Search Results (11,986)

Occupational Health and Safety (OHS) in educational settings is a vital responsibility that is often inconsistently implemented. There is a need for research to bridge the gap between policy and practice. This study employed a cross-sectional mixed-methods design in six schools in the capital city of Indonesia to identify key implementation barriers, strategies, and compliance levels in OHS. Data were collected from 217 teachers using a structured KPAP (Knowledge, Attitudes, Perceptions, Practices) survey and from an additional 38 teachers via Focus Group Discussions (FGDs). Quantitatively, teachers showed highly positive attitudes (99.4% viewing OHS as a professional duty) and generally positive perceptions but implementation practices were sub-optimal (e.g., low participation in drills and PPE usage), showing a gap between awareness and action. Qualitatively, the main barriers identified were a lack of specific OHS regulation or guidance for schools, limited resources/infrastructure, and the perception of OHS as a low priority. Management strategies focused on external collaboration and ongoing in-school initiatives. In conclusion, a significant gap exists between OHS awareness and its integration into school management, highlighting the urgent need for strengthened governance, comprehensive policies, and sustained capacity-building to ensure a proactive, safe, and sustainable school environment for staff and students. Full article

Carbon farming represents a strategic approach to enhancing agricultural sustainability while reducing greenhouse gas (GHG) emissions. In Türkiye, agriculture accounted for approximately 14.9% of national GHG emissions in 2023, dominated by methane (CH₄) and nitrous oxide (N₂O). By increasing carbon storage in soils and vegetation, carbon farming can improve soil health, water retention, and climate resilience, thereby contributing to mitigation efforts and sustainable rural development. This study reviews and synthesizes international and national evidence on carbon farming mechanisms, practices, payment models, and adoption enablers and barriers, situating these insights within Türkiye’s agroecological and institutional context. The analysis draws on a systematic review of peer-reviewed literature, institutional reports, and policy documents published between 2015 and 2025. The findings indicate substantial mitigation potential from soil-based practices and livestock- and manure-related measures, yet limited uptake due to low awareness, capacity constraints, financial and administrative barriers, and regulatory gaps, highlighting the need for region-specific approaches. To support implementation and scaling, the study proposes a policy-oriented, regionally differentiated and digitally enabled MRV framework and an associated implementation pathway designed to reduce transaction costs, enhance farmer participation, and enable integration with emerging carbon market mechanisms. Full article

Objectives: The study aims to assess the strategies used to estimate antimicrobial consumption (AMC) and the barriers encountered in data collection. It also addresses the perception about AMC based on the World Health Organization (WHO) definition. Methodology: The qualitative study adhered to the standard consolidated criteria for reporting qualitative studies (COREQ) guidelines. It involved stakeholders from diverse sectors, i.e., regulatory bodies, the pharmaceutical industry, international health organizations, policy experts, medical professionals, veterinary doctors, and academia (nursing, medicine, and pharmacy). A total of 37 in-depth interviews were conducted using a semi-structured interview schema. The interviews were recorded and transcribed verbatim. Codes were generated afterward and organized into themes. Results: Data analysis yielded five themes consisting of (i) Perception about Antimicrobial Consumption, AWaRe (Access, Watch, Reserve) classification and related terms, (ii) Antimicrobial Consumption: Policy Design, (iii) Data management and record keeping for the Estimation of Antimicrobial Consumption, (iv) Levels of Estimation for Antimicrobial consumption and Organizations, and (v) Challenges and suggested solutions in estimation of AMC: One health approach is the way forward. Conclusions: The study concluded that AMC and AMR are two sides of the same coin. The solution to AMR and excessive AMC is to re-evaluate the policy and implement legislation strictly. Efforts focused on irrational prescribing and unsupervised OTC sales of antimicrobials. This will help in reducing the consumption of broad-spectrum antimicrobials. Full article

Quality of life (QoL) is a multidimensional concept involving physical, psychological, social, and environmental dimensions. Therefore, it reflects not only individual well-being but also the overall well-being and sustainability of societies. Current approaches to QoL have expanded from purely economic or health-based indicators to incorporate a range of multidimensional analyses at urban, regional, and national levels, with more recent emphasis on interlinkages between socio-economic and spatial factors. This research investigates how geoinformation methodologies, including remote sensing, spatial analysis, and machine learning, can be applied to assess QoL across multiple spatial scales. Through a systematic review and comparative evaluation, the study aims to identify which indicators, data sources, and analytical tools are used at each spatial level—from neighborhood and urban scale to regional and national levels. Emphasis was placed on understanding how methodological approaches vary across scales and how spatial resolution, data availability, and urban context influence the design and implementation of QoL assessment frameworks. The main objective was to establish a common analytical framework for evaluating QoL across different spatial scales. The review revealed that combining data, machine learning algorithms, and spatial analysis approaches in a common framework will enhance comparative and predictive capabilities beyond the state of the art, although it will face significant data heterogeneity challenges. Future research aims to develop consistent, multidimensional models supportive of policies fostering sustainability and spatial equity in urban and regional contexts. Full article

Background: The objective of this work was to support the implementation of the European Health Technology Assessment Regulation (EU HTAR) and optimize performance of the evolving EU HTA system. Therefore, an inclusive multi-stakeholder framework of key performance indicators (KPI) for success measurement was developed. Methods: A modified Delphi-procedure was applied as follows: (1) development of a generic KPI pool at the Fall Convention 2024 of the European Access Academy (EAA); (2) review of initial pool and identification of additional KPIs; (3) development of prioritized KPIs covering patient, clinician, Health Technology Developer (HTD), and System/Member State (MS) perspectives, and (4) consolidation of the stakeholder-centric KPIs after EAA’s Spring Convention 2025. Results: Steps 1 and 2 of the Delphi procedure revealed 14 generic KPI domains. Steps 3 and 4 resulted in four prioritized KPIs for patients (patient input; utilization of patient-centric outcome measures; time to access; equity); six for clinicians (population/intervention/comparator/outcomes (PICO); addressing uncertainty; clinician involvement; transparency; equity and time to access); four for HTDs (PICO; joint scientific consultation (JSC) process; joint clinical assessment (JCA) process; time to national decision making); five from a system/MS perspective (PICO; learning and training the health system; reducing duplication; equity and time to access). The scope of, e.g., the PICO-related KPI, differed between stakeholder groups. Also, several KPIs intentionally reached beyond the remit of EU HTA as they are also dependent on MS-specific factors including national health systems and budgets. Discussion and Conclusions: The KPI framework developed here presents a step towards the generation of systematic multi-stakeholder evidence to support a successful implementation of the EU HTAR. The relevance of the identified stakeholder-centric KPIs is confirmed by their alignment with the Health System Goals suggested in the context of “Performance measurement for health improvement” by the World Health Organisation. Implementation of the framework, i.e., measurement of KPIs, is envisioned to provide evidence to inform the 2028 revision of the EU HTAR. Full article

Background/Objectives: The increasing trend of foodborne zoonotic pathogens exhibiting antimicrobial resistance (AMR) represents a growing threat to food safety and public health in sub-Saharan Africa (SSA). Resistant strains of foodborne zoonotic pathogens compromise treatment efficacy, raise illness, and threaten sustainable food systems in human and animal health. However, regional understanding and policy response are limited due to the fragmentation of data and the inadequacy of surveillance. This systematic review and meta-analysis aimed to achieve the following: (1) estimate the pooled prevalence of AMR, including multidrug resistance (MDR) in selected foodborne pathogens; (2) compare subgroup variations across countries, pathogen species, and antibiotic classes; and (3) evaluate temporal trends. Methods: Following PRISMA 2020 guidelines, studies published between 2010 and June 2025 reporting AMR and MDR in Salmonella, Campylobacter, or E. coli from food or animal sources in SSA were systematically reviewed. Data on pathogen prevalence, AMR profile, and MDR were extracted. Random-effects meta-analysis using R software was implemented to estimate the pooled prevalence and the 95% confidence intervals (95% CI). Subgroup analyses were performed to explore heterogeneity across countries, antibiotic class, and bacterial species. Results: Ninety studies from 16 sub-Saharan African countries were included, encompassing 104,086 positive isolates. The pooled foodborne pathogen prevalence was 53.1% (95% CI: 51.5–54.7), AMR prevalence was 61.6% (95% CI: 59.4–63.9), and MDR prevalence was 9.1% (95% CI: 8.3–10.0). The highest resistance was reported in Campylobacter spp. (43.6%), followed by Salmonella spp. (29.1%) and E. coli (22.8%). High heterogeneity was observed across studies (I² = 95–99%, p < 0.001). Conclusions: It is concluded that substantial AMR burden exists in food systems, highlighting an urgent need for integrated One Health surveillance, antimicrobial stewardship, and policy harmonization in SSA. Strengthening laboratory capacity, enforcing prudent antimicrobial use, and promoting regional data sharing are critical for the management of antimicrobial resistance in sub-Saharan Africa. Full article

Municipal solid waste management (MSWM) remains a critical environmental governance challenge in rural and peri-urban regions of the Global South, where service delivery gaps exacerbate illegal dumping and public health risks. Geographic Information Systems (GIS) are increasingly promoted as decision-support tools to improve waste collection efficiency and environmental monitoring; however, their adoption in resource-constrained municipalities remains limited. This study investigates the institutional and policy barriers shaping GIS readiness in four rural municipalities within South Africa’s Vhembe District. Using a qualitative case-study design, semi-structured interviews were conducted with 29 municipal officials across managerial and operational levels, complemented by 399 community responses to an open-ended survey question. Thematic analysis, guided by Institutional Theory and the Technology Acceptance Model (TAM), identified five interrelated themes: waste production and disposal behaviours, collection and infrastructure constraints, institutional and operational challenges, policy and standardisation gaps, and technology readiness. The findings reveal that weak service reliability, fragmented governance structures, limited human and financial capacity, and inconsistent policy enforcement collectively undermine GIS adoption, despite its high perceived usefulness among officials. The study demonstrates that the effectiveness of GIS as an environmental management tool is contingent on institutional readiness rather than technological availability alone and highlights the need for integrated reforms in service delivery, institutional capacity, and policy implementation to enable GIS-supported sustainable waste management. Full article

Background/Objectives: This qualitative study examines strengths and strains faced by professionals working with young carers throughout the United Kingdom (UK) in the context of society’s youngest carers; young carers in early childhood (YCEC) (0–8 years). Methods: The Power Threat Meaning Framework (PTMF) was utilised to map key findings of three focus groups. This conceptual lens offers a narrative-based understanding of ways in which power operates in society. Increasingly applied to explore experiences of individuals, communities, and groups, the PTMF proposes that concepts of distress are founded in broader contexts of injustice and social inequalities. Twenty-four participants were recruited from throughout the UK via the Carers Trust Young Carers Alliance. Results: Findings highlight the strength of legal, ideological, and economic power shaping societal beliefs and policy concerning YCEC. This informs constructs of perceived social norms regarding who young carers are most likely to be, and where they may be found. This power threatens the health and well-being of YCEC, impacting the ability of professionals to provide optimal support. Inappropriate policy formed from these assumptions disempowers those providing services to young carers at the frontline of service delivery. Professionals and adults with living experience of caring in their early childhoods reflect upon silent tensions that exist within society, suggesting that YCEC remain the ‘elephant in the room’. Conclusions: We make recommendations to review the efficacy of statutory mandates concerning the needs assessment of young carers in England, and to align policy concerning early childhood and young carers to embed young carers’ rights consistently, starting in early childhood. Full article

The global proliferation of plastics and their degradation into microplastics (<5 mm) have created a pervasive environmental crisis with severe ecological and human health consequences. Despite the exponential growth in microplastic research over the past decade, standardized protocols are still lacking. The absence of consistent sampling, analysis, and reporting methods limits data comparability, interoperability, and harmonization across studies. This study conducted a systematic bibliographic review of 355 peer-reviewed articles published between 2010 and 2022 that investigated microplastics in freshwater as well as marine water and sediment environments. The goal was to evaluate methodological consistency, sampling instruments, measurement units, reported characteristics, and data-sharing practices to identify pathways toward harmonized and FAIR (Findable, Accessible, Interoperable, and Reusable) microplastic data. Results show that 80.6% of studies focused on marine environments, 18% on freshwater, and 1.4% on both. This highlights persistent data gaps in freshwater systems, which function as key transport pathways for plastics to the ocean. Most studies targeted water (59%) rather than sediment (41%) and were mostly based on single-time sampling, limiting long-term analyses. Surface layers (<1 m) were predominantly sampled, while deeper layers remain understudied. Nets, particularly Manta, neuston, and plankton nets were the dominant tools for water sampling, whereas grabs, corers, and metallic receptacles were used for sediments. However, variations in mesh size and sampling depth introduce substantial biases in particle size recovery and reduce comparability across studies. The most common units were counts/volume for water and counts/g dry weight for sediments, but more than ten unit expressions were identified, complicating conversions. Only 35% of studies reported all four key microplastic characteristics (color, polymer type, shape, and size), and less than 20% made datasets publicly available. To advance harmonization, we recommend the adoption of consistent measurement units, mandatory reporting of key metadata, and wider implementation of open data practices aligned with the FAIR principles. These insights provide a foundation for developing robust monitoring strategies and evidence-based management frameworks. This is especially important for freshwater systems, where data remain scarce, and policy intervention is urgently needed. Full article

Background/Objectives: Poor dietary habits are a major contributor to non-communicable diseases (NCDs), the leading cause of mortality worldwide. To promote healthier eating, governments and stakeholders have implemented various nutrition policies, including front-of-pack nutrition labeling (FOPNL). The Choices International Foundation (Choices), through its criteria, supports these efforts through its standardized nutrient profiling system (NPS). Originally developed to underpin a positive FOPNL logo, in 2021, the criteria were expanded into a globally oriented five-level profiling system covering 23 basic and 10 discretionary food groups, addressing key nutrients such as trans-fatty acids, saturated fat, sodium, sugar, fiber, and energy. To ensure continued scientific relevance, the Choices criteria are periodically reviewed by an independent International Scientific Committee (ISC). Methods: This paper presents the 2025 revision of the Choices criteria, focusing on priority areas identified through stakeholder consultation and recent scientific developments. Results: Key updates include the introduction of nutrient-based equivalence criteria for plant-based alternatives to meat and dairy, based on protein and selected micronutrient thresholds. Non-sugar sweeteners (NSSs) were newly included as a factor that lowers a product’s health classification and makes it ineligible for a positive FOPNL. Additionally, the industrially produced trans-fatty acid (iTFA) criteria were revised and aligned with the latest World Health Organization (WHO) recommendations, improving both technical feasibility and policy coherence. While options for incorporating whole-grain and micronutrient criteria were explored, these were not included in the current revision. Conclusions: The 2025 update system enhances the scientific rigor, policy alignment, and global applicability of the Choices system. By providing a harmonized and evidence-based tool, it aims to support national policies that foster healthier food environments and, ultimately, improve public health outcomes worldwide. Full article

Background/Objectives: Bovine mastitis, a significant global concern in dairy farming, results in substantial economic losses and poses considerable risks to both animal and human health. With the increasing prevalence of antimicrobial resistance (AMR) in mastitis pathogens, the potential for resistant infections to spread from livestock to humans and the environment is becoming a critical public health issue. This narrative review summarizes the current evidence on antimicrobial resistance in pathogens causing bovine mastitis and examines it from a One Health perspective, encompassing animal, human, and environmental interfaces. Results: By examining the complex interplay among animal, human, and environmental health, we highlight key factors that drive resistance, including the overuse of antimicrobials, poor farm management, and environmental contamination. We also discuss innovative strategies, such as enhanced surveillance, pathogen-specific diagnostics, alternatives to antimicrobials, and sustainable farm practices, that can mitigate the emergence of resistance. Key knowledge gaps include a limited understanding of antimicrobial residues, resistant pathogens, and gene transmission pathways and inconsistent implementation of antimicrobial stewardship practices. Conclusions: This review emphasizes the need for a coordinated, multidisciplinary effort to reduce the burden of AMR in bovine mastitis pathogens, ensuring the continued efficacy of antimicrobials and safeguarding public health through responsible management and policy interventions. Full article

Even though environmental health and climate change are rapidly intensifying the severity of determinants of disease and inequity, training for health professionals in these areas remains fragmented across Europe. To address this gap, the European Medical Association (EMA), in collaboration with the European Network on Climate and Health Education (ENCHE), the International Network on Public Health and Environment Tracking (INPHET) and University College London, convened a one-day hybrid roundtable in London on 17 September 2025, focused on “Preparing Health Professionals for Environmental Health and Climate Change: A Challenge for Europe”. The programme combined keynote presentations on global and European policy, health economics and curriculum design with three disease-focused roundtables (respiratory, cardiovascular and neurological conditions), each examining the following topics: (A) climate and environment as preventable causes of disease; (B) healthcare as a source of environmental harm; and (C) capacity building through education and training. Contributors highlighted how environmental epidemiology, community-based prevention programmes and sustainable clinical practice can be integrated into teaching, illustrating models from respiratory, cardiovascular, surgical and neurological care. EU-level speakers outlined the policy framework (European Green Deal, Zero Pollution Action Plan and forthcoming global health programme) and tools through which professional and scientific societies can both inform and benefit from European action on environment and health. Discussions converged on persistent obstacles, including patchy national commitments to decarbonising healthcare, isolated innovations that are not scaled and curricula that do not yet embed sustainability in examinable clinical competencies. The conference concluded with proposals to develop an operational education package on environmental and climate health; map and harmonise core competencies across undergraduate, postgraduate and Continuing -professional-development pathways; and establish a permanent EMA-led working group to co-produce a broader position paper with professional and scientific societies. This conference report summarises the main messages and is intended as a bridge between practice-based experience and a formal EMA position on environmental-health training in Europe. Full article

Workers’ exposure to silica dust is a global occupational and public health concern and is particularly prevalent in Southern Africa, mainly because of inadequate dust control measures. It is worsened by the high prevalence of HIV/AIDS, which exacerbates tuberculosis and other occupational lung diseases. The prevalence of silicosis in the region ranges from 9 to 51%; however, silica dust exposure levels and controls, especially in the informal mining sector, particularly in artisanal small-scale mines (ASMs), leave much to be desired. This is important because silicosis is incurable and can only be eliminated by preventing worker exposure. Additionally, several studies have indicated inadequate occupational health and safety policies, weak inspection systems, inadequate monitoring and control technologies, and inadequate occupational health and hygiene skills. Furthermore, there is a near-absence of silica dust analysis laboratories in southern Africa, except in South Africa. This protocol aims to systematically evaluate the effectiveness of respirable dust and respirable crystalline silica dust exposure evaluation and control methodology for the mining industry. The study will entail testing the effectiveness of current dust control measures for controlling microscale particles using various exposure dose metrics, such as mass, number, and lung surface area concentrations. This will be achieved using a portable Fourier transform infrared spectroscope (FTIR) (Nanozen Industries Inc., Burnaby, BC, Canada), the Nanozen DustCount, which measures both the mass and particle size distribution. The surface area concentration will be analysed by inputting the particle size distribution (PSD) results into the Multiple-Path Particle Dosimetry Model (MPPD) to estimate the retained and cleared doses. The MPPD will help us understand the sub-micron dust deposition and the reduction rate using the controls. To the best of our knowledge, the proposed approach has never been used elsewhere or in our settings. The proposed approach will reduce dependence on highly skilled individuals, reduce the turnaround sampling and analysis time, and provide a reference for regional harmonised occupational exposure limit (OEL) guidelines as a guiding document on how to meet occupational health, safety and environment (OHSE) requirements in ASM settings. Therefore, the outcome of this study will influence policy reforms and protect hundreds of thousands of employees currently working without any form of exposure prevention or protection. Full article

This study examines how parental legal status operates as a fundamental social determinant of health and educational equity, focusing on long-term outcomes among U.S.-born and foreign-born children of immigrants. We hypothesized that intergenerational stress and institutional exclusion associated with undocumented status would lead to lower educational attainment and poorer health. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative cohort, participants were classified by inferred parental legal status: native-born, documented immigrant, and undocumented immigrant. Outcomes included high school graduation, college enrollment, depression scores, and chronic health conditions. Children of undocumented parents exhibited the most adverse outcomes—lower graduation (63.8%) and college enrollment rates (39.9%), higher depression, and greater chronic illness. In models controlling for socioeconomic factors, parental undocumented status independently predicted reduced odds of college enrollment (OR = 0.61, p < 0.001) and increased odds of reporting fair/poor health (OR = 2.10, p < 0.001). Findings highlight legal precarity as a potent driver of intergenerational disadvantage and underscore the need for policies addressing the barriers faced by children in undocumented families to promote health and educational equity. Full article

Background: Black and racialized immigrants with disabilities in Canada face overlapping systems of exclusion rooted in racism, ableism, and migration status. Yet, their experiences within health and rehabilitation services during the COVID-19 pandemic remain largely undocumented. This study explores how structural inequities shaped access to healthcare, rehabilitation, information, and community supports in the Greater Toronto and Hamilton Area (GTHA). Methods: Using narrative inquiry, ten in-depth interviews were conducted with participants who identified as Black or racialized, disabled, and having immigrated to Canada within the last 10 years. Narratives were analyzed through reflexive thematic analysis to identify how systems, relationships, and policies interacted to shape daily life, health and rehabilitation navigation during the pandemic. Results: Participants described systemic barriers in health and rehabilitation systems, experiences of “othering” and conditional belonging, and the critical role of informal and faith-based networks in navigating inaccessible services. Pandemic policies often intensified existing inequities. Conclusions: Findings underscore the need for intersectional health and rehabilitation planning that centers the voices of Black and racialized disabled immigrants. Addressing systemic racism and ableism is essential for equitable preparedness in future public health emergencies. Full article