Search Results (3,821)

Background: The nursing profession is recognized as a high-risk occupation, with the emotional toll on healthcare workers reaching a critical point. A complex interplay of anger and cynicism, often stemming from systemic pressures and chronic moral injury, seems to increasingly affect nurses’ professional and personal lives. This psychological strain does not end when the shift ends; rather, it often manifests as insomnia and nightmare distress, creating a vicious cycle of exhaustion and emotional instability. This article explores how anger, cynical distrust, nightmare distress and insomnia are interrelated and jeopardize the well-being of nursing staff and what these “invisible” symptoms reveal about the current state of healthcare by confirming their prevalence rates. Methods: This cross-sectional study was conducted online in October 2025 and included 441 hospital nurses who completed the Dimensions of Anger Reactions-5 (DAR-5), the 8-item Cynical Distrust scale (CDS-8), the Nightmare Distress Questionnaire (NDQ) and the Athens Insomnia Scale (AIS). Results: The prevalence rates of anger, nightmare distress and insomnia were 41.5%, 6.6%, and 62.1%, respectively. Based on the CDS-8 scores, a notable proportion (20.9%) of nurses fell within the highest quartile of CDS-8 scores (CDS-8 > 29), indicating relatively elevated cynical distrust within this sample; this threshold is sample-derived and does not correspond to a validated clinical cut-off. Hierarchical multiple regression analysis indicated that the DAR-5 explained 22.1% of the variance in AIS, while an additional 10.2% was explained by NDQ and another 1.5% by the CDS-8. Both cynical distrust and nightmare distress displayed a chain mediation pattern in the association between anger and insomnia; however, given the cross-sectional design, the temporal order of these variables cannot be confirmed. Conclusions: Anger exhibited significant direct and indirect associations with insomnia, with cynical distrust and nightmare distress acting as serial mediators in this cross-sectional model. Findings from this cross-sectional study tentatively suggest that future intervention efforts targeting insomnia in nurses might benefit from addressing anger alongside nightmare distress and cynical attitudes; however, experimental studies are needed to confirm whether such interventions would be effective. Full article

Against the global backdrop of carbon neutrality and the green transition of the construction sector, modern timber-framed buildings have emerged as a core enabler of sustainable construction. However, a systematic synthesis of research on indoor hygrothermal environments and thermal comfort in such buildings remains lacking, and the underlying coupling mechanisms—as well as pathways for performance optimization—are still insufficiently understood. To address these gaps, this study aims to systematically characterize and evaluate the performance features of indoor thermal and moisture environments in modern timber buildings, and to identify the key influencing factors and their underlying mechanisms. In accordance with the PRISMA 2020 guidelines for systematic reviews, this study identified and analyzed 203 high-quality peer-reviewed publications retrieved from three major academic databases, covering the period 2010–2025. Specifically, the literature search was conducted across the Web of Science, Scopus, and the China National Knowledge Infrastructure (CNKI), and visualization analysis was performed using VOSviewer 1.6.20 software. The results indicate that timber-framed buildings exhibit distinctive indoor hygrothermal characteristics: rapid temperature response, strong humidity buffering capacity, and superior thermal insulation performance compared with concrete structures, enabling indoor relative humidity to remain stably within the thermally comfortable range. Nevertheless, challenges persist, including summer overheating and elevated risks of mold growth under hot-humid conditions. Furthermore, the PMV model demonstrates significant predictive deviation for thermal comfort in timber-framed buildings; its application thus requires calibration incorporating both the hygrothermal properties of timber materials and occupants’ psychological adaptation. This study synthesizes the current state of research, identifies key influencing factors, and proposes climate-responsive optimization strategies to advance the development of robust thermal comfort models and support the low-energy, high-comfort design of timber-framed buildings. Full article

Industry 4.0 (I4.0) is transforming industrial systems through interconnected, data-driven technologies, raising questions about how these developments affect Occupational Health and Safety (OHS). This study investigates research trends, thematic structures, and knowledge gaps at the intersection of I4.0 and OHS using a multilevel bibliometric framework applied to Scopus records published from 2011 to 2025. The analysis moves from a broad overview of the I4.0 landscape to more focused examinations of specific I4.0–OHS publications, prevention-oriented studies, and emerging-risk research. The results show that OHS has limited visibility in the general I4.0 literature and is more prominent mainly in targeted subsets, where digital sensing, artificial intelligence, machine learning, and immersive technologies drive prevention-focused research. Conversely, emerging risks such as cognitive load, psychosocial stressors, and human–autonomy interaction appear in smaller, more dispersed clusters. Overall, the findings suggest that the relationship between I4.0 and OHS is unevenly developed, with established prevention mechanisms and early-stage conceptualization of new risks. Strengthening this field will require integrating human factors with digital indicators, better characterizing emerging risks, and ensuring that digital transformation supports SDG 8 by fostering safe and healthy working environments. Full article

Background/Objectives: This study aimed to evaluate the relationship between cumulative occupational exposure and ocular surface alterations in Colombian tomato farm workers, using data collected through a cross-sectional survey. In addition, the study sought to explore how occupational exposure duration may support risk stratification and targeted preventive strategies in this vulnerable population. Methods: A cross-sectional observational study was conducted involving 72 tomato farm workers in Colombia. Participants were grouped according to duration of agricultural work experience (<15 years vs. ≥15 years). Clinical assessments included slit lamp examination, tear film break-up time (BUT), Schirmer test, and fluorescein staining. Subjective symptoms were evaluated using the McMonnies Dry Eye Questionnaire. Ocular surface alterations, including conjunctival changes and Meibomian gland dysfunction, were documented and statistically analyzed between groups. Results: Workers with ≥15 years of experience reported significantly higher dry eye symptom scores (McMonnies mean = 8.19 ± 2.54) than those with <15 years (mean = 6.59 ± 2.61; p = 0.006). Schirmer test scores were lower in the experienced group (16.30 ± 11.48 mm vs. 22.71 ± 11.20 mm; p = 0.018), indicating reduced tear production. Bulbar conjunctival alterations and Meibomian gland obstruction were significantly more frequent in the experienced group (p = 0.002 and p = 0.013, respectively). No significant differences were found in BUT or eyelid findings. Conclusions: Long-term agricultural work was associated with increased dry eye-related symptoms and clinical signs of ocular surface compromise among Colombian tomato farm workers. From a personalized medicine perspective, occupational exposure duration may represent a useful risk-stratification factor to identify workers who could benefit from targeted screening, preventive counseling, protective interventions, and individualized follow-up. These findings support the implementation of tailored occupational eye health strategies to reduce cumulative ocular surface damage in vulnerable rural populations. Full article

Background: Nursing students are at high risk of exposure to blood and body fluids due to limited clinical experience. Ensuring adequate knowledge and proper post-exposure protocols is vital for improving safety and post-exposure management. Aim: This study aimed to evaluate the level of knowledge, previous exposure experience, and reporting practices regarding occupational exposure incidents among nursing students at the Faculty of Health Sciences, University of Split, Croatia. Methods: A cross-sectional study was conducted among 274 nursing students using a structured self-administered questionnaire. Descriptive statistical methods were applied, along with univariate and multivariate linear regression analyses. Results: Exposure incidents were experienced by 36.3% of students, with needlestick injuries being the most common (80.1%). In terms of reporting practices, fewer than half (40.8%) of those affected officially reported the incident. While students demonstrated adequate overall performance on the knowledge assessment (median score 12, IQR: 11–14), significant gaps were identified in hepatitis B and C protocols and immediate wound care. Multivariate analysis identified full-time student status (β = 1.24; p = 0.010) and first-year students (β = 0.82; p = 0.036) as factors significantly associated with higher knowledge scores. Conclusions: Although nursing students possess solid fundamental knowledge of exposure-related risks, a significant gap remains in their practical application and incident reporting. The high incidence of needlestick injuries (80.1%) underscores the importance of moving beyond theory toward enhanced clinical supervision. To address these gaps, nursing education should prioritize targeted practical training and cultivate a robust safety culture that encourages incident reporting. Full article

Seatbelt use is well established as a life-saving measure. Nevertheless, many drivers and passengers continue to neglect seatbelt use. This study examines the risks associated with unrestrained occupants involved in motor vehicle crashes. Using data from the Fatality Analysis Reporting System from 2000 to 2018, the relative risk of fatal traffic accidents for unrestrained vehicle occupants in the United States was estimated using the maximum likelihood estimation method. The findings indicate that unrestrained passengers make up about 12% of all passengers on the road and face a roughly 4.3 times greater likelihood of fatality in severe crashes. Additionally, unrestrained drivers, whose higher risk profiles are linked not only to their lack of restraint but also to broader patterns of hazardous driving behavior, account for over 8% of all drivers and exhibit a risk approximately 5.4 times higher in causing fatal crashes compared to restrained drivers. The findings of this study reveal the prevalence and consequences of unrestrained vehicle occupants and supports ongoing efforts to promote seatbelt utilization and bolster road safety protocols. By doing so, we can alleviate the burden of preventable injuries and fatalities on individuals, families, and society at large, thus fostering a safer and more secure transportation environment for all. Full article

Background/Objectives: Vaccine-preventable diseases remain a persistent public health challenge in regions characterized by structural vulnerabilities, including suboptimal vaccination coverage, socioeconomic deprivation, and limited access to healthcare. In structurally vulnerable regions, such as the South-West Romanian region, characterized by persistent vaccination gaps and recurrent outbreaks, these conditions generate a sustained public health burden that requires ongoing preventive risk management strategies. In such contexts, digital risk stratification tools may support preventive decision-making by enabling early identification of patients at increased risk of severe outcomes. This study applied machine learning techniques to routinely collected measles surveillance data from South-West Romania to identify severe disease cases and determine key predictors of severity, offering a pragmatic alternative to outbreak forecasting in a resource-constrained setting. Methods: An open epidemiological dataset of laboratory-confirmed measles cases reported by the Regional Center for Public Health Surveillance Craiova was analyzed. The dataset defined severe cases as those with pneumonia, thrombocytopenia, a hospital stay exceeding three days, or other documented complications requiring medical intervention. Random Forest (RF) and Logistic Regression (LR) classifiers were trained and compared using a 10-fold cross-validation framework across 200 resampling iterations. Model performance was assessed using accuracy, AUC-ROC, sensitivity, specificity, positive predictive value, and F1-score. Feature importance was quantified using permutation-based measures, and the highest-ranked predictors were further evaluated through chi-square tests of independence. Results: RF significantly outperformed LR in accuracy (0.84 vs. 0.82), AUC (0.87 vs. 0.80), specificity (0.87 vs. 0.84), positive predictive value (0.89 vs. 0.86), and F1-score (0.84 vs. 0.83), with p ≤ 0.001 for most metrics. Sensitivity was equivalent between models (approximately 0.81; p = 0.328). Feature importance analysis identified seven key predictors: county of residence, vaccination status, outbreak status, presence of other symptoms, occupation, cough, and conjunctivitis. All seven were significantly associated with disease severity, and six showed significant geographic variation across counties. Vâlcea County had the highest concentration of severe cases. The model was trained on a regional surveillance cohort in which symptomatic and hospitalized cases are over-represented and should be interpreted as a triage-support tool within this surveillance context rather than as a population-level severity estimator. Conclusions: Machine learning, particularly RF, can effectively identify severe measles cases using routinely collected surveillance data in settings where robust outbreak prediction is not feasible. The county of residence functioned as a composite proxy for structural determinants, including healthcare access, vaccination coverage, and socioeconomic deprivation. These findings support the use of ML-based severity classification as a pragmatic tool for clinical risk stratification and targeted public health intervention in resource-constrained environments. Full article

Firefighters and forest brigades engaged in wildfire suppression are routinely exposed to smoke containing toxic compounds that pose acute and chronic health risks, and it is important to understand how they perceive these risks during their work. This study aimed to evaluate health risk perception among military firefighters and contracted forest brigades in the Federal District, Brazil, the use of respiratory protection equipment (RPE), and institutional support. A questionnaire was administered to 150 firefighters and 22 brigades in 2023 and 2024. Most respondents were between 30 and 40 years old, with firefighters having a significantly higher education level than brigades (p < 0.0001). Most were concerned about smoke exposure and recognized its high health risk, including respiratory diseases and cancer, with brigades showing a higher risk perception than firefighters (p < 0.0001). Despite this high perceived risk, about 80% of firefighters and 86% of brigades reported not using RPE, mainly because it was not provided by their institutions (according to 53.8% of firefighters and 73.7% of brigades). The level of concern about wildfire smoke among participants correlated positively with age, years of experience, perceived necessity of RPE, and willingness to use it if provided. Firefighters rated their institution’s performance on occupational health and safety significantly less positively than brigades (p < 0.0001). The results of this study demonstrated that the lack of preventive and protective practices is not due to low risk perception, but rather to institutional failures in guidance, support, and provision of RPE. Full article

Background: Workplace-related outbreaks of invasive pneumococcal disease (IPD) have been increasingly reported among shipyard workers, yet their epidemiological and clinical features remain incompletely characterized. This systematic review and meta-analysis aimed to synthesize available evidence on IPD outbreaks in shipyard settings. Methods: A systematic search of PubMed/MEDLINE, Scopus, EMBASE, and medRxiv was conducted up to March 2026. Observational studies reporting IPD outbreaks in shipyards were included. Pooled incidence rates and clinical outcomes were estimated using random-effects models, with heterogeneity assessed by I² statistics. Risk of bias was evaluated using the Newcastle–Ottawa Scale. Results: Eight studies describing six outbreaks across four European countries (France, Norway, Northern Ireland, Finland; 2015–2025) were included, encompassing 131 cases among 35,623 workers. The pooled incidence was 368.9 cases per 100,000 workers with an attack rate of 2.36 per 1000 person-months for total cases, compared to 200.49 cases per 100,000 workers (95%CI 103.54–387.85) and 1.10 cases per 1000 person-months (95% CI 0.17–2.03) for laboratory confirmed cases, with considerable heterogeneity across studies. Most cases occurred in men (97.7%), with the median age ranging from 39 to 48 years. Hospitalizations occurred in 79.1% of cases, intensive care unit admission in 13.7%, and the case fatality ratio was 0.8%. Serotype 4 accounted for 67.2% of characterized isolates. Occupational exposures and shared accommodation may have contributed to transmission, although this could not be formally assessed. Conclusions: IPD outbreaks in shipyard settings are characterized by high incidence but relatively favorable outcomes, likely reflecting workforce demographics. However, considerable heterogeneity and methodological limitations across studies constrain the interpretation of pooled estimates. Preventive strategies, including vaccination and workplace-targeted interventions, should be considered as plausible public health measures, with a proactive role for occupational health services. Full article

Objectives: Traumatic fractures represent a considerable burden to military personnel across nations. Despite substantial research examining traumatic fracture incidence and risk factors, there is no comprehensive synthesis of evidence on traumatic bone fractures in military populations. This study aimed to identify and synthesise findings from studies reporting on the incidence of, and risk factors for, traumatic fractures in military personnel. Design: Systematic review. Methods: A structured search was performed in PubMed, EBSCO, CINAHL, and ProQuest using key terms related to fractures, occupational exposure, and risk. Eligible studies were screened, and key findings including risk factors, incidence rates, and effect sizes were systematically extracted and summarised. Results: Twenty-nine studies were included, with four studies reporting on recruits/trainees and 25 on qualified personnel. Recruit incidence ranged from 21.8 to 105.3 fractures per 1000 person-years, while the incidence in qualified personnel ranged from 1.9 to 57.6 fractures per 1000 person-years. Enlisted personnel, younger servicemembers (18–29 years), and personnel of the Army and Marine Corps branches were at increased risk. Traumatic fractures predominantly occurred in the lower extremities. Risk factors and mechanisms for traumatic fractures in military personnel included sports participation and physical training. Other common mechanisms included motor vehicle accidents and collisions, and (in combat settings) blasts from improvised explosive devices and gunshot wounds. Conclusions: Traumatic fractures are a substantial source of injury across military careers, not limited to initial training. Army and Marine Corps personnel face higher fracture risks, particularly in the lower limbs, with sports/physical training and combat-related risk factors associated with increased susceptibility. Full article

This study aims to identify key health and safety challenges and examine root causes while developing a conceptual framework to improve safety. Results of the study will be useful for policy makers, regulatory authorities, construction managers, safety professionals and researchers to improve regulations, safety practices, training programs and policy development. The emerging construction industry in Sri Lanka is facing significant safety challenges for workers, including poor practices, inappropriate conduct, and negative attitudes. The construction industry was selected for this study due to its labor-intensive nature and its consistently high exposure to occupational hazards compared to other industrial sectors. The underlying root causes of these health and safety challenges remain unclear, primarily due to a lack of comprehensive government regulations, which are currently limited to the outdated Factories Ordinance of 1942. Sri Lanka was chosen as the focus of this study because of its rapidly expanding construction sector and outdated regulatory framework; it is also a representative of underdeveloped countries. Several studies have identified contributing factors such as outdated legislation, a shortage of qualified officers, poor attitudes, lack of funding, negligence, and limited awareness. To address this research gap, the safety aspects of the Sri Lankan construction industry have been examined, revealing emerging challenges such as poor safety practices, the presence of foreign workers, and the inadequate use of personal protective equipment (PPE) by staff. A deeper examination of these challenges indicates that sufficient safety budgets reflect leadership attitudes toward preventing injuries, and that targeted safety training for different roles can help mitigate these issues. Accordingly, a conceptual safety framework has been developed. A qualitative, semi-structured interview comprising both open- and closed-ended questions was conducted to gain insights from 26 experts (including engineers, architects, human resource personnel, safety officers, and managers) regarding workplace safety challenges. The interview data was thematically categorized based on the identified safety challenges using NVivo analysis, to determine their root causes and develop strategies to improve workplace safety. To evaluate the emotional tone of participants’ response, sentiment analysis was conducted. Results highlighted participants’ optimism when discussing proactive or successful safety measures, neutrality in objective assessments, and concern or dissatisfaction when addressing safety challenges and organizational shortcomings. Experts recommended that safety education should be introduced in universities and vocational institutes. Firms can incorporate safety training through toolbox talks and induction sessions, and they can allocate a safety budget in their contracts. The study suggests developing a certificate-level safety training module for the construction industry and provides fresh insights into the underlying causes of safety issues in the Sri Lankan construction sector. Furthermore, the study has implications for delivering a health and safety framework for project risk management in developing countries that face budget constraints and limited training and development opportunities for enhancing construction skill sets. Full article

Although Non-Wood Forest Products can offer interesting economic opportunities for rural communities, little is known about their commercial harvesters. Our work aims to shed light on the labour profiles, their accessibility to new entrants, and attractiveness for future green jobs. Through in-depth interviews, we explored the five-capitals profile of commercial resin, cork, mastic foliage, chestnut, pine nut, and wild mushroom harvesters in Spain. We found either freelance harvesters or entrepreneurs with a small gang. Our data show a typical male collector, who started the activity through his social networks (Social Capital), and whose origin depends on the product and Spanish region. Some commercial female harvesters were found in mushroom, chestnut and resin harvesting. Social constructs around the masculinization of these activities may explain their limited attractiveness for women. The ratio of non-Spanish commercial harvesters correlates with the weight of migrants in the analysed regions. Only a subgroup of resin harvesters devotes most of their year to this single activity. The rest complement NWFP income with a main forestry (cork and pinenut) or non-forestry occupation (mushroom, chestnut and mastic). For the latter products, access to Natural Capital was found to be crucial for job progress, as non-landowners require administrative and/or negotiation capacities to secure harvesting permits. Human Capital differs across NWFPs, from simpler skills such as recognising marketable produce and handling easy tools (mushroom, chestnuts, pine nut ground gathering and mastic), to complex abilities needed to balance efficiency with minimising tree damage (in resin tapping, pinenut shaking, and cork extraction). Such specialised tools and machinery (Built Capital) typically act as a barrier to entry and advancement. These profiles are expected to help decision-makers to design instruments promoting and regulating commercial harvesting, and tackle their risks: local landowners in allocating harvesting rights to external collectors; regional policymakers as competent authorities in forest legislation; and state-level administration concerning cultural, fiscal and labour-permit aspects. Full article

The public sector constitutes a complex system of psycho-affective management, where leadership and autonomy are crucial for institutional efficacy. The objective of this study was to analyze the relationship between leadership, autonomy (control over work), and other psychosocial risk factors across six departments of a government agency in Mexico, under the framework of NOM-035-STPS-2018. A quantitative, cross-sectional, and correlational design was utilized with 235 public servants, employing Reference Guide III of the official standard to identify psychosocial risk categories. The results, analyzed through Welch and Games–Howell tests, reveal significant differences based on the operational nature of each unit. Public Safety and Civil Protection present critical risks due to high demand and low control. The Municipal DIF (System for the Integral Development of the Family) stands out as a protective environment thanks to its positive leadership. A statistically significant association was identified between lower leadership quality and a decrease in work autonomy (rho = 0.701), along with a consistently low perception of performance recognition across all evaluated departments (p = 0.056). It is concluded that management style influences the perception of psychosocial risk, suggesting the need for interventions centered on humanistic leadership to mitigate occupational stress. Full article

Firefighters are repeatedly exposed to occupational trauma in high-risk work settings, and PTSD symptoms represent an important occupational and public health concern. This study examined the association between psychological safety and PTSD symptoms among firefighters and tested whether this association is conditioned by occupational identity and peer support within an occupational health framework. A cross-sectional survey was conducted with 314 firefighters in Gyeongsangbuk-do, South Korea. PTSD symptoms were assessed using eight selected items adapted from the PCL-5 representing core symptom domains. Confirmatory factor analysis, correlation analysis, and regression analysis were performed, and moderation analyses were conducted using PROCESS Macro (Model 1). Results indicated that psychological safety was negatively associated with PTSD symptoms. Both occupational identity and peer support significantly conditioned this association. The negative association was consistently observed across all levels of occupational identity, whereas it was significant only at or above the mean level of peer support. These findings suggest that psychological safety may be understood as an organizational resource related to PTSD symptoms in high-risk occupational contexts, while occupational identity and peer support may function as individual and social resources that condition this association. The findings highlight the importance of understanding occupational mental health based on the integrated roles of organizational, individual, and social resources. Full article

The textile industry is highly globalized, with production processes spread across multiple countries. While environmental impacts have been widely examined, less attention has been paid to how social risks are distributed along these supply chains. This study applies a Social Life Cycle Assessment (S-LCA) framework, utilizing the Social Hotspots Database (SHDB), to assess social risks in the production of cotton trousers. The analysis focuses on a supply chain linking Turkey, Thailand, and Cambodia, and integrates factory-level data with sector-level risk indicators. The results show that social risks are unevenly distributed across the supply chain. The highest risks occur in fabric production in Thailand and garment manufacturing in Cambodia, particularly in relation to wages, labor conditions, and occupational health. These findings point to the importance of labor-intensive stages in shaping overall risk patterns. The results suggest that globalization does not eliminate social risks, but rather shifts them across countries with different institutional conditions. These findings highlight the need to better account for social factors in establishing sustainable supply chains. Full article