Search Results (268)

Heavy metals are widespread environmental contaminants from natural and anthropogenic sources, posing risks to human health and ecosystems. In urban areas, levels are elevated due to industrial activity, traffic emissions, and building materials. Camden, New Jersey, a city with a history of industry and illegal dumping, faces increased risk due to aging sewer and stormwater systems. These systems frequently flood neighborhoods and parks, heightening residents’ exposure to heavy metals. Despite this, few studies have examined metal distribution in Camden, particularly during storm events. This study analyzes stormwater metal concentrations across residential and commercial areas to assess contamination levels, potential sources, and land use associations. Stormwater samples were collected from 33 flooded street locations after four storm events in summer 2023, along with samples from a flooded residential basement during three storms. All were analyzed for total lead, cadmium, and arsenic using inductively coupled plasma–mass spectrometry (ICP-MS, (Department of Chemistry and Biochemistry, Rowan University, Glassboro, NJ, USA)). Concentration data were visualized using geographic information system (GIS)-based mapping in relation to land use, socioeconomic, and public health factors. In Camden’s stormwater, lead levels (1–1164 µg L⁻¹) were notably higher than those of cadmium (0.1–3.3 µg L⁻¹) and arsenic (0.2–8.6 µg L⁻¹), which were relatively low. Concentrations varied citywide, with localized hot spots shaped by environmental and socio-economic factors. Principal component analysis indicates lead and cadmium likely originate from shared sources, mainly industries and illegal dumping. Notably, indoor stormwater samples showed higher heavy metal concentrations than outdoor street samples, indicating greater exposure risks in flooded homes. These findings highlight the spatial variability and complex sources of heavy metal contamination in stormwater, underscoring the need for targeted interventions in vulnerable communities. Full article

Small-scale artisanal mine production processes are characterized by significant environmental and human health impacts, especially in countries with ineffective economic resources and policies. This study accurately quantifies the impacts of artisanal gold production processes, identifying the dominating hotspots in a holistic perspective. The life cycle assessment (LCA) methodology was applied to perform an environmental sustainability appraisal for Doré and Cyanidation Gold (CyG) extraction from Mina Nueva, a small-scale artisanal mine managed by the local population, located in Asociación Campesina del Valle del río Cimitarra, near the city of Segovia in the department of Antioquia in Colombia. The obtained single-score LCA results showed a total damage of 4.99 × 10⁰² Pt, of which 55.2% was associated with the cyanidation process, 34.4% with the whole-ore amalgamation phase, and 10.4% with mine construction. A sensitivity analysis was also performed to study the potential effects of particulate emissions generated by the mine construction phase. Full article

Background: Herpes zoster (HZ) represents a substantial public health concern among aging populations, yet regional variability in clinical patterns and risk determinants remains insufficiently documented. In southeastern Romania, epidemiological data are limited, and the combined influence of demographic, behavioral, and metabolic factors on disease severity has not been systematically evaluated. Methods: We performed a retrospective observational study including 100 consecutive patients diagnosed with HZ between 2019 and 2023 in a dermatology department in southeastern Romania. Demographic characteristics, lifestyle behaviors, anthropometric status, clinical manifestations, and outcomes were extracted from medical records. Associations between categorical variables were assessed using Chi-square tests and Cramer’s V, while interaction patterns were explored through log-linear modeling. Heatmaps were generated in Python (version 3.10) using the Matplotlib library (version 3.7.1) to visualize distribution patterns and subgroup relationships. Results: The cohort showed a marked age dependence, with 77% of cases occurring in individuals ≥ 60 years, consistent with immunosenescence-driven reactivation. Women represented 59% of cases, and 84.7% of female patients were postmenopausal. Urban residents predominated (91%). Vesicular eruption (84%) and acute pain (79%) were the most frequent symptoms. Localized HZ was observed in 81% of cases, while ophthalmic involvement (11%) and disseminated forms (8%) were less common. Lifestyle factors significantly influenced clinical severity: smokers, alcohol consumers, and sedentary individuals exhibited higher proportions of postherpetic neuralgia (PHN) and ocular complications (p < 0.001). Overweight and obese patients demonstrated a higher burden of PHN, suggesting a role for metabolic inflammation, although BMI was not associated with incidence. No significant association between age category and complication type was detected, likely due to small subgroup sizes despite a clear descriptive trend toward increased severity with advanced age. Conclusions: These findings support a multifactorial model of HZ severity in southeastern Romania, shaped by age, lifestyle behaviors, hormonal status, and metabolic risk. While incidence patterns align with international data, the strong impact of modifiable factors on complication rates highlights the need for targeted prevention and individualized risk assessment. Results offer a regional perspective that may inform future multicenter investigations. Full article

Despite ongoing advances in maritime safety research, ship accidents persist, with significant consequences for human life, marine ecosystems, and port operations. Because many accidents occur in or near ports, assessing a vessel’s ability to enter or depart safely remains critical. Although ports apply local navigational rules, safety criteria could be strengthened by adopting more adaptive and data-informed approaches. This study presents a mathematical framework that links Key Performance Indicators (KPIs) to a Ship Risk Profile (SRP) for collision/contact/grounding risk indication. Expert-based KPI importance weights were derived using the Average Rank Transformation into Weight method in linear (ARTIW-L) and nonlinear (ARTIW-N) forms and aggregated into a nominal SRP. Using routinely monitored KPIs largely drawn from the Baltic and International Maritime Council and Port State Control/flag-related measures, the results indicate that critical equipment and systems failures and human/organisational factors—particularly occupational health and safety and human resource management deficiencies—are the most influential contributors to the normalised accident-risk index. The proposed framework provides port authorities and maritime stakeholders with an interpretable basis for more proactive risk-informed decision-making and targeted safety improvements. Full article

Opioid overdoses in the United States remain a significant public health concern. Opioid use disorder (OUD) is stigmatized, exacerbating negative health outcomes. Reducing stigma in healthcare, including in pharmacies, is critical. The “Let’s Talk Stigma” program was collaboratively developed with two schools of pharmacy, a local health department, and individuals with lived drug use experience. It aimed to reduce OUD-related stigma among pharmacists, pharmacy technicians, student pharmacists, and other allied health professionals. The program included six core components: a podcast, continuing education, a standardized curriculum for student pharmacists, training for pharmacy technicians and medical assistants, pharmacy outreach by student pharmacists, and partnerships with chain pharmacies. The anti-stigma podcast reached a global audience with nearly 22,000 listens, while local sessions engaged over 5000 individuals. These initiatives were integrated into Doctor of Pharmacy curricula, with student pharmacists distributing stigma-reduction kits in local pharmacies. A mixed-methods approach, incorporating qualitative data from participant reflections and quantitative data from surveys, podcast analytics, and attendance records, was used for program evaluation. Participants reported increased awareness of stigma, improved attitudes, and greater professional responsibility to reduce stigma. The program successfully leveraged partnerships, flexible delivery methods, and inclusion of people with lived drug use experience in its design. Full article

Background/Objectives: Inefficient postoperative handovers contribute to medical malpractice and care discontinuity by omitting critical patient information and compromising patient health. This study aimed to evaluate and compare the quality of postoperative nurse handovers in ORs, PACUs, ICUs, and wards across four hospitals in Jeddah, Saudi Arabia. Methods: A descriptive, cross-sectional, comparative study was conducted among postoperative care nurses across four hospitals in the second health cluster in Jeddah, Saudi Arabia. Data were collected through an online questionnaire to assess handover quality via a Handover Quality Rating Form and sociodemographic information. Data analysis was performed using SPSS v28. Results: Among the 521 nurse participants (84.1% female, M_age = 34.5 years), the overall postoperative handover quality was 76.8%, with handover conduct and quality scoring the highest (27.9 ± 4.8 and 17.7 ± 3.1, respectively). Female nurses demonstrated significantly higher performance in teamwork and handover circumstances, whereas older nurses demonstrated significantly better teamwork, handover conduct, and quality. Saudi and younger nurses experienced significantly higher handover circumstances. Nurses’ educational level and years of experience in the present ward were significantly correlated with handover circumstances, conduct, and quality. Handovers from the theater to recovery resulted in higher average circumstances than those from recovery to the ward. The study setting was significantly associated with handover quality. Conclusions: These findings highlight the importance of local evaluating the handover quality of nurses in various contexts, specifically considering the circumstances, conduct, and teamwork when planning implementation and developing standardized handover protocols for different departments, specialties, and healthcare settings. These results support the development of targeted training programs and unit-specific handover protocols. Full article

Background/Objectives: Multidrug-resistant (MDR) Escherichia coli is a critical One Health challenge, with rising resistance in both humans and animals. The present study aimed to compare antimicrobial resistance (AMR) profiles of E. coli isolates from hospitalized patients and food-producing animals in Satu Mare, a county located in northwestern Romania. Methods: Between 2022–2023, 701 samples were collected, leading to 571 non-duplicate E. coli isolates (420 human, 151 animal). Human strains were recovered from 21 hospital departments and originated from feces, urine, blood, sputum, ear secretions, cerebrospinal fluid, purulent wound secretions, and puncture fluids. Animal isolates were obtained from ceca collected at local slaughterhouses serving farms in north-west Romania, including samples from turkeys, broilers, and pigs. Antimicrobial susceptibility testing was performed against eight antimicrobials (amikacin, ampicillin, cefotaxime, ceftazidime, cefepime, ciprofloxacin, gentamicin, sulfamethoxazole/trimethoprim) using standardized methods. Resistance classification followed international definitions of MDR. Statistical associations between host species and resistance were assessed with chi-square tests. Results: Resistance levels were consistently higher in E. coli strains isolated from animals compared with those from humans (p < 0.05). Among human isolates, resistance to ampicillin (41.9%), ciprofloxacin (41.4%), and sulfamethoxazole/trimethoprim (45.7%) approached, but did not exceed 50%. In contrast, E. coli strains recovered from animals showed markedly higher resistance, exceeding 50% for ampicillin (78.8%), ciprofloxacin (65.6%), and cefotaxime (55.0%). Amikacin retained full activity against all animal isolates, whereas 2.8% of human strains were resistant. Overall, multidrug resistance (MDR) was observed in 70.0% of E. coli isolates from humans and 79.7% from animals, with the highest resistance burden in pig-derived isolates. Conclusions: The study underscores the veterinary sector as a key contributor to the maintenance and spread of MDR E. coli. Even in clinically healthy animals, resistance levels exceeded those observed in human isolates. These findings emphasize the need for coordinated One Health monitoring and stricter antimicrobial use policies in livestock to reduce transmission risks across human and animal populations. Full article

Super-utilization, defined as frequent and often avoidable use of emergency departments and hospital admissions, has attracted significant policy and research attention due to its impact on healthcare costs. Over the past decade, care management and integrated care interventions have been promoted as solutions to reduce per capita expenditure and service use. However, systematic reviews and primary studies consistently report limited success in shifting utilization patterns or improving care experiences. This narrative review based upon critical systems heuristics explores the conceptual evolution of super-utilization and examines whether current approaches reflect the underlying complexity of the health system and patient needs. The three-phase narrative and complexity-informed review aimed to identify the evolution of Super-utilization as an issue and its key drivers, in relation to the dynamic systems in which it occurs. The findings reveal a predominant emphasis on cost containment and acute care metrics, with minimal incorporation of person-centered outcomes, lived experience, or local system dynamics. Even when addressing social determinants, interventions remain narrowly focused on utilization and/or costs as the key outcome. Super-utilization or High-Need/High-Cost trajectories reflect multi-level dynamics—biological, psychological, social, and political—yet these are rarely integrated into program design or evaluation. Centralized policy frameworks such as the Triple Aim risk reinforce inequities unless they actively address under-resourced populations and the complexity of chronic illness and ageing. Radical transformation of policy is required to make the nature of care of high-cost/high-need super-utilizers central to quality metrics that may improve outcomes rather than inappropriate utilization metrics which make little impact on healthcare costs. This review concludes that super-utilization requires a shift in paradigm toward systems-informed, needs-based approaches that integrate complexity theory and distributive justice to guide future research and interventions. Full article

On 25 April 2014, the municipal water source in Flint, Michigan, was switched to the Flint River. Failure to properly treat the water for corrosion resulted in lead contamination of the water system. Resident concerns were dismissed by local, state, and federal government agencies until community participatory and clinical pediatric research demonstrated the contamination, and the water was restored to the original source 18 months later. Recovery efforts established a public health registry, funded by the Centers for Disease Control and Prevention. A grant of public health authority and registry funding were awarded to Michigan State University in August 2017 to establish a health surveillance system and public health intervention to refer exposed individuals to community services. Community feedback requested tiered data-sharing consent options. Participants who consented to join the registry were presented with four consent questions: to be contacted about future research opportunities, to use survey data to make referrals to services on their behalf, to share with the registry their State of Michigan Department of Health and Human Services (MDHHS) program data, and to share Michigan Medicaid administrative data. This descriptive study found that most participants consented to being contacted for future research (88%), sharing data for referrals (84%), and sharing data from MDHHS programs (77%) with the registry. Among participants with Medicaid insurance, 74% consented to sharing Medicaid data. Consent increased with age and decreased with income and education. Consent was higher among participants reporting food insecurity in the last 12 months. Consent to share data was unexpectedly high in the context of environmental disaster, trauma, and government distrust. Further work is needed to explore whether participation in public health activities is positively impacted by the implementation of a tiered consent process to share data. Full article

Background/Objectives: Frequent users (FUs) are patients who repeatedly attend Emergency Departments (EDs). This study aims to identify the clinical and social characteristics of FUs in a Local Health Authority in Rome and to quantify and compare the variation in the probability of being FU attributable to General Practitioners (GPs) and Local Health Districts (LHDs). Methods: The Healthcare Emergency Information System and an automated database of Lazio Region residents were used for the collection of data on the patients’ socioeconomic status, GP, LHD and chronic diseases. Different FU thresholds (attendances ≥4, 5, 7 or 10) were used for descriptive analyses. Univariate logistic analysis and a multilevel logistic model were performed for inferential analyses. Results: A total of 89,036 individuals attended at least one of the 13 EDs included in the study. Mental illness was present in 2.6% of non-FUs compared with 7.6% of FUs with ≥4 attendances. The OR of being FU increased with higher clinical complexity. GP appeared to play an important role in determining FU behavior, while no significant effect was found on the LHD level. Conclusions: This study identified potential risk factors predictive of disproportionate ED use and may help policymakers address the FU phenomenon. Full article

Water is a vital resource for human survival, economic development, and environmental sustainability. It is essential to agriculture, energy production, public health, and biodiversity preservation. Efficient water management is even more important in areas that are prone to scarcity. This paper presents a systematic review of the management of water resources in South Africa, a country characterized by significant water scarcity challenges compounded by its socio-economic and ecological needs. South Africa’s limited freshwater resources are under extreme stress due to its semi-arid climate, unequal rainfall distribution, expanding population, and industrial needs. The nation’s water security has also been made more difficult by historical injustices, climatic fluctuations, and decaying infrastructure. Through a systematic review of 60 scholarly articles published between 2011 and 2025 in the Web of Science database, this study discusses the historical context of water management in South Africa, including the legacy of apartheid-era policies and their impact on access to water. It also examines current management practices, governance structures involving national and local authorities, the role of key institutions such as the Department of Water and Sanitation (DWS), climate change impact on water availability, population growth and urbanization, inequality and access, and challenges in South Africa’s water resources management (WRM). In particular, this review highlights the integration of scientific water quality and biostability assessment into the Integrated Water Resources Management (IWRM) framework in order to produce actionable insights that enhance resilience, sustainability, and equity in WRM. Furthermore, it explores future strategies for sustainable WRM, emphasizing the importance of IWRM, community participation, technological innovation, and climate change adaptation. Through this comprehensive analysis, the paper aims to contribute to a deeper understanding of the complexities and opportunities in ensuring water security for all South Africans. Full article

Urban noise levels that exceed the World Health Organization (WHO) recommendations have become a growing concern due to their adverse effects on public health. In Bogotá, Colombia, studies by the District Department of Environment (SDA) indicate that 11.8% of the population is exposed to noise levels above the WHO limits. This research aims to identify and categorize environmental noise sources in real time using an embedded intelligent system. A total of 657 labeled audio clips were collected across eight classes and processed using a 60/20/20 train–validation–test split, ensuring that audio segments from the same continuous recording were not mixed across subsets. The system was implemented on a Raspberry Pi 2W equipped with a UMIK-1 microphone and powered by a 90 W solar panel with a 12 V battery, enabling autonomous operation. The TinyML-based model achieved precision and recall values between 0.92 and 1.00, demonstrating high performance under real urban conditions. Heavy vehicles and motorcycles accounted for the largest proportion of classified samples. Although airplane-related events were less frequent, they reached maximum sound levels of up to 88.4 dB(A), exceeding the applicable local limit of 70 dB(A) by approximately 18 dB(A) rather than by percentage. In conclusion, the results demonstrate that on-device TinyML classification is a feasible and effective strategy for urban noise monitoring. Local inference reduces latency, bandwidth usage, and privacy risks by eliminating the need to transmit raw audio to external servers. This approach provides a scalable and sustainable foundation for noise management in smart cities and supports evidence-based public policies aimed at improving urban well-being. This work presents an introductory and exploratory study on the application of TinyML for acoustic environmental monitoring, aiming to evaluate its feasibility and potential for large-scale implementation. Full article

Background: Vision loss due to chronic eye diseases remains a significant public health challenge. Early detection through screening programs may reduce the burden of vision loss. This study aimed to assess the detection rate of eye diseases (glaucoma, AMD, and diabetic retinopathy), including those newly detected during opportunistic screening and ophthalmological consultations within the local government health policy program “Good Vision for Mazovians” in Mazovia, Poland. Material and methods: This study is a retrospective analysis of medical data from the registry of the Ophthalmology Department of the Międzylesie Specialist Hospital in Warsaw, which implemented the local government preventive program “Good Vision for Mazovians. Data from 1812 individuals (aged 18–92 years) participating in the “Good Vision for Mazovians” preventive program were analyzed. Results: Most participants were female (59.7%), aged over 60, and took medications regularly (62.7%). Excluding subjects with prior diagnosis of eye conditions, the detection rate was 38 suspected cases (3.8%) of glaucoma cases, 84 suspected cases of AMD (4.6%), and 21 suspected cases of diabetic retinopathy (1.2%). Most participants had not visited an ophthalmologist in the past two years (58.6%), reported low or average knowledge of eye health, had difficulty accessing ophthalmology services in their region (57%), and identified long waiting times for appointments as the main barrier to care (83.5%). Conclusions: Opportunistic screening for eye diseases in populations with limited access to eye care should be considered as a method for detecting common causes of irreversible visual impairment, particularly AMD. Older adults and individuals without higher education appear to face the greatest barriers to accessing ophthalmology services and may benefit the most from targeted opportunistic screening initiatives. Full article

Background: Accurate estimation of mortality is essential for effective public health planning, policymaking, and monitoring of health interventions. In Ghana, multiple data sources are used to estimate mortality, including civil registration systems, household surveys, census data, and health and demographic surveillance systems. This scoping review explores the existing sources of mortality data in Ghana, examining their challenges and opportunities. Methods: Using Arksey and O’Malley’s framework, we identified peer-reviewed and grey literature from Ghana Health Service, Ministry of Health, Ghana Statistical Service, WHO, and the United Nations. We selected studies published between 2000 and 2024 that focused on mortality estimation in Ghana. Data was extracted and synthesized into key themes: data sources, challenges, and opportunities. Results: Six major data sources on mortality were identified: Civil Registration and Vital Statistics (CRVS), census data, Demographic and Health Surveys (DHS), Health and Demographic Surveillance Systems (HDSS), Facility-Based Health Information Systems (HMIS), modeled estimates from the Global Burden of Disease (GBD) and from the United Nations Department of Economic and Social Affairs (UN DESA). Key challenges include under-registration of deaths (CRVS and HMIS), recall bias (DHS, census), limited geographic coverage (HDSS), inconsistencies in cause-of-death classification (HMIS, HDSS), and lack of local geographic coverage (GBD, UN DESA, DHS). Nonetheless, benefits include longitudinal follow-up (HDSS), local coverage and ownership (CRVS, HMIS) and international comparability (GBD, UN DESA, DHS). Conclusions: Mortality estimation in Ghana is supported by diverse but fragmented data sources. Strengthening the CRVS and HMIS systems, integrating multiple data streams, standardizing methodologies, and enhancing institutional partnership are essential steps toward improving data quality and coverage. This review provides recommendations for improvement towards better quality estimations of mortality in Ghana. Full article

Background: While disparities in vaccine uptake have been well documented, few studies have evaluated the impact of local vaccine programs on COVID-19 outcomes, namely cases, hospitalizations, and deaths. Objectives: Evaluate the impact of COVID-19 vaccine doses coordinated by the Louisville Metro Department of Public Health and Wellness (LMPHW) on COVID-19 outcomes by race across ZIP codes from December 2020 to May 2022 in Jefferson County, Kentucky. Methods: Fixed-effects longitudinal models with ZIP codes as ecological time-series units were estimated to measure the association between COVID-19 vaccine doses and outcomes with time lags of one week, two weeks, three weeks, four weeks, and one month. Models were adjusted for time (week or month of the year) and its interaction with ZIP code. Results: In the one-week lag model, significant negative associations were observed between LMPHW-coordinated vaccine doses and COVID-19 outcomes, indicating reductions of 11.6 cases, 0.4 hospitalizations, and 0.3 deaths per 100 doses administered. Vaccine doses were consistently associated with fewer deaths among White residents across all lags, with an average reduction of 0.2 deaths per 100 doses. No significant associations were found for Black residents. Temporal trends also indicated declines in COVID-19 outcomes when LMPHW’s vaccine administration program peaked, between March and May 2021. Conclusions: Timely uptake of COVID-19 vaccines remains critical in avoiding severe outcomes, especially with emerging variants. Racial disparities in vaccine–outcome associations emphasize the potential need for equitable, community-driven vaccine campaigns to improve population health outcomes. Full article