Journal of Occupational Health

ObjectiveThis study aimed to adapt and validate Levensteins Perceived Stress Questionnaire (PSQ) within the Ecuadorian sociocultural context. The PSQ measures perceived stress across two temporal frames: general (past two years) and specific (past month). MethodsThe research followed five sequential phases. Study 1: linguistic and cultural adaptation through standardized translation, back-translation, expert review, and a pilot test with 300 participants. Study 2: item refinement with an additional sample of 300 participants. Study 3: Exploratory Factor Analysis (EFA) with 395 participants. Study 4: Confirmatory Factor Analysis (CFA) with 391 participants, complemented by Structural Equation Modeling (SEM) to evaluate factorial structure, internal consistency, and convergent and discriminant validity through correlational analyses. Study 5: multigroup factorial invariance analysis by biological sex. ResultsThe original questionnaire of 30 items across seven factors was refined for the Ecuadorian context into two versions: a General version with 21 items grouped into three factors, and a Specific version with 23 items distributed across four factors. Both versions demonstrated strong reliability, along with satisfactory convergent and discriminant validity. ConclusionsThe findings endorse the PSQ-593 as a reliable and culturally appropriate instrument for assessing perceived stress among Ecuadorian university faculty. Its validation contributes to a deeper understanding of stress as a psychological risk factor for mental health.

Policing is one of the most rewarding occupations; however, it is stressful and demanding. This study was designed to explore stress, stress management, and coping mechanisms among Nigerian Police Officers working across four geopolitical zones in Nigeria. Using an exploratory design, forty in-depth interviews (IDIs) were conducted with police officers. Data was collected using an interview guide. The interviews were conducted in English and the participants indigenous languages (by preference), audio-recorded, and transcribed verbatim. Data were analyzed using the thematic approach. A range of contextual stressors were identified as barriers to the health and well-being of police officers in Nigeria. The police often lack the tools and equipment needed to perform their official duties effectively. This includes items like uniforms, bulletproof vests, and even operational vehicles. Shortage of manpower, lack of operational tools, poor welfare for police officers, and poor remuneration were also among their concerns. The participants were able to identify signs of stress that are common among police officers, which are majorly weaknesses, lack of sleep, dizziness, headache, anxiety, exhaustion, and anger. The common coping mechanisms include regular exercise, adequate rest, and relaxation through recreational activities, regular medical checkups, and seeking support from colleagues, among others. Nigerian police officers face many challenges that affect their health and daily routines. This analysis identifies potential opportunities to improve officers welfare in these contexts.

IntroductionMusculoskeletal injuries (MSKIs) are ubiquitous in the U.S. military, especially among high-performing service members such as Marines. Given that female service members only started to be assigned to ground combat roles since December 2015, evaluation of sex on MSKI risk in ground combat occupations has not been possible until there was an ample population to study. The purpose of this population-level epidemiological study was to assess (1) if female sex was a salient risk factor for MSKI in Marines serving in different military occupations, including combat arms, and (2) the effects of integration period on MSKI risk among female Marines. Materials and MethodsA population-based epidemiological retrospective cohort study of all U.S. Marines was performed assessing female sex, occupation, and integration period on the prevalence of MSKI from 2011 through 2020. The Military Health System Data Repository was utilized to identify initial healthcare encounters for diagnosed ankle-foot, knee, lumbopelvic-hip, thoracocostal, cervicothoracic, shoulder, elbow, or wrist-hand complex injuries. Prevalence was calculated for female and male Marines in each occupational category (combat, combat support, aviators, aviation support, services) during the pre-integration (2011-2015) and post-integration (2016-2020) periods. ResultsDuring the pre-integration period, 520/1,000 female Marines (n=13,985) and 299/1,000 male Marines (n=142,158) incurred MSKIs. In the post-integration period, the prevalence increased to 565/1,000 female Marines (n=17,608) and 348/1,000 male Marines (n=161,429). In the multivariable evaluation of sex, occupation, integration period, and the interaction of sex and occupation on combined MSKIs, only female sex was a significant factor for injury (prevalence ratio [PR]=1.99), with service in ground combat and aviation occupations identified as protective factors when compared with services occupations (PR=0.69). When these same factors were evaluated for specific MSKI outcomes, female sex remained a robust factor in all lower quarter (PR=1.75-2.63) and upper quarter (PR=1.38-2.36) injuries except for shoulder injuries. Service in ground combat and aviation occupations was protective for all lower quarter injuries (PR=0.46-0.71). In the upper quarter, ground combat was protective for all injuries except for elbow injuries (PR=0.67-0.77). Serving as an aviator was a risk factor for cervicothoracic (PR=1.57) and thoracocostal (PR=1.22) injuries and a protective factor for shoulder (PR = 0.73) and wrist-hand (PR = 0.46) injuries. Adjusted risk for lumbopelvic-hip (PR=1.13), ankle-foot (PR=1.53), cervicothoracic (PR=1.19), thoracocostal (PR=1.14), and elbow (PR=1.48) injuries significantly increased during the post-integration period. There was a significant sex-by-period interaction for shoulder injuries alone, with female sex in the post-integration epoch found to be salient (PR=1.26). ConclusionsFemale sex was a salient factor for MSKI, with service in ground combat and aviation occupations identified as protective factors when compared with services occupations. In the evaluation of specific MSKIs, female sex remained a robust and significant factor in all lower quarter injuries and upper quarter injuries except for shoulder injuries. There was only a significant sex-by-period interaction for shoulder conditions, with an increased risk of these injuries in female Marines in the post-integration period.

BackgroundWhile veterinary surgeons are known to have particularly high rates of injury compared to other sectors, little is known about rates of injury among veterinary students. This study aims to understand animal-related injury rates, injury context and mechanisms, attitudes to reporting injuries, and behaviour change among UK and Irish veterinary students. MethodsA survey was distributed to students across all veterinary schools operating in the UK and Ireland in 2021. Questions explored participants experience of injury through asking about their most recent and most severe injuries via quantitative and free-text questions. Data were analysed using descriptive statistics, logistic regression, and qualitative content analysis. Results533 responses were included in the analyses. Overall, 47.5% of students reported having been injured by an animal during the veterinary degree, 35.5% of students reported being injured within the last 12 months. Most recent injuries were caused by companion animals (38.0%), livestock (37.6%), and equids (23.5%). For their most severe injuries, 48.7% involved livestock, 28.7% companion animals, and 22.1% equids. The content analysis highlighted that students normalised injuries and infrequently reported injuries to the university. It was very rare for students to take time off from their studies or placements, due to course pressures. ConclusionsThese findings reflect concerningly high levels of injury, which are being under-reported and reflect a culture of injury acceptance and expectation among students. Veterinary schools should consider lessons learnt in other work environments which have been successful in changing safety culture.

Compassion fatigue is a well-documented hazard among healthcare and veterinary professionals, yet the psychological toll on informal caregivers of feral cat colonies, likely numbering several tens of thousands in Portugal, remains largely unexplored. This cross-sectional study examines internal and external factors associated with the secondary traumatic stress component of compassion fatigue among 172 informal caregivers in Portugal. Secondary traumatic stress refers to work-related secondary exposure to individuals who have experienced extremely stressful or traumatic events. Structured telephone interviews assessed sociodemographics, colony management, compassion satisfaction, resilience, spiritual well-being, and perceived social support. Univariate and multivariable linear regression identified predictors of compassion fatigue. Results indicate that 47% of participants experienced moderate compassion fatigue, and 10% reported high levels. Multivariable analysis revealed that caring for large colonies (more than 25 cats) and being unemployed were significantly associated with higher fatigue. Conversely, older age, higher perceived family support, and the resilience dimension of serenity served as protective factors. Interestingly, finding meaning in life was positively correlated with fatigue, suggesting that caregivers who perceive their role as central to their life purpose may become more emotionally invested, increasing vulnerability to distress when unable to help animals. Official colony registration and formal institutional support did not significantly alleviate fatigue. These findings highlight that institutional support alone is insufficient to mitigate fatigue among informal caregivers, who experience significant distress driven by both practical burdens and profound emotional involvement. The most frequently reported concern among caregivers was the inability to cover the costs of feeding and veterinary care for the cats. Interventions must address both external needs (e.g., support to cover veterinary and feeding expenses for the cats) and internal coping mechanisms. Implementing psychosocial support alongside trap-neuter-return programs may also improve caregiver well-being and foster sustainable urban feral cat management. This underscores a One Health perspective, demonstrating that animal health is closely interconnected with human well-being and environmental health.

Food costs are more significantly impacted by climate change as countries grow. It is well known that climate change has an impact on the productivity of most agricultural goods, but it is unclear how specifically it will affect food costs. The present research explores how the North Atlantic Oscillation (NAO) index, a widely used climate indicator, affects food prices around the world. This is achieved by applying a robust bivariate Hurst exponent (robust bHe). The research creates a color map of this coefficient using a window-sliding technique over various intervals of time, displaying an illustration that changes overtime. Additionally, the NAO index and global food prices are examined for causal connections using variable-lag transfer entropy using a window-sliding technique. The results show that notable rises in a number of international food prices for long as well as short periods are associated with significant increases in the NAO index. Furthermore, the causative function of the NAO index in influencing global food costs is confirmed by variable-lag transfer entropy. Is highly recommended as it directly connects the research to actionable outcomes for policymakers and the overarching goal of sustainability and food security. This study provides the first direct evidence of a robust, long-range cross-correlation and causal link between the North Atlantic Oscillation (NAO) index and key global food prices. It introduces a novel, robust methodological framework to visualize this time-varying relationship, offering a critical tool for policymakers and forecasting models.

BackgroundAntimicrobial resistance (AMR) is a global public health threat driven significantly by antimicrobial misuse in agriculture, particularly in poultry farming. This study assessed the awareness, knowledge, practices, and associated factors related to antimicrobial resistance among poultry farmers in Osun State, Nigeria. MethodsA cross-sectional study was conducted among 289 poultry farmers selected through stratified random sampling across Osun State. The study included actively practicing poultry farmers aged 18 years and above who used antimicrobials in their operations. Farmers not using antimicrobials were excluded. Data were collected using a pre-tested, structured, interviewer-administered questionnaire and analyzed with SPSS version 27. Descriptive statistics, chi-square tests, and inferential analyses were used to examine relationships between variables. ResultsThe majority of respondents (89.6%) had heard of AMR, the majority 239 (92.3%) of the respondents heard it from veterinary doctors. The majority (77.2%) also demonstrated good knowledge. Most farmers (89.6%) used antibiotics, with 52.9% using them occasionally. Personal experience (57.8%) was the primary basis for antibiotic selection. About 71.6% implemented biosecurity measures, and 57.8% had received training on AMR. Significant associations were found between knowledge and practice (p<0.001) and between attitude and practice (p<0.001). ConclusionDespite high awareness, antibiotic misuse persists, driven by factors such as reliance on personal experience and limited veterinary consultation. There is a need for enhanced farmer education, stricter regulatory enforcement, and the implementation of targeted antimicrobial stewardship programs to mitigate AMR risks in poultry farming.

Purpose: The GIG-OSH cohort was established to investigate the impact of digital platform work on occupational safety and health (OSH), working and employment conditions, and health in seven countries in Europe. Participants: The cohort comprises 3,945 digital platform workers from seven European countries. The sample includes both web-based workers (e.g., micro-tasking, freelance design) and on-location workers (e.g., delivery, transport). Participants were recruited using non-probabilistic sampling strategies tailored to national contexts, including social media advertising, recruitment through micro-task platforms, and on-site field outreach. Multidimensional data have been collected through online surveys (implemented via REDCap) covering sociodemographic characteristics, working and employment conditions, psychosocial risks, algorithmic management, and physical and mental health indicators. Findings to date: Participants had a mean age of 32.6 years at baseline (SD 10.4), and the majority are male (58.8%), with a higher concentration of migrants in on-location tasks (62.2%) compared to web-based tasks (48.8%). Regarding educational attainment, 55.4% of the total cohort holds a tertiary degree, reaching 64.4% among web-based workers. Platform work intensity varies significantly: on-location workers averaged 85.4 hours of work in the last month, while web-based workers averaged 47.0 hours. Mean income from platform work as a percentage of the national median was 20.6% (SD 22.2). The mean WHO-5 Well-Being Index score was 58.7 (SD 20.3), which is notably lower than the European general population average (69.4), indicating poorer mental health outcomes among cohort members. Future plans: The GIG-OSH cohort represents the first large-scale, longitudinal study examining occupational safety and health among digital platform workers across multiple European countries. Future waves will prioritize developing precise tools to measure hourly earnings and unpaid waiting time. Future research should aim to include underrepresented subgroups, such as medical and domestic care workers, and explore potential linkage with administrative records to evaluate long-term health trajectories and the impact of new EU labour regulations.

BackgroundProlonged wakefulness, restricted sleep, and circadian factors can impact driving performance and road safety. Currently, there are no effective objective roadside tests to detect the state of drivers sleepiness during or prior to driving, or predict future driving impairment risk. This paper reports on an extended wakefulness protocol used to determine if a portable virtual reality device to administer vestibular-ocular motor function (VOM) tests can effectively detect 1) drivers state of sleepiness during or just prior to driving, and 2) predict trait sleepiness and future driving risk. MethodsFifty healthy adults with regular sleep within 9pm to 8am were recruited for an experimental laboratory procedure which involved two phases: an initial overnight sleep study, and a subsequent period of extended wakefulness lasting ~29 hours. During the wakefulness phase, participants undertook neurobehavioural testing, a simulated driving test, and repeat assessments of VOM to establish if ocular markers can predict sleepiness state and sleepiness-related performance impairments (Trial registry ACTRN12621001610820). DiscussionThis protocol outlined a study that aimed to establish the sensitivity of VOM test the effects of extended wakefulness and circadian phase on driver state and trait sleepiness and subsequent sleepiness-related driving impairment. Furthermore, the protocol aims to define the best VOM predictors to identify driver sleepiness state (road side testing and pre-drive assessments) and sleepiness trait (predicting future driving risk) to establish proof of concept for its potential application as a roadside, pre-drive and general sleepiness related fitness to drive test.

BackgroundLung cancer compensation systems for occupational exposure to asbestos commonly apply Helsinki criteria, which assume 4% excess lung cancer risk per fibre-year of asbestos exposure. The Probability of Causation (PoC) is [&ge;]50% at 25 fibre-years (risk doubling threshold). Large case-control studies have suggested steeper exposure-response relations at lower exposures. We aimed to estimate PoC of asbestos-related lung cancer to evaluate exposure thresholds for compensation of lung cancer cases occupationally exposed to asbestos. MethodsRelative risk of asbestos-related lung cancer was estimated using two approaches: O_LIA meta-regression of 22 occupational studies forming the core evidence on cumulative asbestos exposure and lung cancer since the 1980s (130,341 participants). C_LIO_LIA meta-analysis of the recently conducted SYNERGY pooled case-control study (14 studies, 37,866 participants), adjusted for age, sex, smoking, and study. C_LI The likelihood that lung cancer was caused by asbestos was estimated as the PoC with 95% prediction intervals (95%PI). ResultsOccupational cohort studies produced a shallow exposure-response relation with substantial heterogeneity (I{superscript 2} = 92.7%). SYNERGY showed a steeper relation with 6.8% (95%PI: 0%-17.7%) lung cancer risk increase per fibre-year and lower heterogeneity (I{superscript 2} = 63.4%). PoC [&ge;]50% occurred at 62.93 (point estimate) and 18.2 fibre-years (upper 95%PI) for occupational asbestos studies, compared to 10.5 and 4.3, respectively, in SYNERGY. ConclusionsThe SYNERGY pooled case-control study provided exposure-response estimates that are more representative of current exposure to lower mixed asbestos fibres in the Netherlands, supporting lower exposure thresholds than the existing Helsinki criteria when estimating PoC in compensation contexts.

BackgroundDengue outbreaks have become a severe threat to Bangladesh as the infections and mortality numbers are skyrocketing in recent years. Favorable environmental and anthropogenic conditions have established the capital of Bangladesh, Dhaka city as the epicenter of dengue outbreak. Studies have showed that climate change induced extreme weather events are exacerbating Aedes mosquito breeding and dengue virus transmission conditions. Methodology/Principal FindingsIn this study, short-term (0-6 weeks) associations of maximum temperature and heatwave days on dengue cases in Dhaka city were examined through Distributed Lag Non-linear Model (DLNM) methodology for weekly measurement of 2016-2024, taking into account relative humidity, cumulative rainfall, seasonality and hospital closure effect. Two separate negative binomial models were constructed. The maximum temperature model rendered an overall inverted U-shaped association, where the maximum temperature range of 31.5-33.2{degrees}C showed a sustained elevated dengue risk, with highest risk estimate at 33.2{degrees}C [relative risk (RR): 1.186, 95% CI: 1.002, 1.403]. Whereas, results of weekly heatwave days showed an overall protective effect (RR<1) for dengue cases. The lowest risk of infection was found at 3 heatwave days per week, with RR 0.275 (95% CI: 0.178, 0.423). Multiple sensitivity analyses were conducted for both models to evaluate their robustness. Lastly, the optimized models were analyzed under three distinct sub-periods, to capture the association of exposure variables with predominant circulating serotypes. Conclusions/SignificanceThe findings of the study aim to support public health policymakers and healthcare authorities in designing and implementing effective vector control interventions under emerging climatic emergencies. Author SummaryDengue disease is one of the most buringing issue in Bangladesh in recent years. This vector-borne disease is inherently influenced by climatic variables, i.e., temperature, rainfall, humidity, etc. Moreover, these relations are complex and non-linearly associated. Due to shift in climatic conditions, the occurance of extreme weather events are becoming frequent, with increased magnitude and longer duration. In this study, the nonlinear and delayed association of dengue infections due to the exposure of extreme temperature events were assessed in climate-change vulnerable Dhaka city. To do this, a statistical method was used, called distributed lag nonlinear methodology (DLNM). The results showed that dengue infections had an inverted U-shaped (parabolic) relationship with maximum temperature, while compared to mean maximum temperature, and a suppressive association with heatwaves relative to days without heatwaves. The findings aim to work as an early warning system, and support to policymakes and healthcare authorities to tackle the dengue surge in the changing climate.

BackgroundOutdoor workers are particularly vulnerable to the adverse impacts of heat, but many studies focus on heat exposure in residential settings only. This leads to a limited understanding of the full mortality burden due to occupational heat exposures. Here, we aimed to improve estimates of the total, short-term mortality burden attributable to outdoor occupational heat exposure in the United States (US). MethodsWe developed a panel data set for 3,108 US counties during 2010-2019 by linking all-cause mortality among the working age population, derived from CDC WONDER, with the prevalence of workers exposed to outdoor occupational heat, which integrates data on wet bulb globe temperature, workplace activities, and employment counts. We developed a quasi-Poisson regression model adjusted for ambient temperature, total precipitation, and county and state-year fixed effects to estimate short-term excess deaths attributable to outdoor occupational heat exposure. FindingsNationwide, approximately 3.8% (95% CI: 2.5-5.8%) of all workers were annually exposed to dangerous wet-bulb globe temperatures. This outdoor occupational heat exposure resulted in approximately 9,800 (3,100-17,000) annual excess deaths in the working age population. An estimated 62% of excess deaths occurred in the most socially vulnerable counties despite accounting for 25% of workers. InterpretationThe mortality burden of occupational heat exposure is likely far larger than 39 officially reported annual deaths that the Bureau of Labor Statistics reports for this time period. The workplace should be an explicit focus of heat policies, advocacy, and adaptation measures. FundingUS Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health.

BackgroundBone fractures represent a growing public health concern worldwide, yet national epidemiological assessments remain limited in Brazil. Understanding temporal trends, demographic disparities, and geographic heterogeneity is essential to guide prevention, resource allocation, and trauma-care planning. ObjectiveTo characterize the epidemiological profile of bone-fracture-related hospitalizations and mortality in Brazil between 2015 and 2024, analyzing trends by sex, age, fracture type, and geographic and ethnic distribution. MethodsAn epidemiological, observational, descriptive, and population-based ecological study was conducted using SIH/SUS and IBGE data. Hospitalization rates, case fatality rates (CFR), relative risks, odds ratios, and Years of Life Lost (YLL) were calculated. Temporal trends were evaluated using Annual Percent Change (APC). ResultsOther limb fractures were the most frequent injuries, while femur fractures showed the highest lethality. Men had nearly twice the hospitalization rate of women, driven by high-energy trauma in adults aged 20-59 years, whereas women experienced a sharp increase in femur-fracture admissions at older ages. Skull, facial, and thorax/pelvis fractures contributed disproportionately to premature mortality. Marked geographic and ethnic disparities were observed, with higher burdens in the North/Northeast and predominance among Brown and Indigenous populations. ConclusionFracture-related hospitalizations in Brazil have increased consistently, with distinct epidemiological patterns across demographic and regional groups. These findings highlight the need for targeted prevention and improved trauma-care strategies. Key MessagesO_LIThis study investigated national temporal trends and demographic, geographic, and ethnic disparities in bone-fracture-related hospitalizations and mortality in Brazil from 2015 to 2024. C_LIO_LIWe found a sustained increase in fracture-related hospitalizations, with femur fractures showing the greatest lethality and fractures of other limb bones accounting for the highest volume, and marked disparities by sex, age, region, and ethnicity. C_LIO_LIThese findings are important because they provide the first comprehensive national overview of fracture burden in Brazil and offer evidence to inform targeted prevention policies, equitable resource allocation, and trauma-care planning. C_LI

BackgroundThe COVID-19 pandemic required South African public sector HIV viral load (VL) laboratories to scale up Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) testing while maintaining essential HIV services. This placed additional pressure on diagnostic services. This dual mandate introduced significant occupational and environmental challenges (OEC) for staff that remain underexplored. ObjectiveThis study aimed to investigate the OEC and effects that staff experienced during the implementation of COVID-19 testing at public sector VL laboratories in South Africa. MethodsA quantitative, cross-sectional study utilised a census approach among technical and support staff. Data were collected via a structured REDCap questionnaire using 5-point Likert scales. Pre- and post-implementation challenges were assessed across four domains: workload, environmental conditions (space, ventilation, waste), communication, and PPE availability. Statistical analyses included the Wilcoxon Signed-Rank and Spearmans correlation tests. ResultsPerceived occupational challenges increased significantly across all domains post-implementation. Staff workload saw the highest rise (mean score 3.02 to 3.53). Adverse health effects were pervasive; 80.2% of staff reported burnout/fatigue, and 76.5% reported increased anxiety/stress. A strong positive correlation was observed between post-COVID-19 challenges and adverse mental and physical health outcomes (rho = 0.449, p < 0.001). Furthermore, 35.8% of staff considered resigning due to increased job demands. ConclusionIntegrating COVID-19 testing exacerbated systemic weaknesses, causing measurable psychological injury and threatening workforce retention. Findings suggest that the diagnostic workforce requires formal crisis surge staffing models and institutionalised mental health support to safeguard personnel and maintain essential services during future health emergencies.

ObjectiveTo examine the association between lumbo-pelvic angles (LPAs) and Magnetic Resonance Imaging (MRI) detected discopathy in adults with low back pain (LBP) in the Gaza Strip and to establish local reference values for LPA measurements. MethodologyProspective cross-sectional study, 200 adults with LBP referred for lumbosacral MRI at two major hospitals in Gaza Strip. 1.5T MRI scanners were used, and Lumbar lordosis angle (LLA), sacral kyphosis angle (SKA) and sacral table angle (STA) were measured on mid-sagittal T2 images. Discopathy characteristics were recorded, and disability was assessed using the Oswestry Disability Index. ResultOf the 200 participants (mean age 45.7{+/-}13.6 years; 52.5% male), discopathy was most common at L4/L5 (89.5%), L5/S1 (67%) and L3/L4 (40.5%). LPAs were not significantly associated with discopathy involvement, type or severity, except for SKA discopathy severity at L3/4 (p=0.044). LPA measures were consistent across age groups, though LLA and STA were lower in males (p<0.001 and p=0.008), and obese individuals had higher LLA than those of normal weight (p=0.004). Reference LPA values were established stratified by LBP duration, in acute, subacute and chronic LBP, indicating a negative correlation between LLA and SKA in moderate and chronic duration. ConclusionIn adults with LBP in Gaza Strip, MRI-derived LPA showed limited association with lumbar discopathy characteristics, pain duration or disability. Although small differences related to gender, BMI and a single disc level were observed, overall associations were weak. The study establishes population-specific reference values for LPAs, which should be interpreted cautiously within a broader clinical context.

Hospital-acquired infections are a known and growing problem worldwide. Far-UVC is a novel disinfection method that inactivates bacteria with limited penetration into human skin or eyes. A clustered, unmatched, randomized control trial (RCT) will be implemented in two Bolivian hospitals. The intervention arm will receive functioning Far-UVC lamps, whereas the control arm will receive identical lamps that do not emit UV light (shams). Based on baseline data, 40 lamp fixtures will be installed above hospital sinks, 10 per arm per hospital. Environmental samples (air and surface swabs) will be collected and analyzed via culture and sequencing. Simultaneously, air chemical monitoring data will be collected.

BackgroundSmoking is a major preventable risk factor for all-cause mortality and disability worldwide. It leads to age-related diseases, but the effects and reversibility of smoking behaviors on different epigenetic clocks are not fully explored. ObjectiveTo characterize the association of epigenetic age acceleration in whole blood with active and secondhand smoking (SHS), smoking intensity, and time since cessation among U.S. adults. MethodsThis is a cross-sectional study in adults from the NHANES 1999-2002 survey cycles, a population-based survey representative of the U.S. adult civilian non-institutionalized population. We analyzed 2,320 adults aged [&ge;]50 years, including non-Hispanic White, non-Hispanic Black, Mexican American, and other populations. Those without available self-reported smoking status data were excluded. Smoking exposure was analyzed in terms of self-reported smoking status (current, former, never), intensity (packs in the last month), years since smoking cessation, and SHS (serum cotinine levels: 0.05-10 ng/ml). Epigenetic age was estimated using 12 DNA methylation age biomarkers. Survey-weighted linear models were used to estimate the association of smoking exposure with epigenetic age acceleration while adjusting for confounders and multiple comparisons. ResultsWe analyzed 1,043 never, 903 former, and 374 current smokers (mean age: 65.1{+/-}9.3 years, female: 49.1%). GrimAge2 was 9.1 years (95% CI: 8.0, 10.2) and 2.8 years (95% CI: 2.3, 3.3) higher in current and former smokers, respectively, than in never smokers. Smokers showed an increased pace of aging, with current smokers aging 0.15 (95% CI: 0.13, 0.17) and former smokers 0.04 (95% CI: 0.03, 0.05) additional years per chronological year, and shorter methylation-predicted telomere length (current: -132{+/-}19 bp; former: -30{+/-}15 bp). Each cigarette pack smoked in the past month was associated with increases of 0.1 years in GrimAge2 and PhenoAge, and 0.01 aged months/year in aging pace. Among former smokers, each year since smoking cessation was associated with a deceleration of -0.14 (GrimAge2) and -0.06 (PhenoAge) years, and -0.03 aged months/year in aging pace. Cotinine analyses supported dose-dependent associations of epigenetic aging with smoking and suggested a 0.8-year increase in GrimAge2 with SHS exposure. ConclusionsSmoking was associated in a dose-dependent manner with accelerated epigenetic aging in former and current smokers. However, epigenetic age acceleration declines with time since smoking cessation among former smokers.

Indigenous, mountain communities residing upstream of Bhumibol Dam, Thailand, rely on vulnerable natural water sources for their water supply, yet remain unaware of the associated health risks. This study assessed the water quality, usage patterns and contamination pathways across six villages upstream of Bhumibol Dam to shed light on the obstacles to sustainable water security . Samples from 38 water sources of drinking and/or non-drinking water, soil, and the edible parts of crops were subjected to analyses of physical, chemical (NO3-N, pH), and qualitative pesticide-related variables, alongside a 6-month assessment of a community water filter system. Principal component analysis identified a "at-risk group" of preferred drinking water sources all exhibiting high NO3-N, highly alkaline pH, and substantial pesticide contamination, which was found to likely be caused by agricultural run-off. This was reinforced by the detection of pesticide residues in all soil samples and, critically, in the below-ground edible parts of crops (taro, lemongrass, arrowroot), confirming dietary exposure in the local communities. Further compounding the risks posed by the unsafe water supply, the community water filter was found to be ineffective throughout the 6-month analysis with there being no significant difference in water quality between before and after filtration. The residents paradoxical preference for high-risk, still water (from sand-filtered puddles) for drinking, rather than water from flowing sources, which they used only for cooking and cleaning. These findings reveal a severe, compounded public health threat of chronic exposure to minerals linked to urolithiasis and agrochemicals, highlighting the urgent need for quantitative risk assessment and the implementation of resilient, decentralized water treatment solutions in these mountain communities.

Millions of outdoor workers cannot avoid wildfire smoke, likely leading to inequalities in exposure and health risk. We characterized work-related exposure to wildfire PM2.5 for 3,108 contiguous US counties during 2006-2019. Despite experiencing less ambient exposure to wildfire PM2.5, counties with higher portions of non-Hispanic Black and Hispanic Americans experienced higher work-related exposure. We also find suggestive evidence that the effect of ambient smoke fine particulate matter (PM2.5) concentrations on all-cause mortality may differ by workplace exposure. These findings suggest that workplace exposures should be considered in wildfire smoke adaptation measures.

Abstract This protocol is reported in accordance with the SPIRIT 2025 guidelines for clinical trial protocols. Introduction: Young children, from birth to age 5 y are particularly vulnerable to indoor air pollutants and respiratory pathogens. Portable air purifiers (or filtration) and upper-room ultraviolet germicidal irradiation (UVGI) are two widely used interventions with the potential to improve indoor air quality (IAQ) and reduce sick-related absences. However, a review of the literature revealed no real-world randomized studies evaluating their effectiveness in reducing young children's sick-related absences in early care and education (ECE) classrooms. Methods and Analysis: The OK-AIR study is a longitudinal, cluster-randomized 2x2 factorial trial conducted in Head Start centers using two implementation cohorts: Cohort 1 (five Head Start centers and 20 classrooms from 2023 to 2024) and Cohort 2 (11 centers and 59 classrooms from 2025 to 2026), with expanded inclusion of rural areas. Cohort 1 enrolled 204 children, 48 teachers and 5 site directors, and Cohort 2 enrolled 462 children, 97 teachers and 11 site directors. Within each center, four classrooms are randomized to: (1) control; (2) portable filtration; (3) upper-room ultraviolet germicidal irradiation (UVGI); or (4) both interventions. Cohort 2 was initially planned as a second factorial trial but was amended to a purifier-only design due to funding changes; details are provided in the protocol amendments section. We collect continuous IAQ data, including particulate matter (PM) with aerodynamic diameters [&le;]1 m (PM1), [&le;]2.5 m (PM2.5), [&le;]4 m (PM4), and [&le;]10 m (PM10); total volatile organic compounds (TVOCs) index; nitrogen oxides (NOx) index; carbon monoxide (CO), noise; temperature; and relative humidity, alongside daily child absences. Seasonal environmental surface swabs (dining tables and toilet flooring) are tested by Reverse-Transcriptase quantitative Polymerase Chain Reaction (RT-qPCR) for Influenza A/B, Respiratory Syncytial Virus (RSV), Human Parainfluenza Virus Type 3 (HPIV3), Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), and Norovirus. IAQ monitoring is structured across Winter, Spring, Summer, and Fall, including designated baseline/off-period weeks to characterize temporal and seasonal variability in environmental measures across classrooms and centers. Multi-informant surveys (Director, Teacher, Parent) capture contextual factors, and children's social-emotional development is assessed using teacher ratings on the Devereux Early Childhood Assessment (DECA). The primary outcome is the sick-related absence rate, analyzed as cumulative absences over the attendance year while accounting for clustering by school and classroom using generalized mixed-effects models. Secondary outcomes include children's social-emotional ratings, IAQ metrics and pathogen detection rates; analyses of IAQ incorporate time/seasonal structure, and season-stratified absenteeism analyses will be treated as secondary/exploratory refinements. An economic evaluation will estimate incremental intervention costs and cost-effectiveness/cost-benefit (such as cost per sick-related absence day averted). Ethics and Dissemination: This study was approved by the Institutional Review Board (IRB) at the University of Oklahoma. Findings will be shared through peer-reviewed publications; presentations at local, state, and national conferences; research briefs developed for lay and policy audiences; and community briefings prioritizing the participating early childhood programs and communities. ISRCTN Trial Registration: ISRCTN78764448 Disclaimer: The views expressed are those of the authors and do not reflect the official views of the Uniformed Services University or the United States Department of War. Strengths and Limitations of This Study: {middle dot} Real-world longitudinal cluster RCT: The study uses a rigorous longitudinal cluster-randomized 2x2 factorial design in real-world ECE settings. {middle dot} Combined interventions: Interventions target both air filtration and disinfection, allowing for combined and comparative evaluation. {middle dot} Objective air quality monitoring: Continuous monitoring of IAQ metrics provides objective and reliable data on environmental change. {middle dot} Environmental pathogen surveillance: qPCR on surface swabs yields an objective biological outcome to triangulate with IAQ and absences. {middle dot} Comprehensive context and child measures: Multi-method and multi-reporter data collection includes Head Start attendance records, continuous air monitoring, pathogen detection, contextual surveys completed by center directors, teachers, and parents, and standardized social-emotional assessments (DECA) completed by classroom teachers. Head Start program records providing children's longer-term health data available through Health Insurance Portability and Accountability Act (HIPAA) authorization. {middle dot} Clustered/temporal complexity: Seasonal design accounts for variation over time but may introduce complexity in modeling temporal effects. {middle dot} Practical Implications: Study findings will have practical implications for Head Start and other ECE programs striving to maximize child attendance with cost effective strategies. Keywords: Early childhood; Head Start; indoor air quality (IAQ); air purifiers; filtration; ultraviolet germicidal irradiation; cluster randomized trial; absenteeism; environmental pathogens; DECA; cost-benefit analysis