Green Health doi: 10.3390/greenhealth2020010

Authors: Yuchen Zhang Chenyang Hou Hanliang Xu Zhanhui Qiu Ruiqing Yuan Wei Shao Xiangsheng Xue Jiujing Lin Jia Li Haoran Zhang Qingzhi Hou

Background: Metal elements have been reported to be associated with Alzheimer’s disease (AD). The available epidemiological evidence for these associations is often inconsistent and prone to confounding and reverse causation. We aimed to explore the causal effects of varying metal element levels on AD and investigate potential underlying mechanisms. Methods: To investigate the causal link between multiple metals and AD risk, we employed a bidirectional two-sample Mendelian randomization (TSMR) approach and used single nucleotide polymorphisms (SNPs) as instrumental variables. And the participants were extracted from large GWAS databases in the European Cohort. Our analysis primarily utilized methods including inverse variance weighted (IVW), weighted median, and MR-Egger, and used sensitivity analyses to assess pleiotropy and heterogeneity. To verify the mechanism, we further used the metal element-related genes and disease-related genes to construct a protein–protein interaction (PPI) network. Results: The IVW method results from Mendelian randomization (MR) analysis showed that blood zinc was negatively associated with AD risk (OR = 0.96, 95%CI: 0.93–0.99, p = 0.016) in the forward MR analysis, whereas AD was negatively associated with serum transferrin levels (OR = 0.89, 95%CI: 0.81–0.98, p = 0.015) in the reverse MR analysis in Europeans, which was adjusted for BMI, smoking, education, and coffee intake. However, no causal links were found between blood Cu, Mg, Se, and other iron states in serum and AD risk in Europeans. The PPI network suggested that SLC39A1 played a key role in the zinc–AD relationship, and transferrin might interact with ALB, LTF, HFE, TFRC, TF, and SLC40A1 in the context of AD. Conclusions: Our TSMR study suggested that in European populations, higher blood zinc levels might exert a protective effect against AD, whereas pathology of might lead to decreased serum transferrin levels. These findings provided evidence for metal dysregulation in AD, though further validation through randomized controlled trials is required.

Green Health doi: 10.3390/greenhealth2020009

Authors: Umberto Cornelli Claudio Casella Giovanni Belcaro Maria Rosaria Cesarone Simonetta Marucci Mariangela Rondanelli Martino Recchia Giuseppe Zanoni

The increasing detection of micro-nanoplastics (MNPs) in environmental settings and in human biological samples has raised growing concern about their potential implications for human health. Exposure to plastic particles may cause oxidative stress, inflammation, and metabolic reactions, according to previous studies. It is unidentified, consequently, to what extent these basic processes result in identifiable clinical illness patterns. This narrative review investigated whether a structured symptom-mapping approach might be used to identify recurrent multisystem symptom patterns that might be consistent with environmental exposure. The Chicago Cluster System (CCS) is a conceptual framework that includes four environmental exposure indicators in addition to 26 clinical signs and symptoms. The CCS framework was used for filtering clinical descriptions of 375 disorders in 21 disease groups using conventional medical references. Using exploratory thresholds of at least eight compatible symptoms, the aim of this study was to identify scenarios exhibiting convergence with the CCS symptom pattern. Forty disorders (11%) exhibited eight or more CCS-compatible symptoms out of the 375 diseases that were evaluated. Neurodegenerative, metabolic, inflammatory, and gastrointestinal illnesses were among the various clinical categories in which these symptoms emerged. Fatigue (65%), upper gastrointestinal problems (58%), and increased inflammatory markers (55%) were the most commonly reported symptoms. These results imply that certain types of chronic disorders may exhibit recurrent multisystem symptom patterns. The observed overlap should be regarded cautiously because many CCS signs are non-specific and widely spread across medical conditions. The CCS framework may organize multisystem symptom patterns in environmental health research.

Green Health doi: 10.3390/greenhealth2020008

Authors: Luis Soriano Karla Alarcón

Corporate Social Responsibility (CSR) has evolved into a strategic corporate function; however, most reviews continue to frame it primarily through competitiveness and core-business alignment, offering limited analytical differentiation regarding its integration with environmental governance and public health. This study provides a conceptual synthesis of CSR evolution between 2015 and 2024, emphasizing environmental–health integration and emerging hybrid models, particularly in Latin America. A Narrative Systematic Review following PRISMA guidelines was conducted across Scopus, Web of Science, and Google Scholar, resulting in the analysis of 96 publications. Findings are structured into three ideal-typical configurations: Instrumental Competitive CSR, Adaptive Hybrid CSR, and Transformative Health-Centric CSR. The study proposes a complementary environmental health prevention framework in which companies, stakeholders, and governance actors interact to address structural determinants of health. By conceptualizing CSR as a preventive co-governance mechanism rather than a solely competitive strategy, this study advances a more theoretically grounded understanding of corporate responsibility in sustainable and healthy communities.

Green Health doi: 10.3390/greenhealth2010007

Authors: Maria-Zozefin Nikolopoulou Maria Avgoulea Evgenia Papathanassiou Maria Theodorakopoulou

Climate change poses a growing threat to global health, yet healthcare systems contribute substantially to environmental harm through energy use, waste, and greenhouse gas (GHG) emissions. Among hospital departments, Intensive Care Units (ICUs) are among the most resource- and energy-intensive, generating disproportionately high greenhouse gas (GHG) emissions. The aim of this systematic review is to synthesize the literature on the environmental footprint of ICUs and to develop evidence-based strategies for creating sustainable ‘Green ICUs’ in accordance with the PRISMA 2020 guidelines. Peer-reviewed studies published between 2012 and October 2025 were identified through searches of major biomedical databases. Eligible studies examined the impacts of climate change on human health and infectious diseases, the ecological footprint of medical imaging and personal protective equipment, and sustainability interventions relevant to adult intensive care units. The environmental footprint of ICUs ranges from 88 to 178 kg CO2-equivalents per patient per day. High electricity consumption, especially from heating, ventilation, and air-conditioning (HVAC) systems, along with single-use medical supplies and diagnostic imaging, drives this impact. Life-cycle assessments consistently demonstrate that reusable textiles, optimized energy systems, and rationalized diagnostic practices significantly reduce emissions and waste. Educational and behavioral interventions were effective in reducing unnecessary consumable use while maintaining patient safety. A “Green ICU” model integrating energy efficiency, sustainable procurement, waste reduction, and staff education can substantially reduce environmental harm without compromising quality of care.

Green Health doi: 10.3390/greenhealth2010006

Authors: Daniela Gallon Corrêa Harrison Lourenço Corrêa

The last few years have been marked by intense debates about the environmental agenda. Forums all over the world are discussing effective actions that can mitigate the effects of human actions on the environment. What was once destined for the imposed policy of developed countries upon emerging ones is now a global policy. Countries, nations, and the corporate world need to adopt urgent measures to make their activities less impactful before the feared tipping point is reached. In this context, hospitals (public and private) take on a fundamental role. As major consumers of water, generators of waste, and sources of high greenhouse gas emissions, hospital ecosystems must re-evaluate their processes to ensure the efficient use of water and energy resources. Although still a recent action, the Green Health concept has been disseminated globally, contributing to the achievement of the Sustainable Development Goals. The present study analyzes the current landscape of Green Health within the Brazilian context, based on a review of scholarly literature. To this end, consultations were made to publications deposited in the period from 2003 to 2025, whose information was processed and used to generate similarity visualization maps. This exploratory study sought to provide a proof of concept by defining a baseline to assess how the term ‘Green Health’ is being appropriated by researchers in Brazil. The results indicate that even though there are some actions in Brazil directed toward Green Health practices, they are modest and lack greater integration, especially regarding research on the topic.

Green Health doi: 10.3390/greenhealth2010005

Authors: Dashan Zheng Wanqi Wen Wenxuan Zhao Jianheng Chen Haijian Zhou Lin Tan Hualiang Lin Bo Pang Biao Kan

Cholera outbreaks are prevalent in coastal regions, where hydroclimatic factors play a critical role. However, evidence on their associations with different genotypes remains limited, and global projection remains lacking. We compiled cholera data from EnteroBase and WHO weekly reports covering 110 coastal countries from 1980 to 2022. A generalized additive model was used to examine the associations between hydroclimatic factors and different cholera serotypes and genotypes. We further projected future cholera occurrences for each coastal country under three climate change scenarios from 2025 to 2100. During the study period, Wave 3 of O1 replaced Wave 1 as the predominant genotype of cholera, while cholera O139 remained at low levels and only occurred in Asia. At the country–year level, each 1 °C increase in sea surface temperature (SST) was significantly associated with cholera occurrence (OR: 1.032, 95% CI: 1.023 to 1.040) and Wave 3 of O1 (OR: 1.149, 95% CI: 1.097 to 1.203). Drainage density (m/km2) and coastline ratio (%) were positively related to cholera, with ORs of 1.067 (95% CI: 1.046 to 1.087) and 1.022 (95% CI: 1.019 to 1.027). For future projections, five trend patterns were identified under different emission scenarios, with most countries showing increased cholera risk due to global hydroclimatic changes, peaking under the SSP585 scenario. Our findings reveal associations between hydroclimatic factors and different cholera genotypes and project future cholera risk across coastal countries, thereby providing evidence to inform genotype-specific surveillance and targeted prevention strategies at the global scale.

Green Health doi: 10.3390/greenhealth2010004

Authors: Claudio Casella Umberto Cornelli

Pancreatic cancer (PC) is among the deadliest cancers worldwide, with rising incidence and mortality. In Italy, marked regional differences in PC mortality suggest that diet may play a significant role. Data from 56 food categories across 20 regions were analyzed for PC standardized mortality ratios (PC-SMRs) from 2003 to 2022. The results showed significantly higher PC mortality in northern Italy compared to the South. Spearman correlations identified specific dietary drivers: “positively correlated” foods more prevalent in the North, such as beef, processed meat, yogurt, and non-alcoholic beverages, were associated with higher PC-SMRs; conversely, “negatively correlated” foods, including veal, lamb, flour, legumes, tomatoes, were consumed more in southern regions with lower mortality. Regional disparities in antioxidant micronutrients like selenium and carcinogenic factors like alcohol also aligned with mortality gradients. In conclusion, regional food consumption patterns significantly correlate with PC mortality in Italy. The higher adherence to Mediterranean-style dietary components in the South appears to provide a protective effect, whereas Westernized patterns in the North are associated with increased risk. This study aimed to investigate the association between regional food consumption patterns and PC mortality across Italy, using PC-SMR and household food expenditure data.

Green Health doi: 10.3390/greenhealth2010003

Authors: Indra Sarkar Subhankar Kumar Sarkar

Dengue is the most concerning mosquito-borne neglected tropical disease globally. The disease is caused by the dengue virus (DENV) and transmitted by the vector mosquito species belonging to the genus Aedes Meigen, 1818, particularly Aedes aegypti (Linnaeus, 1762) and Aedes albopictus (Skuse, 1895). In 2024, global cases of dengue exceeded 7.6 million, with India reporting 233,519 cases. These statistics underscore the ongoing challenge of managing dengue outbreaks worldwide. For generations, tribal communities across India have employed medicinal plant-based extracts as mosquito and other insect repellents. Plant-based phytochemicals are largely preferred over synthetic insecticides due to their perceived safety, non-toxicity to non-target organisms, and environmental sustainability. This review provides a comprehensive overview of various phytochemicals extracted from Indian medicinal plants for their larvicidal activity against Aedes mosquitoes. Furthermore, the article also reviews the mode of action of these phytochemicals, including neurotoxicity, mitochondrial dysfunction, sterol carrier protein-2 inhibition, midgut cytotoxicity, insect growth regulation disruption, and antifeedant activity, which aids in formulating dengue vector control strategies. Based on this review, Ecbolin B from Ecbolium viride, Alizarin from Rubia cordifolia, and Azadirachtin from Azadirachta indica exhibited better larval mortality rates against Ae. aegypti, with LC50 values recorded at 0.70, 1.31, and 1.7 ppm, respectively.

Green Health doi: 10.3390/greenhealth2010002

Authors: Talya Scott Paul Corsi Augusta A. Williams

Background: Healthcare is a large contributor to greenhouse gas (GHG) emissions, contributing to climate change and health impairments. However, the magnitude of health and climate benefits of local and regional GHG mitigation strategies has not been well quantified. Few studies have demonstrated the use of public tools for this purpose in healthcare facilities. Methods: We evaluated several renewable energy and energy efficiency scenarios focused on one academic medical center in New York State. We used the Environmental Protection Agency’s (EPA) publicly available AVoided Emissions and geneRation Tool to estimate avoided GHG and health-harmful air pollutant emissions. The economic value of the resulting avoided health and climate damages was quantified using EPA’s CO-Benefits Risk Assessment screening tool. Results: Transitioning one healthcare institution to 100% solar energy and improving energy efficiency by 25% could yield approximately $807,000 to $1.5 million in annual health savings, with an additional $2.3 million benefits in avoided climate damages. There is an approximate $108.5–$196.6 million in annual climate and health benefits when extrapolating these energy solutions to hospitals across the same state. Conclusions: There are significant health savings from healthcare GHG mitigation strategies. This application of publicly available and accessible tools demonstrates ways to integrate climate and health benefits into local decision-making around climate change mitigation and sustainability efforts.

Green Health doi: 10.3390/greenhealth2010001

Authors: Héctor A. Castro-Bastidas Marcos Bucio-Pacheco David R. Aguillón-Gutiérrez

Amphibians, as sensitive bioindicators, reflect environmental health issues that also impact human communities through shared pathways, including contaminated water and agricultural products. This perspective addresses the need to standardize the reporting of anomalies (defined as significant phenotypic deviations from typical morphology, structure, or coloration) in amphibians in Mexico, where inconsistent terminology and incomplete data limit their utility for environmental monitoring. We propose a framework that includes a classification of anomalies (structural and chromatic) and a field-based physical examination protocol to systematically document these cases. The approach integrates detailed guidelines to ensure comprehensive reporting and data comparability, addressing geographic and taxonomic biases. Recent findings highlight that over 50% of anomaly reports in Mexico are incidental, with predominant cases in Ambystomatidae, Hylidae, and Ranidae, and linked to anthropogenic pressures such as agrochemicals. The framework promotes interdisciplinary collaboration, citizen science, and emerging technologies like artificial intelligence for sustainable monitoring. By standardizing the detection and reporting of anomalies, this proposal strengthens the role of amphibians as sentinels of ecosystem health, with applications in Mexico and other regions facing high environmental degradation.

Green Health doi: 10.3390/greenhealth1030025

Authors: Dorji Wangzom

Background: Although there is a considerable body of research evidence on active school travel (AST), the number of children walking to school has decreased over the years in Australia, as well as around the world. Different factors influence AST; the most cited in Melbourne is traffic safety perception. Traffic safety perception is influenced by built environment elements, and improving the built environment can enhance parental perception of traffic safety. Studies have shown that lateral separation from traffic and the provision of a buffer improve the perception of traffic safety, and this has to be explored for children walking to school based on the existing ground situation on a typical street near a school in Melbourne. Based on this background, a pilot study was carried out before the main study to test the reliability and validity of the survey questionnaire. Methods: The survey instrument was developed based on perceptions and/or AST studies, and included safety and probability aspects of the perception construct to elicit responses on perception. The perception of traffic safety was to be rated based on the streetscape videos embedded in the survey. The reliability was tested using Cronbach’s alpha and validity was explored through exploratory factor analysis. The study also checked the feasibility of the recruitment method and whether there would be an observable outcome from the study. The participants were recruited online through community Facebook groups. Results: The survey instrument had excellent reliability (α = 0.945) and was valid. The recruitment method through a Facebook community group was apt for recruiting participants. The preliminary analysis of the pilot data revealed a difference in perception ratings based on the streetscape element intervention. Conclusions: The survey instrument can be used for similar AST research, as it proved to be reliable and valid.

Green Health doi: 10.3390/greenhealth1030024

Authors: Xiaotian Liu Mei Xie Junpeng Chen Marino Bonaiuto

Despite growing attention to corporate environmental responsibility, there is limited understanding of the psychological and social mechanisms linking corporate environmental responsibility to employees’ coworker-focused pro-environmental behaviors in the workplace, such as advocacy directed at peers. This study examined the influence of corporate environmental responsibility on employees’ coworker pro-environmental advocacy in the Chinese energy sector, with a sample of 1528 employees. Focusing on the mediating roles of long-term orientation, meaningful work, and sense of community, the research integrates insights from Social Exchange Theory, Self-determination Theory, and Affective Events Theory. The data were analyzed using structural equation modeling (SEM) to test the hypothesized relationships. The findings revealed that corporate environmental responsibility positively impacted employees’ advocacy for eco-friendly behaviors among coworkers through forward-thinking attitudes, intrinsic motivation, and strengthened social bonds. The study offers theoretical contributions by unpacking the interplay of individual and organizational factors and provides practical recommendations for cultivating an environmentally conscious culture through value alignment, meaningful work initiatives, and fostering a strong sense of community.

Green Health doi: 10.3390/greenhealth1030023

Authors: Jia-Xiu Xu Lap Ah Tse Ignatius Tak-Sun Yu Shao-Hua Xie

Objectives: We performed this systematic review of epidemiological studies to clarify the association between incense and mosquito-coil burning and the risk of nasopharyngeal carcinoma (NPC). Methods: A search of studies published through October 2024 in the MEDLINE and EMBASE databases was performed, supplemented by searches of reference lists, recent reviews, and Chinese databases. The quality of the included studies was assessed, with special attention paid to exposure assessment. Random-effects meta-analysis estimated the pooled odds ratios (OR) and 95% confidence interval (CI) whenever applicable. Results: One cohort and twelve case–control studies were identified. Meta-analysis of one cohort study and four case–control studies with reasonable quality found an increased risk associated with incense burning during adulthood (pooled OR = 1.46; 95% CI 1.24–1.72). Five case–control studies assessed the association between exposure to incense smoke during childhood and NPC risk, and the pooled OR was 1.22 (95% CI 0.76–1.96) associated with incense burning at birth and was 1.37 (95% CI 1.10–1.71) for exposure at the age of 10 years. The pooled OR for mosquito-coil burning during adulthood was 1.31 (95% CI 0.99–1.74). None of the four previous case–control studies found an increased risk of NPC associated with mosquito-coil burning during childhood. Conclusions: Our findings suggest an increased NPC risk associated with burning incense and mosquito coils. More high-quality epidemiological studies with refined exposure assessments are warranted.

Green Health doi: 10.3390/greenhealth1030022

Authors: Sandro Tiziano Stoffel Andrew Phillips Sophie Restellini Tobias Ehmann Omar Kherad Sophie Buyse

Gastrointestinal (GI) endoscopy is a daily procedure in clinical practice but contributes substantially to healthcare’s environmental footprint. Data on sustainability policies in Switzerland, however, remain scarce. This study aimed to assess the implementation of sustainability practices among members of the Swiss Society of Gastroenterology (SGG-SSG). We conducted a web-based cross-sectional survey between September 2023 and January 2024, targeting all 463 practicing Swiss gastroenterologists listed in the latest SGG-SSG roster. The survey comprised eleven questions covering four domains: respondent demographics; waste and single-use device management and procurement; digitalization; and work–life balance. A total of 161 respondents participated (response rate: 34.8%). Less than half (45.1%) reported waste sorting, while policies for single-use device reduction (23.5%) and waste minimization initiatives (27.8%) were even less common. Nearly half (48.8%) reported including sustainability considerations in procurement policies. In contrast, 52.8% reported having policies to promote work–life balance, and 88.2% reported policies requiring the use of electronic health records, reflecting significant progress in digitalization. While procurement and digitalization efforts are more widely implemented, further coordinated action is needed. Future research should investigate professional attitudes, institutional barriers, and strategies to enhance the adoption of environmentally responsible practices in GI endoscopy. Furthermore, professional societies (particularly SGG-SSG), hospital administrators, and cantonal health authorities must coordinate to establish national standards, integrate sustainability into accreditation, and implement incentives and accountability to reduce the environmental impact of GI endoscopy without compromising quality of care.

Green Health doi: 10.3390/greenhealth1030021

Authors: Marilia Salete Tavares Camila Tavares Rodrigues Sara Lucia Silveira de Menezes Adalgiza Mafra Moreno

Air pollution is one of the major global environmental challenges, particularly in urban and industrial areas, where multiple sources emit pollutants that compromise air quality and threaten human health. This study aims to analyze the effects of air pollution on the health of vulnerable urban populations, emphasizing monitoring techniques for key pollutants and comparing national and international air quality standards through a literature review. It also discusses the implications of these pollutants considering the 2030 Agenda, highlighting environmental education as a strategy for pollution mitigation, public awareness, and strengthening air quality policies. A qualitative and descriptive methodology was adopted, based on national and international research publications between 2005 and 2023, using databases such as PubMed, Scopus, Web of Science, LILACS, and Google Scholar, with descriptors including “Air Pollution,” “Industrialization,” “Public Health,” and “Environmental Education.” The results indicate that industrial and transportation activities are the main sources of air pollution, contributing to an increase in cases of asthma, lung cancer, and cardiovascular diseases, as well as negatively impacting ecosystems and the economy. Even when pollutant levels comply with legal standards, vulnerable populations experience higher morbidity and mortality rates, highlighting the need for more stringent protection policies. Comparisons between the standards of the World Health Organization (WHO), the European Union (EU), the United States Environmental Protection Agency (EPA), and the National Council for the Environment (CONAMA) reveal significant disparities in exposure limits. The WHO and the EU, aligned with Sustainable Development Goals (SDGs) 3 and 13, advocate for stricter limits, while EPA and CONAMA regulations remain less stringent. This gap emphasizes the importance of internationally harmonized, evidence-based, and equitable air quality policies. Combating air pollution requires an integrated approach that combines stricter regulations, continuous monitoring, emissions control strategies, and environmental education. Promoting environmental awareness among children and young people can encourage behavioral changes and civic engagement. Environmental education, along with political and social responsibility, remains a fundamental path to mitigating health impacts and promoting sustainable development, in line with the 2030 Agenda.

Green Health doi: 10.3390/greenhealth1030020

Authors: John H. Hartig Lori Newton Todd Scott Marlaine Koehler John E. Gannon Sam Lovall Tom Woiwode Amy Greene Weston Hillier Eric Antolak

The 2026 opening of the Gordie Howe International Bridge between Windsor, Ontario, Canada and Detroit, Michigan, USA, with its multi-use trail for cyclists and pedestrians, is projected to catalyze cross-border trail tourism and help further revitalize these two border cities. Both Windsor and Detroit have unique, extensive trail systems with compelling destinations. However, cross-border trail tourism institutionalization needs improvement. Tourism, greenway, and destination partners should explore creating a boundary organization to foster and market cross-border trail tourism. Recommendations from a 2024 cross-border trail tourism conference include: develop strategies for community engagement and storytelling to enhance cultural connections between regions; strengthen ties between trail groups and environmental organizations to provide trail experiences that reconnect people with the river and other natural resources; support the region’s efforts to obtain a UNESCO World Heritage Site designation for the Underground Railroad and support the Canadian federal designation of Windsor’s Ojibway National Urban Park; strengthen collaborations between tourism and cycling partners to promote and market cross-border trail tourism; institutionalize greenway assessments (every 5–10 years) to evaluate trail segment completions, gaps, potential route improvements, safety improvements, equity considerations, etc., and to keep greenways in the public consciousness; and measure and broadly communicate the economic impact of cross-border trail tourism resulting from the bridge.

Green Health doi: 10.3390/greenhealth1030019

Authors: João Carlos Ferreira de Melo Júnior Celso Voos Vieira Luciano Lorenzi Therezinha Maria Novais de Oliveira Alessandra Betina Gastaldi Aline Krein Moletta Ana Paula de Mello Ana Paula Marcelino de Aquino Daiane Dalmarco Deivid Rodrigo Corrêa Gustavo Borba de Oliveira Laila Cristina Mady Letiane Steinhorst Magda Carrion Bartz Marcelo Lemos Ineu Nara Texeira Barbosa Natalia Cavichioli Ricardo Larroyed de Oliveira Sarah Caroline Lopes Paula Roberta Perondi Furtado

Mangrove forests provide critical ecosystem services, including carbon sequestration, shoreline protection, and serving as a food resource for coastal communities. However, these ecosystems face increasing environmental risks due to industrial and urban pollution, particularly contamination by heavy metals. This study assessed environmental quality in mangrove areas of Babitonga Bay, southern Brazil, using biomonitoring with the oyster Crassostrea rhizophorae and the mangrove tree Laguncularia racemosa. Sediment analyses revealed significantly elevated concentrations of copper, nickel, aluminum, and iron in Vila da Glória compared to Espinheiros, exceeding Brazilian environmental guidelines for copper and zinc. Biomonitoring results indicated high accumulation of arsenic and zinc in L. racemosa leaves, while oysters from Espinheiros exhibited higher concentrations of multiple heavy metals and smaller anatomical dimensions compared to those from Vila da Glória. Strong negative correlations were found between metal concentrations in oyster tissues and sediments, suggesting complex bioavailability dynamics. The study demonstrates the applicability of C. rhizophorae and L. racemosa as possible bioindicators of metal contamination in mangrove ecosystems. These findings underscore the importance of integrating biomonitoring approaches into coastal environmental health assessments to inform public health policies and conservation strategies aimed at promoting balanced ecosystem and human health.

Green Health doi: 10.3390/greenhealth1030018

Authors: Lore Verheyen Maartje Vangeneugden Rossella Alfano Hanne Sleurs Eleni Renaers Tim S. Nawrot Kenneth Vanbrabant Michelle Plusquin

Background: College students face significant stress from academic demands and high pressures, which can contribute to long-term physical and mental health issues. Existing stress-relief strategies are not always immediately available to this population, highlighting the need for accessible, low-cost solutions. Methods: This randomised controlled trial examined the effects of nature exposure on stress and well-being in a sample of 29 healthy college students compared to a healthy control group (n = 28). The intervention group engaged in 30 min walks in a natural environment four times per week over a four-week period. Stress levels and general well-being were assessed using validated self-report questionnaires administered before and after the intervention period, allowing for a comparison of changes in mental health outcomes between an intervention and control group. Eye-tracking analysis during a battery of cognitive tests assessed cognitive functioning. Findings: The intervention was associated with a greater reduction in psychological distress over time (β = −2.98, p = 0.007) and showed a trend toward reduced burnout symptoms (β = −0.12, p = 0.08) compared to the control group. These associations are independent of sex, age, BMI, smoking status, COVID-19 history, and previous diagnosis of mental illness. An increase in the number of saccades during the visual working memory task was observed in the intervention group compared to controls (β = 5.01, p = 0.046), while saccadic activity in other tasks remained unchanged. No significant effects were found for the neurocognitive performance measures. Conclusions: These findings suggest that short-term nature exposure may support psychological well-being and mental engagement in young adults. Our research highlights the use of walking in nature as a realistic and accessible strategy to promote mental health and neurocognitive functioning among students.

Green Health doi: 10.3390/greenhealth1030017

Authors: Jacinta Fernandes Ana Teresa Bento Gabriela Gonçalves Clarice Campos

The present controlled experimental research addresses the effects of exposure to nature on workers’ well-being and job performance in a work-confined setting. Ten individuals working in an open-space office inside a Portuguese military bunker were exposed to simulated nature (audio sounds and/or video images of nature). Quantitative physiological (heart rate) and self-reported measures (perceived positive and negative emotions, environment restorativeness, and work performance) were taken. Results indicate that exposure to nature during working time in confined places, through simulating a window with a view of nature and/or by introducing sounds of nature, promotes physiological and emotional well-being at work (heart rate significantly decreases, positive emotions significantly increase, and negative emotions decrease), and significantly increases employees’ perception of workplace restorative qualities. The results on work performance were non-significant. The present findings contribute to the evidence of the restorative effects of nature exposure during work. The research bridges a gap by considering workplaces where real nature exposure is not feasible and examining the evidence on the beneficial biophilic interventions (the restorative effects of simulated nature) within confined environments. The strategy to use videos and audio of nature may improve the structural conditions of work, benefiting well-being in these types of work settings.

Green Health doi: 10.3390/greenhealth1030016

Authors: Vincenzo De Luca Mariangela Perillo Carina Dantas Almudena Muñoz-Puche Juan José Ortega-Gras Jesús Sanz-Perpiñán Monica Sousa Mariana Assunção Juliana Louceiro Umut Elmas Lorenzo Mercurio Erminia Attaianese Maddalena Illario

The NewEcoSmart project addresses the need to foster inclusive green and digital transitions in rural habitat sectors by systematically assessing local socio-technical readiness and tailoring capacity-building interventions. We adapted the validated SCIROCCO Exchange Maturity Self-Assessment Tool—selecting eight dimensions relevant to environmental, technological and social innovation—and conducted a two-phase evaluation across three pilot sites in Italy, Portugal and Spain. Phase 1 mapped stakeholder evidence against predefined criteria; Phase 2 engaged local actors (45+ adults, SMEs and micro-firms) in a self-assessment to determine digital, green and entrepreneurial skill gaps. For each domain of the SCIROCCO Tool, local actors can assign a minimum of 0 to a maximum of 5. The final score of the SCIROCCO tool can be a minimum of 0 to a maximum of 40. Quantitative maturity scores revealed heterogeneous profiles (Pacentro and Majella Madre = 5; Yecla = 10; Adelo Area = 23), underscoring diverse ecosystem strengths and limitations. A qualitative analysis, framed by Smart Healthy Age-Friendly Environments (SHAFE) domains, identified emergent training needs that are clustered at three levels: MACRO (community-wide awareness and engagement), MESO (decision-maker capacity for strategic planning and governance) and MICRO (industry-specific practical skills). The adapted SCIROCCO tool effectively proposes the assessment of socio-technical maturity in rural contexts and guides the design of a modular, multi-layered training framework. These findings support the need for scalable deployment of interventions that are targeted to the maturity of the local ecosystems to accelerate innovations through equitable green and digital transformations in complex socio-cultural settings.

Green Health doi: 10.3390/greenhealth1030015

Authors: Suleyman M. Demi Timage Alwan Ahmed

Climate change remains one of the existential threats to humanity in particular and life on earth in general. It presents significant impacts on food and nutritional security, health, and the general well-being of living organisms globally. Despite global efforts to tackle the climate crisis, the record shows that limited progress has been made in curbing the problem. Consequently, this study intends to address the following research question: How does the climate crisis affect indigenous food systems, farmers’ livelihoods, and local communities in the study area? This study was conducted in the Tolon district of the northern region of Ghana from 2017 to 2022. Grounded in the theoretical prism of political ecology and indigenous knowledge perspective, we selected individuals who were smallholder farmers, students, faculty members, extension officers, and an administrator from the Ministry of Food and Agriculture. The data were gathered through in-depth interviews, focus groups, and workshops and analyzed using coding, thematization, and inferences drawn from the literature and authors’ experiences. This study discovered some of the effects of a changing climate, including the extinction of indigenous food crops, poor yield resulting in poverty, and food and nutritional insecurity. This study concludes that failure to tackle climate change could pose a greater threat to the survival of smallholder households in Ghana.

Green Health doi: 10.3390/greenhealth1020014

Authors: Lea Kutscher Eva Notté Kimberley Anderson

In order to meet the Paris Agreement and EU Green Deal, the demand for critical minerals (e.g., cobalt, nickel, lithium, and rare earth elements) is growing exponentially. With their demand arise urgent concerns about the injustices of their supply chain, including concerns about labour exploitation, environmental degradation, and child labour. This literature review examines news media, blogs, governmental and NGO reports, and academic sources to assess the risk of child labour in the extraction of 34 EU-designated critical minerals, 17 of which are considered ‘strategic.’ Using a combined risk reduction and assessment framework, the study identifies high-risk minerals (cobalt, graphite, nickel, aluminium, copper, and rare earth elements) and high-risk countries (the Democratic Republic of the Congo, Mozambique, India, the Philippines, Indonesia, and Myanmar). The findings reveal the broader negative impact on communities of mining, including increased vulnerability to child trafficking and sexual exploitation. Thus, the risk of child labour does not imply its actual occurrence due to the biased undercount of child labour numbers. Recommendations include further research, raising awareness of children’s rights, supporting household livelihoods, and improving traceability in artisanal and small-scale mining to ensure a just transition.

Green Health doi: 10.3390/greenhealth1020013

Authors: Jin Feng Fei Tian Jingyi Zhang Zhenhe Huang Ge Chen Zhengmin (Min) Qian Yuhua Wang Katherine A. Stamatakis Steven W. Howard Guzhengyue Zheng Chongjian Wang Hualiang Lin

Background: Published studies have documented the association between sunshine duration and depression symptoms; however, the evidence regarding the long-term effects and potential mechanisms remains insufficient. This study aimed to examine the association between sunshine duration and incident depression and to explore potential mediating pathways. Methods: A total of 336,805 participants from the UK Biobank were included in the study. Meteorological exposures were estimated using the bilinear interpolation approach and time-weighted method. The association between sunshine duration and incident depression was examined through the time-dependent Cox proportional hazard model and generalized propensity score model. Vitamin D, calcium, immune biomarkers, an aggregated inflammation score (INFLA-score), and sleep pattern were selected as the potential mediators. Causal mediation analysis was employed to elucidate underlying mediating effects. Results: With a median follow-up of 13 years, 13,862 cases of incident depression were identified. Sunshine duration demonstrated a negative association with the incident depression. The effects were stronger among the elderly, alcohol consumers, individuals who spent less time outdoors, and those who were less physically active. Vitamin D, calcium, INFLA, neutrophils, and monocytes emerged as the top five contributors of immune biomarkers to the natural indirect effect. The combined mediating effect of top five biomarkers and sleep pattern accounted for 30% of the total effect of sunshine duration on the incident depression. Conclusion: Our study suggests that longer sunshine duration might mitigate depression through vitamin D-related metabolism, inflammation, and sleep pattern. It may serve as an effective natural antidepressant, particularly for the elderly, alcohol consumers, less outdoor spenders, and those who were less physically active.

Green Health doi: 10.3390/greenhealth1020012

Authors: Suellen Secchi Martinelli Vanessa Mello Rodrigues Suzi Barletto Cavalli Greyce Luci Bernardo Ana Carolina Fernandes Paula Lazzarin Uggioni Yasmin El Kadri Monteiro Jeffery Bray Heather Hartwell Rossana Pacheco da Costa Proença

This study aimed to identify and analyse the main difficulties faced by family farmers in producing and supplying vegetables through short food supply chains. Semi-structured interviews were conducted with seven family farmers in a large city in southern Brazil. We sought to include at least one farmer supplying each of the main identified outlets: schools, restaurants, supermarkets, street markets, and consumer groups. Contacts were obtained through rural producer organisations. Data were recorded, transcribed, and analysed using thematic analysis. Three groups of difficulties emerged: (i) production—including seasonality, pest, and disease management, climate-related losses, and limited technical support; (ii) sales—such as price competition, logistical challenges, and inconsistent demand; and (iii) consumption—particularly low consumer habits regarding vegetable purchase and preparation, and preference for non-seasonal products. The study concludes that the main challenges to strengthening short food supply chains are the limited engagement of young people in farming, lack of specialised technical assistance, climate-related risks, bureaucratic barriers, and the high costs of organic certification. Farmers also reported logistic difficulties and constraints in supplying restaurants due to demand for a narrow range of products disregarding seasonality. At the consumer level, habits shaped by conventional food systems emerged as obstacles. Strategies such as alternative markets, farmer organisations, supportive public policies, and initiatives to promote cooking skills and consumer awareness are key to enhancing resilience and expanding the supply of healthy foods.

Green Health doi: 10.3390/greenhealth1020011

Authors: Yuan Zheng Xinqi Zhong Wan Peng Zhiqing Chen Lv Wang Changshun Xia Yixiang Huang Qijiong Zhu Yuwei Fan Yiyu Lai Qiliang Cui Tao Liu

Twin pregnancies have a higher risk of preterm birth (PTB) than single pregnancies, but studies about prenatal air pollution exposure and PTB in twin pregnancies are still scarce. To explore associations of prenatal fine particulate matter (PM2.5) exposure with PTB in twins, we collected birth data from 21 hospitals across China. Data on PM2.5 and its compositions (NO3−, BC, NH4+, SO42−, and OM) were collected from Tracking Air Pollution. Generalized linear models were used to examine associations of air pollution with PTB. Each IQR increment in PM2.5, NH4+, SO42−, NO3−, BC, and OM during entire pregnancy, the OR (95% CI) were 1.46 (1.34–1.59), 1.54 (1.39–1.70), 1.34 (1.25–1.44), 1.44 (1.30–1.59), 1.28 (1.20–1.37), and 1.28 (1.18–1.38), respectively. The results of trimester-specific analyses followed the patterns as seen during the entire pregnancy (all p < 0.05). The PAF of PTB attributable to PM2.5 was 40.75% (95% CI: 32.5%, 48.26%) in the total population. Participants living in warmer regions and lower residential greenness were more susceptible to PM2.5. Our findings suggest pregnant women should avoid severe air pollution exposure throughout pregnancy. Reducing heat exposure and increasing green spaces in communities can reduce PTB risk.

Green Health doi: 10.3390/greenhealth1020010

Authors: Rafael Moreno-Gómez-Toledano

Plastic pollution is one of the leading global problems of modern society. The growing demand for and production of plastic polymers has caused bisphenol A (BPA) and its emergent substitute molecules bisphenol S and F (BPS and BPF) to be present in water, food, and soil worldwide, exposing humans to endocrine disruptors. Exposure to these compounds has been associated with pathologies such as diabetes, obesity, hypertension, and psychiatric disorders. Interestingly, hypovitaminosis D (or low 25(OH)D) is also associated with this class of diseases. Therefore, the present work, for the first time, explores the relationship patterns between urinary bisphenols (BPs) and low 25(OH)D in a large general cohort (NHANES 13–16). Descriptive statistical analyses, comparative analyses, linear regressions, and binomial and multinomial logistic regressions were performed. Descriptive and comparative analysis, and simple linear regressions, showed different trends between BPs, and binomial logistic regressions showed that only BPS is a risk factor of low 25(OH)D, independently of age, BMI, gender, diabetes, dyslipidemia, smoking, and vitamin supplements consumption; odds ratio (95% confidence interval) of 1.10 (1.04–1.17). The different trend patterns observed in urinary bisphenols show that, despite being structurally similar molecules and potential analogs, they may affect the body in different ways. From an integrated perspective, this could represent an even greater potential threat than that posed by BPA alone. Future integrated studies will be required to further explore and clarify this emerging paradigm.

Green Health doi: 10.3390/greenhealth1020009

Authors: Luigi Cofone Maria Assunta Donato Marise Sabato Carolina Di Paolo Livia Maria Salvatori Stefano Di Giovanni Lorenzo Paglione

Introduction: Ecological networks (ENs) are critical frameworks designed to protect biodiversity, enhance habitat connectivity, and provide ecosystem services in fragmented landscapes. Urban ecological networks (UENs) adapt this concept to address the challenges posed by urbanization, habitat fragmentation, and climate change. Methods: This systematic review follows the PRISMA methodology, with the search strategy applied across PubMed, Scopus, and Web of Science. Articles published until 29 July 2025, were evaluated based on their alignment with One Health domains: human, animal, and ecosystem health. The included studies underwent independent review and quality assessment using the Newcastle–Ottawa Scale. Results: Only nine of the 228 articles that were found satisfied the requirements for inclusion. These studies examined UENs’ effects on biodiversity, species migration, and climate resilience but lacked direct evaluation of human health impacts. Key findings highlighted the role of ecological corridors in improving habitat connectivity, promoting biodiversity, and mitigating climate-related fragmentation. Conclusions: While UENs show significant potential to enhance biodiversity and urban resilience, their direct impacts on human health remain underexplored. Future interdisciplinary research should focus on quantifying these links and integrating UENs into urban planning to address ecological and Public Health challenges under a One Health framework.

Green Health doi: 10.3390/greenhealth1020008

Authors: Chibueze G. Achi Oluwafemi F. Ariyo Akinwale O. Coker Samuel J. Abbey Kofi Agyekum Colin A. Booth Rosemary E. Horry

Safe and adequate water supply, sanitation, and hygiene (WASH) in schools are prerequisites within the right to basic education. WASH facilities across schools in developing nations, particularly in Africa, are unsatisfactory and expose children to risks of disease and infection. This study aims to gather insights into the WASH status of secondary schools in Ibadan, Nigeria, to develop a sustainable water management framework for schools. A concurrent mixed-method design (questionnaires and interviews) was adopted to benchmark water management in schools and inform the design of a framework. Results reveal a wealth of issues and concerns that include infrastructure challenges accessing reliable and safe water supplies, rundown and unhygienic toilet/urinal facilities, and dilapidated sinks/taps, plus resource challenges, such as an absence of tissue paper and soap. These issues are exposing schoolchildren to unnecessary health risks, further supported by reported illnesses and reduced school attendance. Based on these findings, and guided by the UN SDG#6 targets, a water improvement framework has been created and validated by school officials. The framework identifies both short-term and long-term guidance/actions to improve water management in schools across Sub-Saharan Africa. These form crucial steps toward better WASH, building healthier communities and enhancing educational environments and outcomes for schoolchildren.

Green Health doi: 10.3390/greenhealth1020007

Authors: Cátia Sousa Maria Jacinta Fernandes Tiago Encarnação Gabriela Gonçalves

The relationship between natural environments and psychological well-being has gained increasing attention in environmental and health sciences. However, there is still a lack of robust quantitative instruments to assess the restorative potential of different environments. This study aimed to adapt and validate the Portuguese version of the Perceived Restorativeness Scale (PRS), an instrument based on Attention Restoration Theory that evaluates the perceived restorative qualities of environments. In Study 1, exploratory and confirmatory factor analyses were conducted on data from 410 participants. The results supported a refined 20-item version of the scale, comprising four factors—being away, fascination, compatibility, and legibility—with good internal consistency and acceptable model fit. Measurement invariance analysis confirmed configural, metric, and scalar invariance across gender. In Study 2, a separate sample of 212 participants completed the PRS along with additional validated measures: the Sublime Emotion toward Nature Scale (SEN), an aesthetic evaluation of landscapes, and the Positive and Negative Affect Schedule (PANAS). The PRS showed strong convergent and discriminant validity and significantly predicted restorative outcomes. These findings support the psychometric adequacy of the Portuguese PRS and its relevance as a valid tool for assessing perceived restorativeness in both natural and built environments. The scale may inform future research and public policies aimed at designing spaces that promote psychological restoration and mental well-being.

Green Health doi: 10.3390/greenhealth1020006

Authors: Lan Chen Chongjian Wang Shiyu Zhang Shengtao Wei Jinde Zhao Zilong Zhang

Background: The associations between physical activity (PA) and all-cause mortality remain under-investigated among individuals with impaired lung function. Methods: With 201,596 participants from the UK Biobank cohort, baseline pre-bronchodilation lung function tests and a modified International Physical Activity Questionnaire were used to assess lung function status (normal, restricted, obstructed) and PA attributes (volume, intensity, duration). All-cause mortality was determined through linkage to the National Health Services Register. Cox proportional hazard regression was applied to characterize the associations between PA metrics and all-cause mortality among people with different lung function statuses. Dose–response relationships between PA metrics and all-cause mortality risks were examined using restricted cubic splines (number of knots = 4). Results: Over a 11.81-year median follow-up, 5.24% of participants died. All-cause mortality risk declined with increasing total PA volume, plateauing at 1800 MET-min/week without further reduction in individuals with and without impaired lung function. Similar trends were observed for PA intensity and duration, with both factors demonstrating reduced mortality risk that plateaued after reaching a specific threshold. Notably, 24.1% (95% CI: 16.7%, 30.8%) and 43.1% (95% CI: 36.1%, 49.7%) lower mortality risk was observed among individuals with and without impaired lung function for PA with 1201–1800 MET-min/wk. Conclusions: PA was associated with a decreased risk of all-cause mortality among individuals with and without impaired lung function, suggesting that those with impaired lung function might also benefit from PA.

Green Health doi: 10.3390/greenhealth1010005

Authors: Marcel Ashley Paulino Leite André Cristiano Silva Melo Renata Melo e Silva de Oliveira Eliane de Castro Coutinho Iedo Souza Santos Vitor William Batista Martins

The aim of this research was to develop and validate a framework capable of enhancing the management of ballistic waste considering the context of the training activity of a Public Security Institute in Belém do Pará. A literature review was adopted as a method to provide the theoretical basis necessary to understand the context and develop the proposed conceptual framework, a questionnaire was developed and applied to security professionals, and the data were analyzed using the Lawshe-TOPSIS hybrid approach to validate the framework. The results make it possible to present, in an organized manner, a set of variables considering challenges and benefits for a framework for ballistic waste management. It is possible to conclude that ballistic waste management, especially in environments such as shooting ranges, is configured as a multifaceted challenge that demands a highly complex technical, normative, and operational approach.

Green Health doi: 10.3390/greenhealth1010004

Authors: Jose L. Domingo

Municipal Solid Waste Incinerators (MSWIs) are facilities designed to burn municipal solid waste to reduce its volume and mass and generate energy. A significant concern related to MSWIs is the emission of toxic and carcinogenic pollutants, including polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs), heavy metals, and particulate matter. This review synthesizes global epidemiological and exposure assessment studies investigating cancer risks associated with residential proximity to MSWIs. Findings reveal a complex relationship: older incinerators with high emissions correlate with elevated risks of non-Hodgkin lymphoma (NHL), soft-tissue sarcoma (STS), and liver cancer in some studies, particularly in Europe. However, results remain inconsistent due to methodological limitations such as exposure misclassification, latency periods, and confounding factors like socioeconomic status. Modern facilities equipped with advanced pollution control technologies demonstrate reduced risks, often within regulatory thresholds. Key challenges include accurately quantifying historical exposures and disentangling MSWI-specific risks from other environmental or lifestyle factors. While advancements in dispersion modeling and biomonitoring have improved risk assessments, geographical and temporal variations in findings underscore the need for continued research. The review concludes that while historical evidence suggests potential cancer risks near older MSWIs, stricter emissions regulations and technological improvements have mitigated health impacts, although vigilance through long-term monitoring remains essential to safeguard public health.

Green Health doi: 10.3390/greenhealth1010003

Authors: Gabriel Soares Vieira Sabrina Dias Rodrigues Ingrid Layla Sousa Silva Maria Eduarda Teixeira de Oliveira Gabriella Raiany Teixeira De Brito Priscila Cembranel José Baltazar Salgueirinho Osório de Andrade Guerra Felipe Teixeira Dias

Urban vegetation plays a key role in promoting health and environmental balance in cities. This study analyzed the relationship between green areas and human well-being in the Alvorada neighborhood of Guanambi, Bahia, Brazil. Using an ecological study design, vegetation was assessed through the Vegetation Coverage Index (VCI), percentage of vegetation coverage (PVC), aerial and satellite imagery, and population density data. Field visits were also conducted to validate remote observations. The results revealed that the VCI in the study area was significantly below the levels recommended by the World Health Organization (12 m2/inhabitant), indicating a scarcity of green areas. This deficiency is associated with reduced thermal comfort and potential negative impacts on residents’ physical and mental health. The findings reinforce the urgent need for sustainable urban planning in alignment with Sustainable Development Goals (SDGs) 3, 11, and 13, highlighting vegetation as a determinant of urban quality of life.

Green Health doi: 10.3390/greenhealth1010002

Authors: Susan Strickland Michael Tong

The study aims to identify key features in the built environment that are associated with heat-related health risks among older people in high-income countries, which could inform the development of targeted interventions to reduce built-environment-related heat risks for older populations in the context of climate change. We conducted a systematic review to identify features of the built environment associated with the health impacts of heat amongst people aged 65 or over, living in urban areas. Three databases, PubMed, Scopus, and Web of Science, were searched for the period from database inception until February 2025. The key built environment features associated with adverse health outcomes among older people included urban land surface vegetation, impervious ground surfaces, orientation of bedrooms, top floor locations of apartments, housing age, and the presence and use of air conditioning. The health indicators used in this study were heat-related mortality and morbidity represented by hospitalisations and ambulance call-outs. Built environment features were significantly associated with heat-related health risks among older people. Given the increasing high temperatures and more frequent and intense heatwaves in the context of climate change, there is an urgent need to develop targeted built environment adaptation plans for older people to strengthen their resilience to heat and reduce heat-related adverse health impacts.

Green Health doi: 10.3390/greenhealth1010001

Authors: Hualiang Lin Jose L. Domingo

In an era where global environmental and public health challenges intersect with emerging opportunities, the launch of the journal Green Health (ISSN 3042-5832) [...]