and March 2026, with ongoing enrollment and follow-up. Eligible men were aged [≥]40 years and either on active surveillance or within 3-12 months of initial definitive treatment. Participants provided blood and residential tap water samples, which were analyzed using mass spectrometry (serum) and modified EPA method 537 (water). Geometric means were used to summarize PFAS concentrations by race and assess serum-tap water correlations. Results: Of 235 eligible patients, 124 (60%) enrolled. Median age was 64 years; 63% were non-Hispanic White, 43% had a Gleason score [≤]6. Roughly half of participants provided serum and/or tap water samples. In serum, six PFAS analytes had >80% detection; of these analytes, median concentrations ranged from 0.13 ng/mL (IQR: 0.07-0.20) for PFHpS to 2.55 ng/mL (IQR:1.54-3.82) for nPFOS. Among 74 tap water samples, 9 PFAS analytes had >60% detection; of these, median concentrations of PFNA (0.56 ng/L; IQR: 0.33-0.75), PFOA (3.75 ng/L; IQR: 1.21-5.27), and PFOS (2.29 ng/L; IQR: 0.46-2.89), were below New Jersey Maximum Contaminant Levels. Non-White participants had significantly higher levels of multiple PFAS analytes in both serum and tap water. Serum-tap water correlations were modest (r=0.22-0.41). Significance: The pilot study has demonstrated both the feasibility and importance of studying PFAS exposure pathways as well as potential impacts of PFAS exposure in diverse populations. Keywords: Prostatic Neoplasms, Per- and Polyfluoroalkyl Substances (PFAS), Biomonitoring, Environmental Exposure, Cohort Studies, Pilot study Impact Statement: This study provides some of the first estimates of PFAS exposure among prostate cancer patients in serum and tap water, showing moderate correlations between tap water and serum concentrations of specific PFAS analytes. These findings can support larger studies to identify environmental exposure sources and evaluate the role of PFAS in prostate cancer progression and outcomes.

Residential greenness has been associated with reduced heat-related illness, yet the specific role of greenspace morphology at the neighborhood scale remains insufficiently understood. This study quantified the relationship between heat-related illness and multiple dimensions of greenspace morphology using an eight year (2016-2023) unbalanced panel dataset comprising 19,021 block group year observations across 2,427 census block groups in Arizona, USA. One meter high resolution National Agricultural Imagery Program aerial imagery was classified to calculate greenspace percentage, number of greenspaces, average size, shape complexity, connectedness, and distantness, at the block group level. We applied conditional spatial autoregressive models with a negative binomial distribution to estimate associations between each morphology metric and yearly heat-related illness counts, adjusting for sociodemographic and geographic covariates. We found higher greenspace percentage, aggregation, shape complexity, connectedness, and density were consistently associated with lower heat-related illness risk. A one standard deviation increases in shape complexity corresponded to a 12.4% decrease in expected heat-related illness counts (IRR=0.876, 95% CI: 0.834-0.921). Similarly, increases in greenspace percentage (14.6% decrease; IRR=0.855, 95% CI: 0.827-0.885), number of greenspace patches (3.7% decrease; IRR=0.963, 95% CI: 0.937-0.990), average size (4.5% decrease; IRR=0.955, 95% CI: 0.923-0.989), and connectedness (5.5% decrease; IRR=0.945, 95% CI: 0.918-0.972) were all protective. In contrast, larger inter greenspace distances were associated with increased heat-related illness risk (6.1% increase; IRR=1.061, 95% CI: 1.033-1.091). Our findings highlight the critical importance of multiple dimensions of greenspace morphology in mitigating heat-related health risks. These results suggest that heat reduction planning with greening initiatives should consider not only the amount of greenspace but also its spatial configuration to maximize cooling and result in health benefits.

Background Cholera remains a recurrent public health emergency in Zamfara State, northwestern Nigeria, where communities depend predominantly on untreated and poorly protected water sources. Environmental water bodies serve as reservoirs for Vibrio cholerae, sustaining transmission cycles between outbreaks. Despite the severity of recurrent outbreaks in the region, data on the molecular characteristics and serogroup distribution of V. cholerae across different drinking water source types in Zamfara State remain critically limited. Methodology/Principal Findings A cross-sectional environmental surveillance study was conducted between 13 October and 26 November 2025 across five cholera-affected Local Government Areas (LGAs) of Zamfara State: Gusau, Bungudu, Talata Mafara, Zurmi, and Shinkafi. A total of 142 water samples were collected from five source types -- rivers, boreholes, wells, tap water, and sachet water. Presumptive isolation was performed on Thiosulfate-Citrate-Bile Salts-Sucrose (TCBS) agar following alkaline peptone water enrichment. Fifty-five presumptive isolates underwent PCR-based molecular confirmation and serotyping using three gene targets: ompW (species confirmation, 588 bp), ctxA (O1 toxigenicity marker, 302 bp), and tcpA (O139 colonisation factor, 120 bp). Presumptive V. cholerae was recovered from 55 of 142 samples (38.7%; 95% CI: 30.5-47.3%), with well water recording the highest positivity rate (69.7%; 95% CI: 51.3-83.7%). A statistically significant association was observed between water source type and presumptive V. cholerae occurrence ({chi}2 = 23.11, df = 4, p < 0.001). Molecular analysis confirmed 29 isolates (52.7%; 95% CI: 39.2-66.0%) as V. cholerae, comprising 22 O1 serotypes (75.9%), one O139 serotype (3.4%), and six non-O1/non-O139 serotypes (20.7%). Toxigenic O1 strains were detected across all five LGAs and in all five water source types, including commercially packaged sachet water. The O139 serotype was identified in a single well-water isolate from Zurmi LGA, representing the first environmental detection of this serotype in Zamfara State. Conclusions/Significance The co-circulation of toxigenic O1, O139, and non-toxigenic non-O1/non-O139 V. cholerae serogroups across five distinct drinking water source types confirms that community water environments serve as genetically diverse reservoirs sustaining cholera transmission in Zamfara State. These findings underscore the urgent need for integrated water quality surveillance, sanitation infrastructure investment, and sustained molecular monitoring of environmental V. cholerae populations.

The introduction of salt iodization is associated with improved health and socioeconomic outcomes, but is not yet universally adopted and not always sustained. Using a quasi-experimental event study with difference-in-differences over space and time, we quantify the impacts of iodine deficiency in utero and infancy on childhood mortality and later academic achievement in Ethiopia, comparing cohorts born just before and after the May 1998 border closure that interrupted access to iodized salt. Rural children with fewer months of early-life exposure to iodized salt scored lower on standardized secondary-school exams, especially in districts with low environmental iodine, with excess deaths emerging in infancy and persisting through early childhood. These findings reveal the long-term benefits of salt iodization for health and education, especially for people with low intake of iodine from environmental sources.

Background Brucellosis is a severe zoonotic disease with pronounced seasonality and regional heterogeneity in high-incidence areas of China. Reliable forecasting tools are needed to inform prevention strategies, but the optimal modeling approach across different regions remains unclear. Principal Findings We collected monthly brucellosis incidence and 17 environmental variables from 2014 to 2024 across five high-incidence provinces: Inner Mongolia, Xinjiang, Shanxi, Heilongjiang, and Hebei. A three-step procedure--cross-correlation analysis, multicollinearity diagnostics, and stepwise regression--was used to select exogenous predictors. We then compared four time-series models: seasonal autoregressive integrated moving average (SARIMA), SARIMA with exogenous variables (SARIMAX), long short-term memory (LSTM), and LSTM with exogenous variables (LSTMX). All five provinces showed a unimodal seasonal pattern with peaks between April and July, though environmental drivers and optimal lag periods varied substantially by region, ranging from 1 to 6 months. In forecasting performance, LSTM achieved the highest accuracy in Shanxi (R2=0.925), Hebei (R2=0.876), and Xinjiang (R2=0.829), outperforming SARIMA and SARIMAX. LSTMX performed best in Inner Mongolia (R2=0.759) and Heilongjiang (R2=0.772) but showed weaker performance than LSTM in Shanxi and Hebei. Overall, adding exogenous variables did not consistently improve predictions across provinces. Conclusions Our findings demonstrate that LSTM-based models offer clear advantages for brucellosis forecasting in most high-incidence provinces, but the value of incorporating environmental predictors is region-dependent. These results support the development of tailored early warning systems and precision prevention strategies for brucellosis in high-risk areas of China.

While exposure to volatile organic compounds such as ethylene dichloride and vinyl chloride monomer is a well-established cause of liver disease, particularly hepatic hemangiosarcoma, characterizing real-world exposure profiles in communities surrounding industrial centers remains challenging. Calvert City, Kentucky (population ~2,500), provides a unique setting characterized by both active industrial emissions and legacy sources of air toxics. To address these complexities, this method paper describes the framework for the Biomonitoring and Environmental Assessment for Community Outreach and Neighborhood Safety (BEACON) study. By utilizing a novel, multi-dimensional exposure assessment strategy, BEACON aims to characterize air toxic exposures and provide actionable data for community health and safety. For the BEACON study, we will leverage Kentucky Department of Air Quality measures of air toxics, analyze urine samples in a small cohort of community volunteers, analyze community urine via wastewater in an adjacent community, geocode citizen odor reporting, assess blood markers in wildlife, survey small and large animal veterinarians in the area for anomalies in morbidity and mortality, and work with the regional health system to enhance vigilance for health issues associated with toxicants present in the area. In addition, blood samples will be collected at three time points and biobanked for future analyses. Efforts will be made to link this study to additional large-scale long-term cohorts where possible. Throughout the project, community engagement will play a critical role by raising awareness, fostering collaboration, and ensuring that the voices of affected residents are heard.

Abstract Background. Chronic low-level exposure to lead, cadmium, mercury, and arsenic remains a determinant of premature mortality in the U.S. general population, but previous hazard-ratio analyses do not characterize how exposure shifts the lower tail of the survival distribution, where premature mortality is concentrated. Objectives. We estimated the association of whole-blood lead, whole-blood total mercury, urinary cadmium, and the sum of urinary inorganic and methylated arsenic species with the 10th, 25th, and 50th conditional quantiles of follow-up time to all-cause mortality among U.S. adults aged 40 years and older. Methods. NHANES Continuous 1999 to 2018 was linked to the National Death Index through December 31, 2019 (n = 29,652). Censored quantile regression was fit per metal on the log2 scale at quantiles {tau}{0.10, 0.25, 0.50}. A restricted-cubic-spline (RCS) censored-quantile-regression was fit for blood lead and urinary cadmium to investigate the threshold effect. Results. Over a median follow-up of 9.1 years, 7,215 deaths were ascertained. A doubling of urinary cadmium was associated with -1.57 years of follow-up (95% CI: -2.08, -1.07) at the 10th conditional quantile, -1.50 (-2.04, -0.96) at the 25th, and -1.49 (-1.93, -1.04) at the median (Benjamini Hochberg q < 0.001 throughout). A doubling of whole-blood lead was associated with -0.70 years (95% CI: -0.99, -0.40) at the 10th conditional quantile, -0.62 (-0.92,-0.31) at the 25th, and -0.61 years (-0.89, -0.34) at the median; the absolute loss was largest at {tau} = 0.10 for both metals. Urinary arsenic-metabolite sum was not associated with conditional follow-up at the estimable quantiles. Despite adjustment for dark and fatty-fish intake or DHA/EPA, whole-blood total mercury was associated with longer follow-up (i.e., negatively associated with mortality risk), possibly due to residual confounding by broader dietary or socioeconomic factors, rather than a true protective effect. The cadmium association was additionally robust to the mutual adjustment of lead. Discussion. Low-to-moderate urinary cadmium and whole-blood lead were associated with fewer years of follow-up survival at the lower-tail and median conditional quantiles of survival, with the largest absolute losses at the lower tail of the conditional survival distribution, where premature mortality is concentrated. These findings support continued reductions in U.S. cadmium exposure and lead with particular benefit for adults most vulnerable to premature death.

Abstract Climate change is altering environmental conditions that influence foodborne disease transmission, yet traditional systematic reviews cannot keep pace with expanding evidence. We assessed whether an LLM-assisted workflow could generate a rapid, repeatable, and policy-relevant living evidence base for climate-sensitive foodborne disease. We combined structured PubMed searches (2010-2023), gold-standard human labelling, and iterative refinement of a GPT?4?Turbo?based auto-labeller within the SysRev platform. Pathogens of public-health importance in England were selected a priori. Model performance was evaluated against human reviewers using recall, precision, specificity, accuracy, and balanced accuracy. The refined inclusion model achieved 89{middle dot}2% recall, 59{middle dot}2% precision, 84{middle dot}5% specificity, and 85{middle dot}4% accuracy across 1,044 screened abstracts, identifying 436 studies for inclusion. Post-hoc re-evaluation of discordant abstracts showed that records excluded by the model but included during initial human screening did not meet the refined inclusion criteria. Frequently identified climate exposures included rainfall, temperature, seasonality, and humidity; norovirus, Salmonella, Campylobacter, and Cryptosporidium were the most common pathogens. An LLM-assisted workflow can generate living evidence for climate-sensitive foodborne disease with high recall and improved screening consistency. The approach is scalable, auditable, and suitable for secure institutional environments, supporting horizon scanning and climate-health risk assessment.

Background: Monitoring urinary iodine concentration (UIC) after sustained exposure informs iodine delivery strategies. We aimed to compare endline UIC among women of reproductive age (WRA) and preschool children (PSC) receiving multiple micronutrient-fortified (MMF) vs. iodine-only bouillon, and to describe population iodine status at baseline and endline. Methods: This pre-specified secondary outcome analysis used Condiment Micronutrient Innovation Trial (CoMIT) data. Non-pregnant, non-lactating WRA (15-49 years) and PSC (2-5 years) were enrolled at the household level. Households received MMF or iodine-only bouillon for 9 months (38 weeks); both contained iodine (KIO3) at 30 ug/g. Baseline and endline UIC (ug/L) were measured by modified Sandell-Kolthoff reaction in spot urine samples. ANCOVA models, adjusted for baseline log-UIC and recruitment site, compared endline geometric mean UIC between trial arms. Median UIC at both timepoints was compared to WHO cut-offs (ug/L): <100 (insufficient), 100-199 (adequate), 200-299 (above requirements), and >=300 (excessive); the prevalence of UIC <50 ug/L was calculated. Results: Endline UIC data were available for 611 WRA and 630 PSC. Adjusted endline UIC did not differ by arm (geometric mean ratio [95% CI]: WRA 0.97 [0.86-1.10]; PSC 0.96 [0.84-1.10]). With arms combined, median UIC increased among WRA (100.5 to 124.6 ug/L) and PSC (109.6 to 136.9 ug/L), with fewer samples <50 ug/L at endline. Conclusions: Adjusted endline UIC did not differ between trial arms. After 9 months' use of iodine-fortified bouillon, median UIC remained adequate among WRA and PSC, with fewer samples <50 ug/L at endline.

Abstract Objectives: To estimate surveillance-adjusted county-level residual syphilis risk, quantify posterior support for elevated risk, and identify the geographic distribution of stably high-risk areas across the contiguous United States and the District of Columbia. Methods: County-year primary and secondary syphilis counts from 3,109 counties during 2010-2022 were analyzed using a Bayesian negative-binomial spatial model with county-level covariates capturing social vulnerability and healthcare and surveillance related structure. Residual spatial risk, posterior exceedance probabilities, and stably high-risk counties were estimated. External validation examined whether county-level residual syphilis risk was associated with HIV and gonorrhea burden. Results: A total of 850 stably high-risk counties were identified. These counties were concentrated in the southeastern United States and along the Gulf Coast, with additional clusters in the north-central region and along the Atlantic and Pacific coasts. The social vulnerability index showed the strongest positive association with reported syphilis rates, followed by primary care physician density. External validation and sensitivity analyses showed that higher county-level residual syphilis risk estimates were positively associated with higher HIV diagnosis rates and gonorrhea rates, indicating that these estimates were not merely model-derived numerical outputs but were meaningfully related to the county-level distribution of sexually transmitted infection risk. These findings indicate that surveillance-adjusted residual spatial risk estimates and posterior exceedance probabilities may provide useful county-level evidence for syphilis control prioritization and resource allocation.

Climate and land use change are reshaping the dynamics of vector-borne diseases. West Nile virus (WNV), the most widespread zoonotic arbovirus in the United States, illustrates the need to integrate climate, land cover, and social vulnerability across heterogenous landscapes when assessing spatial risk. We present a nationwide, county-level assessment of WNV risk, using complementary statistical and mechanistic models to (1) identify socio-ecological correlates of current WNV incidence, and (2) project vector species-specific, temperature-dependent transmission suitability under mid- and late-century climate change scenarios. We find that land cover gradients, temperature-driven transmission, and both occupational and residential exposure are associated with WNV incidence, particularly in mixed urban-agricultural landscapes. Future temperature and land cover projections suggest spatially variable shifts in environmental risk, driven by divergent physiological responses among Culex species vectors. Our results highlight temperature and land cover as consistent, mechanistically grounded correlates of WNV risk at the national scale, while underscoring the need for refined, species-specific analyses at local levels. These insights can inform more targeted surveillance, vector control, and climate adaptation strategies. We also identify key knowledge gaps, particularly around host and vector ecology, that must be addressed to improve public health response in the face of ongoing environmental change.

Background German cockroach (Blattella germanica) infestation is an important urban environmental health menace associated with food contamination, allergic disease, and reduced quality of life. Long-term control depends not only on professional pest management, but also on residents knowledge and preventive behaviors. This study assessed the knowledge, Health belief model (HBM) constructs, self-efficacy, and preventive practices related to German cockroach infestation among urban residents in Tehran, Iran. Methods In this cross-sectional study, 120 adults with professionally confirmed household German cockroach infestation were recruited from licensed pest-control companies in Tehran. Data were collated using a 39-item HBM-based questionnaire assessing knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and preventive practices. Descriptive statistics, Pearson correlation, and multiple linear regression were performed. Results Participants demonstrated modest knowledge regarding German cockroach biology (mean score: 0.538) and moderate preventive practices (3.157). Preventive practices were positively correlated with knowledge (r = 0.256, P = 0.005), perceived benefits (r = 0.292, P = 0.001), and self-efficacy (r = 0.244, P = 0.007). Regression analysis showed that the model explained 17.3% of the variance in preventive practices (R2 = 0.173, P = 0.001). Knowledge ({beta} = 0.191, P = 0.036), perceived benefits ({beta} = 0.231, P = 0.010), and self-efficacy ({beta} = 0.229, P = 0.012) were significant predictors. Conclusions Urban residents with confirmed German cockroach infestation showed limited knowledge and moderate preventive behaviors. Knowledge, perceived benefits, and self-efficacy were independently associated with preventive practices and demonstrated modest predictive value. Interventions targeting these behavioral factors, alongside environmental and structural improvements, may enhance sustainable household cockroach control.

Abstract To identify countries with potential weaknesses in respiratory public health protection, we characterised shared hotspot patterns across three major respiratory infectious diseases and assessed whether the resulting shared hotspot scores were associated with worse COVID-19 outcomes. A Bayesian multivariate shared-component spatiotemporal model was fitted to data from 204 countries over 1990-2023 using Global Burden of Disease 2023 estimates to derive a shared hotspot score for each country. Generalized estimating equation negative binomial models were then used to examine associations between the shared hotspot score and COVID-19 incidence and mortality over 2020-2023. The shared hotspot score showed substantial cross-country heterogeneity, with the highest values concentrated in sub-Saharan Africa, South Asia, and Southeast Asia. Tuberculosis showed the strongest contribution to the shared spatial component (lambda = 1.657, 95% highest density interval: 0.883-2.506). Higher shared hotspot scores were significantly associated with both higher COVID-19 incidence (incidence rate ratio = 1.6783, 95% confidence interval: 1.4564-1.9340; p = 8.308 x 10^-13) and mortality (incidence rate ratio = 1.7436, 95% confidence interval: 1.5061-2.0186; p = 9.912 x 10^-14). Countries with persistently high co-occurrence of common respiratory infectious diseases also experienced worse COVID-19 outcomes, suggesting that the shared hotspot score may inform preparedness-oriented surveillance and resource allocation for future large-scale respiratory epidemics or pandemics.

Introduction: Climate change disproportionately affects disadvantaged communities, yet construction workforce education rarely addresses interconnected pathways linking energy efficiency, nature exposure, and public health. Green-blue infrastructure delivers co-optimized benefits: reducing building energy consumption 15-30% while decreasing heat-related mortality by approximately 3.9% per degree Celsius of urban cooling (Gasparrini et al., 2017) -- epidemiological benchmarks that inform the dose-response functions embedded in the Ecosystem Justice Translator (EJT). This protocol describes, to our knowledge, the first randomized controlled trial evaluating a curriculum intervention designed to develop planetary health competencies and environmental justice awareness among high school students pursuing construction careers. Methods and analysis: This two-arm, parallel-group randomized controlled trial targets enrollment of N=200 high school students (ages 14-18) from construction career pathway programs in the San Francisco Bay Area (over-recruitment target N=250; 25% buffer for attrition). Students are individually randomized 1:1 to intervention (Community-Centered Design curriculum integrating the Ecosystem Justice Translator) or control (traditional Virtual Design and Construction curriculum), stratified by school site using block randomization. The 6-month intervention features the Ecosystem Justice Translator (EJT) -- a computational system using large language models to translate community health equity concerns into quantifiable investment priorities. The EJT's 51-theme health equity taxonomy was derived from validated public health frameworks (Centers for Disease Control and Prevention [CDC] Social Vulnerability Index, Environmental Protection Agency [EPA] EJScreen, Healthy People 2030). Primary outcome is Health-Integrated Equity Consciousness Index (HI-ECI), measured at baseline, 3, 6 (primary endpoint), and 12 months. Analysis uses intention-to-treat linear mixed-effects models with random intercepts for participants. The minimum required sample (n=26 per arm; G*Power, two-tailed a=0.05, 80% power, Hedges' g=0.80) is exceeded by enrolled N=200, which provides >99% power at Hedges' g=0.80 and supports multi-site confirmatory factor analysis. Ethics and dissemination: This protocol has been approved by Stanford University Institutional Review Board (IRB eProtocol #84369, approved February 13, 2026). Parental consent from a parent or guardian and written assent from each student participant are required prior to enrollment. All instruments, curriculum materials, and EJT source code will be released open-source under CC BY-NC-SA 4.0, permitting free use for educational, research, and non-profit purposes, concurrent with primary publication. Commercial licensing may be pursued separately through Stanford University Office of Technology Licensing (OTL docket S25-565). Trial registration: ClinicalTrials.gov NCT07315919. Pre-results. Protocol version 4.0, June 2026.

Abstract Background Neighborhood socioeconomic disadvantage may contribute to inequities in access to dental care by influencing the geographic distribution of providers. The Area Deprivation Index (ADI) is a validated measure of neighborhood deprivation, but its association with dental workforce availability has not been examined statewide in California. This study evaluated the relationship between neighborhood deprivation and dental provider density across California ZIP Code Tabulation Areas (ZCTAs). Methods We conducted a cross-sectional ecological study of California ZCTAs using publicly available data from the National Plan and Provider Enumeration System (April 2026), the Neighborhood Atlas 2023 ADI, and 2024 U.S. Census population estimates. Active dental providers were linked to ZCTAs and provider density was calculated per 10,000 residents. ADI was aggregated to the ZCTA level using the median ADI national percentile. Negative binomial regression was used to assess the association between ADI and dental provider density, with population included as an offset. Secondary analyses examined California-specific ADI quartiles, dental deserts, and specialist versus general dentist availability. Results The final analytic sample included 1,426 California ZCTAs representing 39,016,384 residents and 37,945 active dental providers. Greater neighborhood deprivation was significantly associated with lower dental provider density. Each one-percentile increase in ADI corresponded to a 1.8% reduction in provider density (incidence rate ratio [RR] 0.9823, 95% confidence interval [CI] 0.9799-0.9847; p < 0.001). Compared with the least deprived quartile, the most deprived quartile had 61% fewer dental providers (RR 0.39, 95% CI 0.34-0.45; p < 0.001). Overall, 15.9% of ZCTAs contained no active dental providers, increasing from 6.8% in the least deprived quartile to 31.1% in the most deprived quartile. Specialist availability demonstrated an even steeper deprivation gradient, with specialist density declining by 86% between the least and most deprived quartiles.

Abstract Background: Despite considerable reductions in under-five mortality during the Millennium Development Goal era, progress towards Sustainable Development Goal (SDG) 3.2 remains uneven across Africa. Identifying countries at greatest risk of missing the target is essential for prioritizing interventions and resource allocation. Methods: A Bayesian spatial forecasting ecological study was conducted using 2024 country-level data from 49 African countries obtained from UNICEF. Spatial dependence was assessed using Global Moran's I and Local Indicators of Spatial Association. Bayesian structured additive regression models with Gaussian, Gamma, and Exponential likelihoods were fitted using Integrated Nested Laplace Approximation (INLA) and compared using the Deviance Information Criterion (DIC), Watanabe-Akaike Information Criterion (WAIC), and conditional predictive ordinates. Posterior exceedance probabilities were estimated, an SDG Failure Index (SFI) and a Priority Intervention Index (PII) were developed, and Bayesian posterior predictive simulations were performed to estimate country-specific probabilities of attaining SDG 3.2 by 2030. Results: Significant spatial clustering of under-five mortality was observed with (Moran's I = 0.355, p < 0.001), and hotspots in Benin, Cameroon, and Nigeria. The Gamma model provided the best fit (DIC = 114.92; WAIC = 111.71). Diarrhoea was the only significant predictor (posterior mean=0.030; 95% credible interval: 0.004-0.056). Twenty-three countries (46.9%) were classified as high risk, whereas only five (10.2%) had achieved SDG 3.2. West Africa recorded the highest mean mortality (7.05%) and North Africa the lowest (1.64%). Bayesian projections indicated that only five countries were likely to achieve SDG 3.2 by 2030, while 41 (83.7%) were unlikely to do so. Conclusion: Considerable geographical inequalities in under-five mortality persist across Africa, and most countries remain off-track for achieving SDG 3.2 by 2030. The integration of exceedance probability mapping, the SDG Failure Index, the Priority Intervention Index, and Bayesian probability forecasting provides a practical framework for monitoring progress and prioritizing countries requiring accelerated action towards achieving SDG 3.2.

Background Leptospirosis is substantially underdiagnosed across sub-Saharan Africa, with its contribution to acute undifferentiated fever (AUF) poorly characterized. We determined the prevalence, risk factors, and clinical profile of leptospirosis among adolescents and adults presenting with AUF at a referral hospital and health centre in Hoima, western Uganda. Methods: In a prospective health facility-based study with convalescent follow-up, blood and urine from AUF patients were tested by LipL32 real-time PCR (qPCR) and microscopic agglutination (MAT). Leptospirosis was confirmed by qPCR positivity, a single test MAT titre of 1:800, or at least a fourfold titre rise or seroconversion in paired sera. Seroconversion was defined as a change from negative or 1:50 to 1:100 (conservative) or 1:200 (lenient). Seroprevalence was defined as a MAT titre of 1:100 or above in any sample. Risk factors were identified by multivariable logistic regression. Results: Among 330 AUF patients, acute leptospirosis prevalence was 27.0% (95% CI 22.3 to 32.1; conservative) and 32.7% (95% CI 27.7 to 38.1; lenient), comparable to malaria at 30.3% (95% CI 25.3 to 35.3), with co-infection in 8.8% (95% CI 5.7 to 11.8). qPCR detected Leptospira DNA in 9.1%, with 63.3% of qPCR-positive cases serologically confirmed and 24.4% of serological cases, qPCR-positive. Seroprevalence was 35.8% (95% CI 30.6 to 41.2); L. interrogans serovar Bataviae was predominant (18.2% of serological cases), reported here for the first time in Uganda. Skinning animals (aOR 5.19, 95% CI 1.40 to 21.16) and mosquito exposure (aOR 2.31, 95% CI 1.17 to 4.70) were the only independent risk factors in multivariable analysis. Discussion: Leptospirosis occurs as frequently as malaria among AUF patients in Hoima and warrants inclusion in Uganda's national febrile illness guidelines. The association of leptospirosis with skinning of animals suggests a potential role of animal exposure in leptospirosis transmission. Poor qPCR-MAT concordance confirms that accurate case ascertainment requires combined molecular and serological diagnostics.

Background Severe Clostridioides difficile infection (CDI) morbidity and mortality disproportionately affect Black and Hispanic patients in the United States. Antibiotic exposure is the primary modifiable risk factor for CDI, and clindamycin is among the agents most strongly associated with related harm. Characterizing inequities in prescribing is critical. Dentistry is a major source of clindamycin prescriptions. Academic dental clinics serve diverse patient populations and provide an ideal setting to evaluate prescribing across racial and ethnic groups. We therefore examined antibiotic use and cumulative clindamycin exposure as measures of CDI-associated risk. Methods We conducted a retrospective study of electronic health records from 5 US academic dental institutions from 2021 through 2023. We analyzed 552,428 encounters among 132,770 patients with documented race/ethnicity to estimate adjusted odds of receiving any oral antibiotic and clindamycin by race/ethnicity. Secondary outcomes evaluated total antibiotic exposure among dental provider-prescribed antibiotics, focusing on higher-than-standard cumulative dosing of clindamycin (>8400 mg) and amoxicillin (>10,500 mg). Results Oral antibiotic prescribing occurred in 1.9% of encounters. Compared with White patients, Black, Hispanic, and Other race patients had slightly lower adjusted odds of receiving any oral antibiotic, while Black patients had greater odds of receiving a higher-than-standard cumulative clindamycin dose when clindamycin was prescribed (adjusted odds ratio, 2.19; 95% confidence interval, 1.25-3.82). Conclusion Racial and ethnic inequities in dental antibiotic prescribing extended beyond antibiotic receipt to cumulative clindamycin exposure. Although CDI outcomes were not directly measured, these prescribing differences may have implications for disparities in CDI-associated harm and warrant further investigation.

Background: Human activities such as mining generally lead to increased heavy metal concentrations in the environment. While traditional remediation techniques are often costly, the use of fungi as bioremediators, known as mycoremediation, is increasingly gaining attention as a sustainable approach for removal of heavy metals. Here, we evaluated heavy metal levels inside the Kiirunavaara iron ore mine in Northern Sweden and analysed fungal responses to various metal concentrations by comparing growth and metal uptake in mine-derived isolates and closely related control isolates. Results: Sediments inside the mine were enriched in heavy metals compared to those from the outlet of the mine to natural lakes. Six Fusarium isolates were recovered from contaminated mining environments: five isolates from inside the mine were identified as Fusarium oxysporum, and one isolate from the outlet was identified as Fusarium tricinctum. Isolates from the mine and outlet showed overall higher survival and biomass production in presence of copper, iron, and zinc across a range of concentrations (up to 1000 mg/L) compared to control isolates. At the same time, these isolates often exhibited reduced relative metal uptake. As a result, mycoremediation potential, assessed as total uptake in the grown mycelium, was isolate-dependent. Conclusions: Based on these results, we conclude that Fusarium isolates from the Kiirunavaara mine show increased growth in media enriched with heavy metals compared to closely related control isolates. We additionally show that mycoremediation potential is not necessarily associated with environmental origin. Instead, mycoremediation potential should be evaluated on a case-by-case basis for each isolate and based on specific needs for mycoremediation.