Search Results (15,562)

Brazil presents a distinctive convergence of continental-scale climatic diversity, extensive urbanization, large-scale biomass burning, rapid land-use change, persistent air-quality monitoring gaps, and deep social inequalities, producing highly heterogeneous and compound environmental health risks. In this context, treating air pollution and climate change as parallel environmental crises obscures their structural interconnections through shared emission sources, mutually reinforcing exposure pathways, and overlapping health and social consequences. In this narrative review, we critically synthesize scientific and institutional lines of evidence and argue that air pollution and climate risks can be more effectively addressed in Brazil through a single strategic agenda for science, public health, and governance. We first discuss why these challenges cannot be managed in isolation, emphasizing the effects of heat, drought, stagnation events, biomass burning, and extreme weather on pollutant formation, dispersion, and health burden. We then examine Brazil as a critical case where recent regulatory advances coexist with structural limitations in monitoring, data integration, and territorial coverage. Based on this diagnosis, we propose an integrated national agenda organized around five mutually reinforcing priorities: monitoring through hybrid networks; predictive science through climate-informed modeling and early warning; public health through the convergence of epidemiology, toxicology, and mechanistic research; equity-oriented research and action through the explicit incorporation of vulnerability, inequality, and climate justice; and policy appraisal through the assessment of disease burden, economic costs, mitigation co-benefits, and trade-offs. We further discuss the governance mechanisms needed to connect these priorities and translate evidence into coordinated action and adaptive public policies. We also argue that the Amazon should be approached not as an isolated ecological exception but as a central component of a broader Brazilian and Global South discussion on environmental health, land-use change, and climate justice. In this scenario, Brazil has the scientific capacity and regulatory momentum to become a reference in the integrated management of air pollution and climate risks, but this will depend on replacing fragmented approaches with a coordinated framework capable of linking exposure, mechanism, burden, inequality, and action. Full article

Background: Indoor air quality (IAQ) represents a key public health and accessibility concern. Improving IAQ through policies and practices that reduce exposure to fragranced products and other indoor air contaminants may enhance accessibility and support equitable participation for individuals with Multiple Chemical Sensitivity (MCS). Methods: Using a qualitative-dominant mixed-methods design, we examined IAQ accessibility barriers and explored perceived implementation and accessibility gaps in existing fragrance-free policies among sixty individuals with MCS and related IAQ exposures across ten focus groups. Qualitative and quantitative data were collected in parallel, with thematic analysis conducted in NVivo. A structured IAQ and policy survey was administered to quantify reported experiences and policy impacts. Results: Approximately 63.3% of focus group participants reported dissatisfaction with the indoor environments they encountered. Qualitative findings highlighted indoor environments as inaccessible, inadequately controlled, and associated with ongoing exposure to fragranced products as well as other indoor pollutants. These findings indicate that current approaches often fail to ensure accessibility, leaving individuals with MCS exposed and excluded from full participation in workplaces, healthcare settings, and other public spaces. Conclusions: Comprehensive fragrance-free policies incorporating source control, education, ventilation, and accountability mechanisms may reduce exposure while improving accessibility and inclusion across the built environment. Full article

Health taxation has become an increasingly important fiscal policy instrument for promoting healthier consumption and improving public welfare. However, limited evidence exists regarding public perceptions of health taxation in countries where such policies have not yet been implemented. This study develops and empirically tests an integrated behavioral framework that examines the relationships among perceived health taxation, healthy consumption behavior, and sustainable public welfare, while considering the moderating roles of chronic disease in the family, trust in public health policy, and generation. Data were collected through a structured questionnaire administered to 402 adult respondents in Azerbaijan and analyzed using Structural Equation Modeling. The results indicate that perceived health taxation is positively associated with sustainable public welfare but negatively associated with respondents’ self-reported healthy consumption behavior. In contrast, healthy consumption behavior is positively associated with sustainable public welfare. Furthermore, chronic disease in the family negatively moderates the relationship between perceived health taxation and sustainable public welfare, whereas trust in public health policy and generation positively moderate the proposed relationships. The study contributes to the health taxation literature by providing evidence from a pre-implementation policy context. These findings offer practical implications for designing socially acceptable and effective preventive fiscal policies. Full article

Background: Multiple chemical sensitivity (MCS), a recognized disability, is a chronic, multisystem condition in which exposure to common chemical substances provokes adverse health effects and functional impairment. Although population-level data and emerging clinical research support the pathophysiological basis of MCS, individuals living with the condition frequently encounter barriers to recognition and accommodation across employment, healthcare, and housing systems. This study examines patterns of accommodation requests, refusals, and associated socioeconomic impacts among adults living with MCS in Canada, with particular attention to how institutional recognition shapes access to supports. To our knowledge, this is the first national Canadian study to examine accommodation request outcomes across both employment and housing among adults with MCS, combining quantitative and qualitative data. A national cross-sectional survey of 119 Canadian adults living with MCS was conducted between January and February 2021. Quantitative data were analyzed descriptively to assess accommodation requests, outcomes, employment status, income, and housing stability. Qualitative responses were analyzed thematically to contextualize participants’ experiences of disclosure, and accommodation outcomes. Participants were predominantly female (87%) with post-secondary education (90%). Among participants who reported being unemployed (29%), 94% attributed it primarily to MCS-related limitations. Accommodation denial was common: 85% of respondents reported requesting accommodations, and 78% of those experienced refusals. On housing conditions, 52% reported living in unsafe housing (defined as housing with the presence of mould or symptom-triggering exposures), while 17% reported being homeless (e.g., moving frequently, personal vehicle, tent). Findings should be interpreted in light of the cross-sectional design, self-reported data, and community-based recruitment, which may limit generalizability. The findings suggest that inconsistent institutional recognition of MCS can function as a barrier to accommodation, contributing to health, economic, and social inequities. Addressing these barriers requires clarified guidance on the duty to accommodate multiple chemical sensitivity, proactive scent-free and lowest-emission policies in workplaces and housing, and improved healthcare provider education to support accommodation documentation. Full article

Background/Objectives: Healthcare personnel (HP) are a priority group for seasonal influenza vaccination due to their increased occupational exposure and potential to transmit influenza in healthcare settings. This study examined patterns and factors associated with in-season influenza vaccination uptake among HP in Kuwait. Methods: A nationwide observational study was conducted using Ministry of Health (MOH) administrative records covering the 2022/2023 through 2024/2025 influenza seasons. A person–season dataset was constructed, comprising one observation per HP for each of the three seasons. The primary outcome was in-season influenza vaccination, defined as receipt of an influenza vaccine between September and March of a given study season. Independent variables included age, sex, nationality, governorate of residence, profession, managerial position, previous-year influenza vaccination status, and pre-season sickness absence duration (days). Generalized estimating equations (GEE) logistic regression model with an exchangeable correlation structure was used to estimate factors associated with vaccination uptake. Results: The final analytic dataset included 48,886 HP contributing 146,658 person–season observations across three influenza seasons. Overall, in-season vaccination uptake was 8.7%, and repeated vaccination across seasons was uncommon. Older age, male sex, non-Kuwaiti nationality, and being a physician were independently associated with higher odds of in-season influenza vaccination. Previous-year influenza vaccination was the strongest predictor of current-season vaccination uptake (aOR 2.01, 95% CI 1.87–2.16; p < 0.001). Compared with HP with no pre-season sickness absence, those with 1–3 pre-season sickness absence days had slightly higher adjusted odds of vaccination (aOR 1.08, 95% CI 1.03–1.14), whereas those with ≥8 days had lower adjusted odds (aOR 0.91, 95% CI 0.85–0.97). Conclusions: In-season influenza vaccination uptake among HP in Kuwait was low across three consecutive influenza seasons, with limited continuity of annual vaccination. Previous-year vaccination was the strongest predictor of current-season vaccination uptake, while the association between pre-season sickness absence and vaccination varied by absence duration. These findings support continued efforts to improve and sustain in-season influenza vaccination uptake among HP, while further research is needed to clarify the factors underlying vaccination decisions. Full article

Background/Objectives: Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults, and in Mexico’s rapidly growing older-adult population it may place increasing pressure on hospital-based care; however, Mexico-specific evidence to inform adult RSV immunization policy remains limited. This study estimated the long-term clinical and economic burden of medically attended RSV among adults aged 60–99 years in Mexico and evaluated the health impact and cost-effectiveness of a year-round RSVpreF vaccination program. Methods: A population-based Markov cohort model compared the RSVpreF vaccination with no vaccination in a hypothetical Mexican cohort aged 60–99 years over a lifetime horizon. Outcomes included RSV-related hospitalizations, emergency department (ED) and physician office (PO) encounters, in-hospital deaths, life-years (LYs), and quality-adjusted life-years (QALYs). Analyses were conducted from Mexican healthcare system and societal perspectives in 2025 Mexican pesos (MXN$) and US dollars (US$), with costs and outcomes discounted at 5% annually. One-way and probabilistic sensitivity analyses and scenario analyses assessed the robustness of the findings. Results: With 58% uptake, RSVpreF reduced hospitalizations by 187,825, ED encounters by 178,278, PO encounters by 465,976, and RSV-related deaths by 15,384. In the first 5 years, hospitalizations, ED encounters, and deaths declined by 31% each, and PO encounters by 14%. Over the lifetime horizon, vaccination generated an additional 96,227 discounted LYs and 71,526 discounted QALYs, while avoiding MXN$ 19,484 million (US$ 1061 million) in direct medical costs and MXN$ 3324 million (US$ 181 million) in indirect costs. Conclusions: Year-round RSVpreF vaccination in Mexico among adults aged 60–99 years could substantially reduce medically attended RSV cases and RSV-related mortality and is projected to be cost-effective, thereby supporting the adoption of preventive strategies to address the growing clinical and economic burden of RSV in Mexico’s aging population. Full article

Children living in agricultural communities are particularly vulnerable to pesticide exposure through multiple environmental pathways, yet community-level public policies specifically designed to protect children remain limited in many low- and middle-income countries. This study aimed to develop a community-based public policy for preventing pesticide exposure among young children in rural Thailand through a participatory action research (PAR) approach. Guided by the Kemmis and McTaggart PAR framework, one complete PAR cycle was conducted between February 2022 and January 2023 in Ban Nangoi Village, Sakon Nakhon Province, Thailand. Purposive sampling recruited 62 stakeholders representing parents, farmers, healthcare personnel, local government representatives, academics, and community members. Data were collected through semi-structured interviews, focus group discussions, participant observations, and community meetings and analyzed using thematic analysis. The PAR process enabled stakeholders to jointly identify local priorities and co-develop a context-specific public policy summarized as the “3 Cs for Farmers, 2 Ps for People, and 1 S for Community” framework. Participants reported greater awareness of pesticide-related health risks, stronger multisectoral collaboration, improved stakeholder communication, and wider adoption of preventive practices. These findings suggest that PAR is a feasible approach for co-creating context-specific public policies while strengthening local environmental health governance. Rather than demonstrating the effectiveness of the policy in reducing pesticide exposure, this study highlights the value of stakeholder participation and policy co-creation in supporting sustainable community action. Future research should incorporate objective pesticide exposure measures, quantitative outcome indicators, and longer-term follow-up to evaluate policy effectiveness across diverse agricultural settings. Full article

The introduction of Joint Clinical Assessments (JCAs) under the European Union Health Technology Assessment Regulation (EU HTAR) represents a major structural reform aimed at reducing fragmentation and duplication in clinical evidence assessment across Member States. While JCAs are intended to support national health technology assessment (HTA) processes through a common EU-level clinical evaluation, their integration into established national HTA and reimbursement systems remains untested at this early stage of implementation. This paper reports findings from two surveys conducted in 2025 among local affiliate representatives with expertise in relevant HTA and market access activities across 25 European countries (comprising 24 EU Member States and Norway), capturing early national perspectives on key aspects of JCA implementation. The surveys explored anticipated impact on national reimbursement timelines, current opportunities for early HTA advice and PICO input, approaches to handling post-JCA data availability, and nationally prioritised policy and implementation issues. Results indicate mixed expectations regarding the potential impact of JCA on reimbursement timelines, with perceived risks of delay largely viewed as possibly transitional and mitigable through national process adaptation. Respondents emphasised the importance of transparency in PICO consolidation and clarity on the use of JCA reports in national appraisals. Overall, the findings suggest that JCA may represent a reconfiguration rather than a centralisation of evidence assessment, with national influence exercised earlier in the assessment lifecycle. These insights provide policy-relevant input to inform ongoing EU HTA implementation and future refinement of the JCA framework. Full article

The 1st International Online Conference on Environments addresses issues of environmental understanding, management, and restoration. Sessions ranged from general frameworks to a broad area of specific investigations: heavy metal removal using inactive yeast, gadolinium’s aquatic toxicity, adsorptive removal of pollutants, energy recovery from waste and wastewater treatment, recycled carbon fibers, climate-resilient urban development, renewable biofuel production, green hydrogen, anthropogenic and volcanic CO₂ emissions, quantifying aging dignity in urban ecosystems and stray dogs as pollution health sentinels. Keynotes covered digital plant phenotyping for restoration, microplastic dynamics, agricultural residue management, carbon credits, air quality, atmospheric pollution, transitional waters, green chemistry, ecotoxicity, micropollutants, and coastal darkening effects on plankton, among others. Applied solutions included phytoremediation of eutrophication in urban streams, circular approaches in aquaculture, biochar for wastewater treatment, AI-assisted mangrove monitoring, and true-cost accounting for food systems. The conference demonstrated that effective environmental policy requires the integration of laboratory findings, field restoration, and shared resource responsibility across terrestrial and marine ecosystems. Full article

This study aims to develop and examine Lazarus and Folkman’s psychological stress and coping theory, utilizing scales that measure problem-focused and emotion-focused coping in the context of environmental issues, as defined by Homburg and colleagues, to predict adaptation behavior in agriculture. The goal is to analyze Iranian farmers’ problem-focused and emotion-focused coping styles in response to climate change stress. Using structural equation modeling (SEM), we examined the effects of cognitive appraisals, including demand appraisal and self-efficacy, along with collective efficacy, on problem- and emotion-focused coping. The data for this study were collected through paper-based questionnaires from 250 farmers in Iran. Our results indicate that the perception of increased threat and harm posed by water scarcity to agricultural income and health (demand appraisal), the belief in one’s ability to adapt (self-efficacy), and the perception of the effectiveness of collaborative efforts among farmers in enhancing adaptation (collective efficacy) are associated with both problem- and emotion-focused coping responses. Notably, the Cognitive Theory of Stress model was a stronger predictor of problem-focused coping, accounting for 91% of the variance, compared to just 15% for emotion-focused coping. The results from this study shed light on the cognitive processes most associated with particular types of coping styles. Our findings may inform and guide climate change policy and programs that aim to target and enhance farmers’ climate change adaptation and resilience. Full article

In regulated cross-institution electronic health record (EHR) sharing, access control may need to respect patient consent while also providing issuance accountability and revocation correctness. Existing multi-authority ciphertext-policy attribute-based encryption (MA-CP-ABE) schemes provide decentralized attribute management but generally do not bind key issuance and ciphertext use to explicit patient-authorized sharing episodes, nor do they provide proactive verification that accepted key packages are consistent with authenticated user requests and the current revocation state. In this paper, we propose a verifiable, consent-bound MA-CP-ABE scheme for cloud-assisted EHR sharing. The scheme binds ciphertexts and attribute key packages issued to a patient-signed consent identifier, supports request-consistent and verifiable key issuance, integrates revocation freshness and stale-key detection, and provides a two-layer accountability framework consisting of proactive issuance verification together with reactive tracing and audit. In addition, each issued package is bound to the enrolled user public key and to a user-originated commitment, supporting restricted designated-user delivery. Theoretical and experimental evaluations indicate that, under the stated trust and non-collusion assumptions, the proposed design strengthens consent-scoped access control and accountability while maintaining competitive computational efficiency for cloud-based EHR systems. Full article

Future climate projections suggest an increase in heat-related mortality and a decrease in cold-related deaths under warming scenarios. Understanding the health impacts of extreme heat, and their implications for healthcare demand is essential for assessing the future burden of climate-related illnesses. In this study, we examined the relationship between extreme heat events and Emergency Department Visits (EDV) for heat-related illnesses (HRIs) across the United States from 2018 to 2025. Using data from the Centers for Disease Control and Prevention (CDC) Heat and Health Tracker and other relevant sources, we analyzed EDV rates standardized to 100,000 population. We aggregated daily into the 10 U.S. Health and Human Services (HHS) Regions. We used 0.5° × 0.5° gridded maximum daily temperature data (aggregated to HHS regions with proportional area weighting) and daily maximum heat index extracted from the CDC data portal (estimated using the US National Weather Service methodology and aggregated to HHS regions using total population weighting) to characterize seasonal patterns and regional variability. The association between peak heat events and EDV time series was explored using log-linear mixed-effects models, which accounted for seasonal trends, climate variables, and their regional variability. Random effects were used to capture regional heterogeneity in predictor-response relationships, accommodating variation in associations across regions. Model performance was evaluated using prediction error metrics and goodness-of-fit assessments. Maximum temperature and heat index were both significant predictors, with the heat index offering a slightly better fit. Associations were largely contemporaneous, with peak correlations at lag zero, underscoring the need for real-time response. EDV increased several days before peak environmental conditions, consistent with early exposure effects. While temperature-EDV relationships varied regionally, heat index associations were more stable. This work underscores the urgent need for regionally adaptive public health strategies in the face of intensifying climate extremes and outlines future directions for research and policy to strengthen health systems’ preparedness in a warming world. Full article

Digital transformation is reshaping the mining industry by improving resource efficiency and environmental performance. However, empirical evidence explaining how, why, and under which organizational and institutional conditions digitalisation enhances sustainable operational performance (SOP) in Sub-Saharan African mining remains limited, despite the region’s strategic role in global mineral supply. This study examines the effect of digitalisation on sustainable operational performance using longitudinal panel data from 48 mining companies operating in Sub-Saharan Africa between 2013 and 2022. Digitalisation is conceptualized as a multidimensional organizational capability and measured through a Digitalisation Index. The index was systematically derived from corporate annual environmental, social and governance reports using transparent coding procedures and Principal Component Analysis, enhancing measurement transparency and reproducibility. SOP is measured using a composite index encompassing operational efficiency, equipment utilization and maintenance effectiveness, resource utilization and environmental sustainability, and occupational health and safety. Fixed effects panel regression serves as the primary estimator, while the two-step System Generalized Method of Moments addresses endogeneity and dynamic persistence, with robustness analyses confirming result stability. The findings show that digitalisation significantly enhances sustainable operational performance by transforming digital resources into organizational capabilities that strengthen operational resilience, optimize resource allocation, and improve sustainability outcomes. By integrating the Resource-Based View, Dynamic Capabilities Theory, the TOE framework, and the Natural Resource-Based View into a unified explanatory framework, this study advances theory while providing practical guidance for digital capability development and Industry 4.0 investment and informing policies that strengthen digital infrastructure, institutional readiness, and regulatory support for sustainable mining in Sub-Saharan Africa. Full article

IoT-connected healthcare sensor networks require authenticated and privacy-preserving data exchange among wearable sensors, mobile medical terminals, edge gateways, cloud servers, and medical institutions. Existing authentication schemes for healthcare IoT often bind signatures directly to user identities, exposing sensitive personal or institutional information and imposing heavy verification costs on resource-constrained sensing devices. To address this problem, we propose a fine-grained and flexible dual authentication scheme for healthcare sensor networks. In the proposed scheme, health data and diagnoses are signed with a fresh signing key and a fine-grained access control policy each time, so that the signer identity remains hidden while authorized entities can still modify permitted parts of signed data. No entity other than an authorized entity can trace a malicious signer or modify signed data without changing the data source. To support lightweight verification in sensor-edge-cloud deployments, we further present a verifiable outsourced authentication scheme that outsources time-consuming pairing operations to cloud servers; the online verification process then requires only six multiplication operations. As a fundamental technical component, we present a practical attribute-based sanitizable signature with shorter signature and key lengths and more efficient signing and signature-changing operations than the state-of-the-art policy-based sanitizable signature (P3S). Formal security analysis and experiments demonstrate the security and practicality of the proposed scheme for privacy-preserving healthcare sensing and medical data exchange. Full article

Artificial intelligence (AI) is transforming cardiovascular medicine through applications in disease detection, diagnosis, risk prediction, and clinical decision support. However, the clinical implementation of these technologies remains poorly characterised. This systematic review evaluated the current landscape of AI applications in cardiovascular medicine, focusing on implementation maturity and clinical translation. The review followed PRISMA guidelines and a prospectively registered PROSPERO protocol. Data extraction included study characteristics, cardiovascular domain, AI methodology, clinical application, validation strategy and implementation maturity, assessed using a predefined five-level framework. AI methodologies were classified as conventional machine learning, deep learning, hybrid ML/deep learning, multimodal AI, or large language models/generative AI. Seventy-four studies met the eligibility criteria. Conventional machine learning was the most frequently used methodology (47.3%), followed by deep learning (41.9%), whereas multimodal AI (5.4%), hybrid ML/deep learning (2.7%), and large language models/generative AI (2.7%) were uncommon. Applications focused mainly on screening and early detection (31.1%), risk stratification and prognosis (25.7%), treatment planning (16.2%), diagnosis (13.5%), and monitoring (12.2%). Most studies reached implementation maturity Level 3 (clinical validation, 47.3%) or Level 2 (technical validation, 35.1%), while only 13.5% achieved routine clinical implementation (Level 5) and 4.1% reached clinical deployment (Level 4). Although AI demonstrated promising diagnostic and prognostic performance across multiple cardiovascular conditions, most applications remain at the validation stage. Future research should prioritise implementation science, pragmatic evaluation, and real-world evidence to facilitate routine adoption and maximise patient benefit and healthcare value. Full article