International Journal of Environmental Medicine doi: 10.3390/ijem1030015

Authors: Edoardo Cavalieri D’Oro Claudio De Maio Rita White Enrico Greco

Indoor environments are increasingly recognized as key determinants of human microbial exposure and skin health. Microbiome-aware interventions, including probiotic and prebiotic formulations, have been proposed to complement conventional environmental hygiene. However, quantitative data on the spatial distribution of nebulized prebiotic/postbiotic mixtures in enclosed spaces are lacking. The aim of this exploratory study was to characterize the aerosolization efficiency and spatial deposition of a prebiotic/postbiotic solution nebulized by two different devices in standardized indoor microenvironments. Two nebulizing devices were tested separately in two identical 20′ ISO containers (33.2 m3). A liquid prebiotic/postbiotic mixture at two concentrations (10% and 20% v/v in water) was nebulized for 1 or 2 h. Surface deposition was assessed using passive paper samplers placed at horizontal distances of 0, 25, 50, 100 and 200 cm from the aerosol outlet. A volatile chemical marker contained in the solution was quantified by gas chromatography–mass spectrometry to estimate deposited volume per unit area. Both devices generated detectable marker deposition at all distances, ranging from 0.22 to 14.42 µL·cm−2 of concentrate equivalent. In a mixed-effects model treating the individual run as the unit of replication, distance was the only factor reaching statistical significance, deposition decreasing approximately twofold per 100 cm (p < 0.001); the apparent effects of device type, concentration and run time did not reach significance. Spatial decay profiles were condition-dependent rather than systematically device-specific. Nebulized prebiotic/postbiotic mixtures can be delivered across meter-scale distances in enclosed indoor settings. Because each condition was tested in a single run, aerosol properties were not characterized and no microbiological or clinical endpoints were assessed; these findings represent a feasibility and exposure-characterization step rather than evidence of biological or health benefit, and they support further investigation of nebulized microbiome-modulating interventions in environmental and occupational medicine.

International Journal of Environmental Medicine doi: 10.3390/ijem1030014

Authors: Dristi Sapkota Sachin Sapkota Dinesh Phuyal

In 2024, the annual global surface temperature rose more than 1.5 °C above pre-industrial levels for the first time. This single-year figure is not the same as the long-term warming limit set by the Paris Agreement, but it signals a rising heat-related risk. Extreme heat is already the deadliest weather hazard in the United States, yet most outpatient clinics have no structured protocol for vulnerable patients. This narrative review does three things: it explains how heat stress injures compromised cardiovascular and renal systems, catalogs the primary care medications that impair thermoregulation, and offers a Heat Action Plan (HAP) toolkit for family medicine clinics. We searched PubMed, EMBASE, Google Scholar, and Web of Science for work published from 2000 to May 2026, supplemented by WHO, CDC, and national heat-health guidelines. Patients with cardiovascular disease, chronic kidney disease, diabetes, obesity, and serious mental illness face disproportionate risk during heat events. More than 20 drug classes, among them diuretics, beta-blockers, anticholinergics, and renin–angiotensin–aldosterone system inhibitors, weaken heat defense by blunting sweating, reducing cardiac output, or suppressing thirst. We present a three-tier risk classification and a four-stage toolkit that, when built into routine chronic disease care, may help reduce preventable heat-related illness and death.

International Journal of Environmental Medicine doi: 10.3390/ijem1030013

Authors: Alex O. Okaru Dirk W. Lachenmeier

The African esophageal squamous cell carcinoma (ESCC) corridor extends from Ethiopia to the Eastern Cape and contains some of the highest age-standardized ESCC incidence rates reported anywhere, with five-year survival below 5%. The corridor’s heterogeneous incidence (sex ratios from 1:1 to 7:1; tenfold variation between adjacent populations) has resisted single-factor explanation through more than half a century of investigation. We synthesize the multicenter evidence accumulated since the IARC 2018 Group 2A classification of very hot beverages (>65 °C), with particular attention to the African Esophageal Cancer Consortium (ESCCAPE) outputs and to whole-genome sequencing. We argue, on the convergent evidence of animal toxicology, human in vitro mucosa, and population genomics, that thermal exposure acts as a tumor promoter rather than an initiator. On this reading, the corridor’s heterogeneous burden reflects heterogeneous chemical co-exposure profiles operating against a shared thermal-promoter substrate. Extending the comparative margin-of-exposure (MOE) methodology to esophageal squamous carcinogenesis, we present an MOE framework distinguishing genotoxic compounds (within-mode-of-action additive) from thermal exposure (separate companion figure) and apply it to two corridor scenarios. The framework supports a four-lever prevention strategy combining tobacco control, alcoholic-strength reduction in unrecorded spirits, clean-cookstove deployment, and graduated thermal-exposure reduction.

International Journal of Environmental Medicine doi: 10.3390/ijem1030012

Authors: Alessandro Miani Fabrizio Capaccioli David Mariani Daniele Guglielmino Rita White

Human health is increasingly shaped by the environments in which people live, work, learn, receive care and age [...]

International Journal of Environmental Medicine doi: 10.3390/ijem1030011

Authors: Holly M. Walder Shane Fitzgerald Leon P. Barron Ian S. Mudway

Understanding indoor and outdoor airborne organic mixtures, including semi-volatile organic compounds (sVOCs), remains challenging as quantitative monitoring is often costly and difficult to scale across buildings and individuals. Here we present a low-cost, miniaturised passive sampler-based methodology for static and wearable deployment to generate time-integrated chemical fingerprints and source prioritisation. New sampler devices containing replicate 9 mm sorbent discs (Tenax® TA and/or polydimethylsiloxane) were deployed for 28 days in indoor (kitchen, bedroom) and outdoor (roadside) environments and worn by five participants; extracts were analysed by liquid extraction and gas chromatography–mass spectrometry (GC-MS) using conservative, transparent criteria for tentative compound identification. Across the household deployments, 52 compounds met inclusion criteria and distinct room-specific and outdoor chemical signatures were observed. Wearable deployments also produced differentiable chemical profiles, with greater similarity among co-inhabitants, but still could differentiate co-habitant activities based on exposure. These results demonstrate the feasibility of using miniature passive samplers to obtain reproducible, information-rich profiles that can help discriminate environments and exposure scenarios.

International Journal of Environmental Medicine doi: 10.3390/ijem1030010

Authors: Antonio Cristaldi Salvatore Scondotto Vincenzo Restivo

Climate change is significantly altering the distribution, seasonality, and transmission dynamics of vector-borne diseases, posing an increasing public health concern, particularly in regions previously considered at low risk. Key climatic variables, including temperature, precipitation, and humidity, strongly influence vector survival, reproduction, and pathogen transmission capacity. This review provides an overview of current evidence on the relationship between climate change, vector ecology, and vector-borne disease epidemiology in Europe, based on evidence extracted from peer-reviewed literature published between 2010 and 2024 and retrieved from PubMed, Scopus, and Web of Science. Particular attention is given to vector-borne diseases with current or potential relevance to Europe. This includes infections that are already endemic, such as leishmaniasis and tick-borne encephalitis, as well as diseases currently imported, such as malaria, dengue, chikungunya, Zika, yellow fever, and Chagas disease, that may pose a future risk of local transmission due to climate-driven changes in vector distribution and abundance. The analysis highlights potential health and economic impacts, and discusses implications for public health preparedness, environmental sanitation, surveillance, and vector control strategies. Strengthening adaptive and mitigation policies, alongside targeted research efforts, is essential to enhance resilience of health systems against climate-driven epidemic risks.

International Journal of Environmental Medicine doi: 10.3390/ijem1020009

Authors: Margarita Rosa Montoya-Hernández

The aim of this study was to determine the effects of PM10 and PM2.5 particulate matter pollution from the coal mining sector in the three municipalities of Cesar, La Guajira, and El Magdalena on respiratory morbidity in children under 5 years of age and adults over 60 years of age residing in these municipalities. This descriptive time series study included three municipalities in three departments: Algarrobo, Albania, and La Jagua de Ibirico. The SEVCA (Seasonal Environmental Monitoring System) was used to collect PM10 and PM2.5 pollutants. Data on secondary source air quality (RIPS) were collected from the public health services (ESE) in each municipality. The daily average concentration of μg/m3 was used for the statistical analysis of the pollutants. A time series statistical model was applied to compare the temporal variations in exposure levels and the event itself. The air quality data databases were analyzed using descriptive statistics. A logistic regression model was used to assess the association between pollutants and air quality. To account for the effects of time lags in air quality data, moving averages with lags of 0 to 3 days were used. Statistical analyses were performed using R version 4.5.1. We found daily averages of ARI in children under 5 years of age and adults over 60 years of age in the three municipalities of (1.35) admissions per day. The average daily concentrations of μg/m3 for Algarrobo were (29.79 μg/m3) for PM10 and (12.68 μg/m3) for PM2.5, for Albania (33.49 μg/m3) for PM10 and (13.23 μg/m3) for PM2.5, and for La Jagua (41.42 μg/m3) for PM10 and (15.18 μg/m3) for PM2.5. Significant positive associations greater than 1 were obtained between ARI admissions and PM10 and PM2.5 pollutants, with an RR of 1.105, 1.106, 1.125, 1.124, 1.157, and 1.155 95% CI, when PM10 and PM2.5 increase by 10 μg/m3 and for delays of 1 and 1–3 days. In conclusion, we observed significant positive associations between hospital admissions for ARI in children under 5 years of age and adults over 60 years of age for the three municipalities and the pollutants PM10 and PM2.5, which leads us to conclude that there is an epidemiological association and that the change in μg/m3 levels represents a change in the risk of hospital admission for ARI for children under 5 years of age and older adults in this coal corridor of the Colombian Caribbean.

International Journal of Environmental Medicine doi: 10.3390/ijem1020008

Authors: Mansaa Singh Sneha Gupta Jayanta K. Pal Nilesh Kumar Sharma

Cancer is attributed to being caused by multiple genetic, epigenetic, and various direct and indirect environmental factors. Microplastics are defined as pieces of plastic that are smaller than five millimeters. Microplastics have been emphasized as ubiquitous environmental contaminants found in terrestrial and aquatic systems, food webs, and the human body. Moreover, microplastics can bind to environmentally harmful pollutants, heavy metals, and refractory organic pollutants that can aggravate the biological effects of these pollutants. Microplastics are suggested to induce chronic inflammation, oxidative stress, and genotoxicity by adsorbing and modifying the biomolecules in the biological systems. Oxidative stress, inflammation, and chemical-induced genetic and epigenetic changes in cancer cells and cancer-associated cells are considered as crucial processes in the development, progression, and therapeutic outcome of cancer. Among numerous tumor-promoting environmental factors, preclinical and clinical evaluations of how microplastics contribute to cellular and non-cellular pro-tumorigenic mechanisms like inflammation, genomic instability, and epigenetic modulation are emerging. This review will contribute to a better understanding of microplastics as additional environmental components apart from established carcinogens and genotoxic substances that directly or indirectly influence the pro-tumor microenvironment.

International Journal of Environmental Medicine doi: 10.3390/ijem1020007

Authors: Akira Onodera

Environmental exposure to particulate matter, including PM2.5 and engineered nanomaterials, is a major global health concern. Although acute toxic effects have been widely documented, new evidence suggests that the retained particle burden arising from incomplete clearance, tissue retention, and redistribution plays a key role in long-term health outcomes. This review synthesizes knowledge on particle accumulation at multiple biological levels. It examines how particles are retained in pulmonary and lymphoid tissues, their uptake by immune cells, and their sequestration within organelles, particularly the endo-lysosomal system. The mechanisms by which lysosomal dysfunction can cause mitochondrial stress, redox and metabolic disturbances, and impaired autophagy are also discussed. These disruptions can alter the status of immune cells and disturb immune homeostasis. This review also examines how immune perturbation from accumulation may contribute to chronic lung diseases. Understanding these mechanisms explains the persistent health effects associated with low-dose exposure and supports more effective risk assessment and prevention.

International Journal of Environmental Medicine doi: 10.3390/ijem1020006

Authors: Nicole Montes Pérez Tia Warrick

Flooding is an increasingly frequent climate hazard with the potential to mobilize environmental contaminants and elevate human health risks. In this study, we assessed heavy metals and metalloids across five sites arranged along a flood-risk gradient from low to high. Six replicate samples per site (n = 30 per contaminant) were collected in a single sampling event. Contaminants were evaluated using the US Environmental Protection Agency (EPA) risk assessment framework to calculate chronic daily intake (CDI), hazard quotients (HQs), and lifetime cancer risk. Arsenic, chromium, and nickel emerged as the most concerning cancer drivers, with nickel cancer risk consistently exceeding 1 × 10−3 (equivalent to one additional cancer case per 1000 exposed individuals) and arsenic at 4.4 × 10−4 (about 1 in 2250). Lead posed non-cancer risks (HQ = 0.912, near the threshold of concern), while cobalt demonstrated a significant decreasing gradient with increasing flood-risk (p = 0.018). Arsenic and thallium more than doubled in concentration at high-flood sites relative to low-flood sites, while cadmium, cobalt, and nickel decreased. These findings suggest flooding may mobilize arsenic, lead, and thallium, while diluting or displacing other metals such as cadmium, cobalt, and nickel. Organs of concern include the liver and kidneys for arsenic, cadmium, nickel, and cobalt, the brain and bones for lead, and the lungs and liver for chromium. Although statistical significance was limited by the small sample size, effect sizes and fold-changes indicate meaningful flood-related differences. This study highlights the importance of considering flood-risk in contaminant hazard assessments and the need for flood-adaptive risk management strategies in vulnerable communities.

International Journal of Environmental Medicine doi: 10.3390/ijem1010005

Authors: Dristi Sapkota Dinesh Phuyal

Contamination of agricultural water poses significant health risks that are often underrecognized in clinical practice. This review synthesizes peer-reviewed literature from biomedical and environmental sciences. It examines the pathways by which nitrates and zoonotic pathogens contaminate rural drinking water and delineates the resulting spectrum of acute and chronic health risks relevant to primary care. Agricultural practices are a primary source of nitrates and pathogens (e.g., Escherichia coli, Cryptosporidium, Giardia) in rural water supplies. Nitrate nitrogen exposure is linked not only to acute infant methemoglobinemia but also to chronic conditions like colorectal and thyroid cancers and adverse birth outcomes. These risks are observed at concentrations below the current United States Environmental Protection Agency regulatory limit of 10 mg L−1 NO3−–N. Pathogen exposure leads to acute gastrointestinal illness and can trigger long-term sequelae, including irritable bowel syndrome. Agricultural communities are uniquely vulnerable because they rely heavily on unregulated private wells, which are more prone to contamination than public systems. Evidence suggests a substantial and often underrecognized burden of waterborne disease in agricultural communities. The findings highlight a critical need for clinical vigilance regarding low-level nitrate nitrogen exposure and long-term post-infectious syndromes. By identifying these patterns, family physicians serve as essential sentinels for both individual patient safety and community public health.

International Journal of Environmental Medicine doi: 10.3390/ijem1010004

Authors: Ravi Shankar Aaron Goh Qian Xu

The transition to environmentally sustainable healthcare is gaining urgency, yet public discourse shaping this shift remains underexamined. This study employs natural language processing (NLP) to analyze 15,976 English-language tweets (2006–2024) related to sustainable healthcare. Using Latent Dirichlet Allocation (LDA), eight dominant topics were identified, including eco-friendly access, net-zero implementation, climate impact, emissions, cost and waste, education, infrastructure, and green technologies. Sentiment analysis (VADER) of 9433 tweets showed 59.1% positive, 31.1% neutral, and 9.8% negative sentiment, with AI and technology topics receiving the highest positivity (73.5%) and climate-related topics the most negativity. Thematic analysis of 800 tweets revealed six cross-cutting themes, including healthcare’s environmental responsibility, co-benefits for health, urgency of climate action, and optimism in technological solutions. These findings offer a nuanced understanding of public perceptions, informing targeted strategies and communication for healthcare sustainability. The study also demonstrates the value of mixed-method NLP in examining enablers and barriers to health system transformation.

International Journal of Environmental Medicine doi: 10.3390/ijem1010003

Authors: Pedro Henrique Campello Torres Sandra Momm Beatriz Milz Thais Tartalha Lombardi Gabriel Machado Araujo Bruna Bauer Dorcas Nthoki Nyamai

The COVID-19 pandemic has underscored and intensified existing structural inequalities, particularly in urban centers of the Global South. This paper revisits the Sustainable Livelihoods Framework (SLF), originally designed for rural contexts, proposing its adaptation to centralize mobility as a critical analytical axis in urban contexts. Through an examination of São Paulo, Brazil, we explore how mobility restrictions, access to natural capital, and health outcomes intersected during the pandemic, disproportionately affecting vulnerable populations. To explore the application of the adapted framework, we analyze two contrasting neighborhoods in São Paulo, highlighting how different urban contexts mediate the impacts of systemic crises. By integrating mobility into the SLF, we aim to provide a more nuanced tool for analyzing and addressing urban vulnerabilities in times of systemic crises.

International Journal of Environmental Medicine doi: 10.3390/ijem1010002

Authors: Alessandro Miani Jing Shang

Contemporary global society is confronting unprecedented health challenges [...]

International Journal of Environmental Medicine doi: 10.3390/ijem1010001

Authors: Giulia Stefenelli

We are delighted to announce the launch of the International Journal of Environmental Medicine (ISSN: 3042-7681) [...]