Search Results (812)

(1) Background: Dioxins and dioxin-like polychlorinated biphenyls (dl-PCBs) are persistent organic pollutants (POPs), characterized by high toxicity and strong lipophilicity, which promote their bioaccumulation in human tissues. Their detection in breast milk raises concerns about early-life exposure during lactation. Although dietary intake is the primary route of maternal exposure, environmental pathways—including inhalation, dermal absorption, and residential proximity to contaminated sites—may also significantly contribute to the maternal body burden. (2) Methods: This narrative review examined peer-reviewed studies investigating maternal and environmental determinants of dioxin and dl-PCB concentrations in human breast milk. A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science (2000–2024), identifying a total of 325 records. Following eligibility screening and full-text assessment, 20 studies met the inclusion criteria. (3) Results: The included studies consistently identified key exposure determinants, such as high consumption of animal-based foods (e.g., meat, fish, dairy), living near industrial facilities or waste sites, and maternal characteristics including age, parity, and body mass index (BMI). Substantial geographic variability was observed, with higher concentrations reported in regions affected by industrial activity, military pollution, or inadequate waste management. One longitudinal study from Japan demonstrated a declining trend in dioxin levels in breast milk, suggesting the potential effectiveness of regulatory interventions. (4) Conclusions: These findings highlight that maternal exposure to dioxins is influenced by identifiable environmental and behavioral factors, which can be mitigated through public health policies, targeted dietary guidance, and environmental remediation. Breast milk remains a critical bioindicator of human exposure. Harmonized, long-term research is needed to clarify health implications and minimize contaminant transfer to infants, particularly among vulnerable populations. Full article

Background and Aim: Type 2 diabetes (T2D) continues to pose a significant public health challenge worldwide. Among therapeutic options, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have proven effective in optimizing glycemic control and improving cardiometabolic profiles. Semaglutide, now available in an oral formulation, represents a modern strategy to improve patient adherence while supporting glucose and weight regulation. This study primarily investigated the effects of oral semaglutide on key metabolic indicators and secondary endpoints included cardiovascular risk markers (blood pressure and lipid profile) and patient-reported quality of life (QoL). Study Design and Methods: A longitudinal, prospective observational study was conducted involving patients with T2D across two Italian healthcare facilities. Participants were assessed at baseline (T0) and at three subsequent intervals—6 months (T1), 12 months (T2), and 18 months (T3)—following the initiation of oral semaglutide use. Key Findings: Out of 116 participants enrolled, 97 had complete and analyzable data. Across the 18-month follow-up, significant improvements were observed in glycemic parameters, with a notable reduction in HbA1c levels (T0 vs. T3, p = 0.0028; p ≤ 0.05, statistically significant). Self-reported outcomes showed enhanced quality of life, especially in treatment satisfaction and perceived flexibility (T0 vs. T3, p < 0.001). Conclusions: Daily administration of 14 mg oral semaglutide in individuals with T2D resulted in substantial benefits in glycemic regulation, weight reduction, cardiovascular risk management, and overall patient satisfaction. These findings reinforce its potential role as a sustainable and effective option in long-term diabetes care from both a clinical and public health perspective. Full article

Furunculosis caused by Aeromonas salmonicida poses a significant challenge to the sustainable production of maraena whitefish (Coregonus maraena). This case report outlines a multi-year disease management strategy at a European whitefish facility with two production departments, each specialising in different life-cycle stages. Recurrent outbreaks of A. salmonicida necessitated the development of effective vaccination protocols. Herd-specific immersion vaccines failed to confer protection, while injectable formulations with plant-based adjuvants caused severe adverse reactions and mortality rates exceeding 30%. In contrast, the bivalent vaccine Alpha Ject 3000, containing inactivated A. salmonicida and Vibrio anguillarum with a mineral oil adjuvant, yielded high tolerability and durable protection in over one million whitefish. Post-vaccination mortality remained low (3.3%), aligning with industry benchmarks, and furunculosis-related losses were fully prevented in both departments. Transcriptomic profiling of immune-relevant tissues revealed distinct gene expression signatures depending on vaccine type and time post-vaccination. Both the herd-specific vaccine and Alpha Ject 3000 induced the expression of immunoglobulin and inflammatory markers in the spleen, contrasted by reduced immunoglobulin transcript levels in the gills and head kidney together with the downregulated expression of B-cell markers. These results demonstrate that an optimised injectable vaccination strategy can significantly improve health outcomes and disease resilience in maraena whitefish aquaculture. Full article

Urban forests, as a form of green infrastructure, play a vital role in enhancing urban resilience, environmental health, and quality of life. However, users perceive and utilize these spaces in diverse ways. This study aims to identify latent perception types among urban forest visitors and analyze their behavioral, demographic, and policy-related characteristics in Incheon Metropolitan City (Republic of Korea). Using latent class analysis, four distinct visitor types were identified: multipurpose recreationists, balanced relaxation seekers, casual forest users, and passive forest visitors. Multipurpose recreationists preferred active physical use and sports facilities, while balanced relaxation seekers emphasized emotional well-being and cultural experiences. Casual users engaged lightly with forest settings, and passive forest visitors exhibited minimal recreational interest. Satisfaction with forest elements such as vegetation, facilities, and management conditions varied across visitor types and age groups, especially among older adults. These findings highlight the need for perception-based green infrastructure planning. Policy recommendations include expanding accessible neighborhood green spaces for aging populations, promoting community-oriented events, and offering participatory forest programs for youth engagement. By integrating user segmentation into urban forest planning and governance, this study contributes to more inclusive, adaptive, and sustainable management of urban green infrastructure. Full article

Recently, solar energy technologies are a cornerstone of the global effort to transition towards cleaner and more sustainable energy systems. However, in many rural areas of developing countries, unreliable electricity severely impacts healthcare delivery, resulting in reduced medical efficiency and increased risks to patient safety. This review explores the transformative potential of solar energy as a sustainable solution for powering healthcare facilities, reducing dependence on fossil fuels, and improving health outcomes. Consequently, energy harvesting is a vital renewable energy source that captures abundant solar and thermal energy, which can sustain medical centers by ensuring the continuous operation of life-saving equipment, lighting, vaccine refrigeration, sanitation, and waste management. Beyond healthcare, it reduces greenhouse gas emissions, lowers operational costs, and enhances community resilience. To address this issue, the paper reviews critical solar energy technologies, energy storage systems, challenges of energy access, and successful solar energy implementations in rural healthcare systems, providing strategic recommendations to overcome adoption challenges. To fulfill the aims of this study, a focused literature review was conducted, covering publications from 2005 to 2025 in the Scopus, ScienceDirect, MDPI, and Google Scholar databases. With targeted investments, policy support, and community engagement, solar energy can significantly improve healthcare access in underserved regions and contribute to sustainable development. Full article

The continuous variability in the microbiological quality of surface waters presents significant challenges for ensuring the production of safe drinking water in compliance with public health regulations. Inadequate treatment of surface waters can lead to the presence of pathogenic microorganisms in the drinking water supply, posing serious risks to public health. This research presents an in-depth data analysis using machine learning tools for the induction of models to describe and predict microbiological water quality for the sustainable management of the Butoniga drinking water treatment facility in Istria (Croatia). Specifically, descriptive and predictive models for total coliforms and E. coli bacteria (i.e., classes), which are recognized as key sanitary indicators of microbiological contamination under both EU and Croatian water quality legislation, were developed. The descriptive models provided useful information about the main environmental factors that influence the microbiological water quality. The most significant influential factors were found to be pH, water temperature, and water turbidity. On the other hand, the predictive models were developed to estimate the concentrations of total coliforms and E. coli bacteria seven days in advance using several machine learning methods, including model trees, random forests, multi-layer perceptron, bagging, and XGBoost. Among these, model trees were selected for their interpretability and potential integration into decision support systems. The predictive models demonstrated satisfactory performance, with a correlation coefficient of 0.72 for total coliforms, and moderate predictive accuracy for E. coli bacteria, with a correlation coefficient of 0.48. The resulting models offer actionable insights for optimizing operational responses in water treatment processes based on real-time and predicted microbiological conditions in the Butoniga reservoir. Moreover, this research contributes to the development of predictive frameworks for microbiological water quality management and highlights the importance of further research and monitoring of this key aspect of the preservation of the environment and public health. Full article

The colonization of Legionella spp. in engineered water systems constitutes a major public health threat. In this study, a six-year environmental surveillance (2020–2025) of Legionella colonization in five different types of facilities in Crete, Greece is presented, including hotels, passenger ships, primary healthcare facilities, public hospitals, and private clinics. A total of 1081 water samples were collected and analyzed, and the overall positivity was calculated using culture-based methods. Only 16.46% of the samples exceeded the regulatory limit (>10³ CFU/L) in the total sample, with 44.59% overall Legionella positivity. Colonization by facility category showed the highest rates in primary healthcare facilities with 85.96%, followed by public hospitals (46.36%), passenger ships with 36.93%, hotels with 38.08%, and finally private clinics (21.42%). The association of environmental risk factors with Legionella positivity revealed a strong effect at hot water temperatures < 50 °C (RR = 2.05) and free chlorine residuals < 0.2 mg/L (RR = 2.22) (p < 0.0001). Serotyping analysis revealed the overall dominance of Serogroups 2–15 of L. pneumophila; nevertheless, Serogroup 1 was particularly prevalent in hospitals, passenger ships, and hotels. Based on these findings, the requirement for continuous environmental monitoring and risk management plans with preventive thermochemical controls tailored to each facility is highlighted. Finally, operational disruptions, such as those experienced during the COVID-19 pandemic, especially in primary care facilities and marine systems, require special attention. Full article

Leptospirosis is a (re-)emerging and global zoonotic disease. Given the complex host-pathogen interaction and the numerous environmental risk factors related to the transmission, a One Health approach to both disease prevention and control is needed. Occurring at the human–cattle–environment interfaces, bovine leptospirosis represents a zoonotic risk for the professionals in the field, besides being a potential cause of significant economic losses due to the bovine reproductive disorders. Although climatic change is a potential factor in exacerbating the risk of leptospirosis in Europe, this disease remains largely neglected, with several knowledge gaps in research, investigations, and diagnosis of bovine genital leptospirosis syndrome across the continent. The present report describes the results of the diagnostic investigations on a case of chronic bovine leptospirosis in a breeding bull. Following the seroconversion to Leptospira Sejroe var Hardjo after the arrival of the animal in a quarantine facility, a monitoring plan including both serological/molecular analyses and a therapeutic protocol was undertaken. The bull exhibited a persistent seroconversion and a repeated positivity for Leptospira to real-time PCR in urine samples, indicative of a chronic shedder pattern. This report emphasizes the diagnostic and management challenges in the context of such a complex but frequently overlooked disease. Full article

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. Full article

In recent decades, the River Ganges in India has been heavily contaminated with domestic waste and industrial toxins because of cultural activities, a lack of community awareness, an absence of sewage disposal facilities, and rapid population growth. Previous studies have focused separately on either the physical or social factors associated with River Ganges pollution but have not combined these elements in a single study. To fill this research gap, our study assesses the bio-physical and social vulnerability of the River Ganges by using a holistic approach. The following four sampling stations were selected: Rishikesh, Haridwar, Kanpur, and Varanasi. These locations were chosen to test the water quality in bio-physical aspects and to assess the social perceptions of river vulnerability among the residents and visitors. Perceptions of river water quality and likely sources of pollution were gathered via the distribution of over 1000 questionnaires. Data collection took place in the winter and summer of 2022 and 2023. The results showed that river water quality is not suitable for drinking purposes at any of the four cities without conventional treatment, and that the river is unsuitable for bathing at all locations, except upstream of Rishikesh. Nearly 50% of those questioned agreed that the river is polluted, whilst 74% agreed that pollution has increased in recent decades, particularly in the last 10 years. These compelling results are critical for policymakers and decision makers. They highlight the urgent need for novel strategies that address Ganges pollution while fostering community health education and environmental management. By dispelling myths surrounding river quality, this study strengthens the ongoing efforts to restore the Ganges, ensuring that it remains a vital lifeline for present and future generations. Full article

Increasing the use of healthcare facilities has resulted in the growing production of biomedical waste, which poses health risks to users, health professionals, and the environment. The aim of this research is to study the correlation between governance in Togo’s public health facilities and the quality of biomedical waste management within these facilities. Methods: This was a cross-sectional, descriptive, and analytical study conducted from September to December 2024. It involved 264 public health facilities of all types in all health regions of Togo. Health facilities were selected using the simple random selection technique. Healthcare providers were selected using the reasoned choice technique. The statistical tests used were the chi-square test and logistic regression, which enabled proportions to be compared and confounding factors to be eliminated, respectively. Results: Multivariate analysis revealed a statistically significant association between the organization and training component of governance and the quality of biomedical waste management (BMWM) in health facilities (OR = 3.79; 95% CI [1.79–8.03]; p < 0.001). This relationship suggests that health facilities with functional infection prevention and control (ICP) or BMWM committees, trained staff at all levels (nursing, technical, and administrative), and dedicated waste management personnel are more likely to implement compliant waste management practices. Analyses of the data also revealed that, among the criteria for assessing the quality of biomedical waste management (BMWM), the most significant were sorting (OR = 1.482; 95% CI [1.286; 1.708]), quantification (OR = 2.026; 95% CI [1.491; 2.753]), transportation (OR = 1.403; 95% CI [1.187; 1.66]), and disposal infrastructure (OR = 1.604; 95% CI [1.298; 1.982]). The application of this grid shows that 17.8% of the health facilities surveyed had a score equal to or above 80% on all the criteria used to assess the quality of biomedical waste management, and they were therefore managing waste in an “acceptable” manner. The study highlights key findings in biomedical waste management practices, providing actionable insights for improving public health safety. Full article

Indoor environmental quality (IEQ) of higher education (HE) buildings significantly impacts the built environment sector. This research aimed to optimize learning environments and enhance student comfort, especially post-COVID-19. The study adopts the principles of Post-occupancy Evaluation (POE) to collect and analyze various quantitative and qualitative data through environmental data monitoring, a user perceptions survey, and semi-structured interviews with professionals. Although the environmental conditions generally met existing standards, the findings indicated opportunities for further improvements to better support university communities’ comfort and health. A significant challenge identified by this research is the inability of the facility management to physically manage and operate the vast and complex spaces within HE buildings with contemporary IEQ standards. In response to these findings, this research developed a BIM-based prototype for the real-time monitoring and automated control of IEQ. The prototype integrates a BIM model with Arduino-linked sensors, motors, and traffic lights, with the latter visually indicating IEQ status, while motors automatically adjust environmental conditions based on sensor inputs. The outcomes of this study not only contribute to the ongoing discourse on sustainable building management, especially post-pandemic, but also demonstrate an advancement in the application of BIM technologies to improve IEQ and by extension, occupant wellbeing in HE buildings. Full article

As industries become increasingly dependent on cyber-physical systems (CPSs), failures within these systems can cause significant operational disruptions, underscoring the critical need for effective Prognostics and Health Management (PHM). The large volume of data generated by CPSs has made deep learning (DL) methods an attractive solution; however, imbalanced datasets and the limited availability of fault-labeled data continue to hinder their effective deployment in real-world applications. To address these challenges, this paper proposes a transfer learning approach using a pre-trained transformer architecture to enhance fault detection performance in CPSs. A streamlined transformer model is first pre-trained on a large-scale source dataset and then fine-tuned end-to-end on a smaller dataset with a differing data distribution. This approach enables the transfer of diagnostic knowledge from controlled laboratory environments to real-world operational settings, effectively addressing the domain shift challenge commonly encountered in industrial CPSs. To evaluate the effectiveness of the proposed method, extensive experiments are conducted on publicly available datasets generated from a laboratory-scale replica of a modern industrial water purification facility. The results show that the model achieves an average F1-score of 93.38% under K-fold cross-validation, outperforming baseline models such as CNN and LSTM architectures, and demonstrating the practicality of applying transformer-based transfer learning in industrial settings with limited fault data. To enhance transparency and better understand the model’s decision process, SHAP is applied for explainable AI (XAI). Full article

Background: Antimicrobial resistance (AMR) poses a critical global health challenge, particularly in resource-limited settings. A hub-and-spoke model, decentralising expertise and distributing resources to peripheral facilities, has been proposed as a strategy to enhance the antimicrobial stewardship (AMS) capacity in low- and middle-income countries. Aim: This study sought to understand healthcare professionals’ experiences of a hub-and-spoke AMS model in the Volta Region of Ghana and its influence on clinical practice, leadership, and collaborative endeavours to address AMR. Methods: A qualitative descriptive design was adopted. In-depth interviews were conducted with 11 healthcare professionals who participated in the AMS program. Thematic analysis was used to identify key themes related to the knowledge and skills that were gained, clinical and leadership practice changes, capacity building, and challenges. Results: Participants reported an increased awareness of AMR, particularly regarding the scale and clinical implications of antimicrobial misuse. The clinical practice improvements included more judicious prescribing and enhanced adherence to infection prevention and control measures. Many respondents highlighted stronger leadership skills and a commitment to capacity building through AMS committees, multidisciplinary collaboration, and cross-organisational knowledge exchange. Despite resource constraints and logistical hurdles, participants expressed optimism, citing data-driven approaches such as point prevalence surveys to track progress and inform policy. Engagement with hospital management and public outreach were viewed as essential to sustaining AMS efforts and curbing over-the-counter antibiotic misuse. Conclusions: The hub-and-spoke model caused observable improvements in AMS knowledge, clinical practice, and leadership capacity among healthcare professionals in Ghana. While challenges remain, particularly in securing sustainable resources and shifting community behaviours, these findings underscore the potential of network-based programs to catalyse systemic changes in tackling AMR. Future research should explore long-term outcomes and strategies for embedding AMS practices more deeply within healthcare systems and communities. Full article

In 2020, Directive (EU) 2020/2184 was published and subsequently transposed into Italian legislation via Legislative Decree 18/23 (Lgs.D. 18/23). The Directive aims to protect public health through a proactive approach based on a site-specific risk analysis along the entire water supply chain (Water Safety Plan, WSP). Between February and November 2024, a survey was conducted in Italy to assess both hospitals’ knowledge of Lgs.D. 18/23 and the application of the WSP in these facilities. A total of 300 hospitals were asked to complete an anonymous questionnaire containing 60 questions about the characteristics of the facility and the management of the water network, including the chemical–physical and microbiological monitoring of Legionella and other microbiological parameters. A total of 102 questionnaires were sent out (response rate: 34%), but only 72 were properly completed and analyzed. The results of the chemical–physical monitoring are not presented in this manuscript. Overall, 52.8% of the hospitals were built before 2000, and most are aware of Directive (EU) 2020/2184, Lgs.D.18/23 (80.6%), in particular, Article 9 on the risk assessment and management of internal water systems and the guidelines for its implementation (77.8%). All hospitals perform annual microbiological water testing, including Legionella analysis, with a detection rate of <50%. National guidelines for the implementation of WSPs are known in 75% of the hospitals, but only 38.9% have started planning to implement them, and 13.9% organize staff training on the subject. The questionnaire responses highlight the need to train hospital staff in water system risk management and WSP planning, which will be mandatory by 2029. Full article