Search Results (257)

Pesticide use remains important in modern agriculture, vector control, and household pest management. However, exposure to pesticide active ingredients and residues remains a persistent public health concern. In addition to active ingredients, people may also be exposed to other constituents of commercial pesticide formulations, such as adjuvants and solvents, which can influence overall toxicity and health outcomes. These exposures may occur among direct applicators and may also affect other populations through contaminated air, water, soil, food, clothing, and household surfaces. This narrative review examines pesticide exposure from a community health perspective, emphasizing occupational, para-occupational, residential, dietary, drinking-water, airborne, and cumulative exposure pathways. It highlights vulnerable groups, including agricultural workers, children, pregnant women, women in agricultural communities, older adults, people with chronic illness, and marginalized rural populations. Evidence reviewed in this article links pesticide exposure with acute poisoning, respiratory effects, neurobehavioral and neurodevelopmental outcomes, cancer-related risks, reproductive and developmental effects, endocrine and metabolic disruption, cardiovascular outcomes, dermatological reactions, immune dysregulation, and biomarker-based subclinical changes. Beyond disease endpoints, pesticide exposure may also affect household income, education, mental well-being, food security, livelihoods, and intergenerational health. Major challenges include weak exposure assessment, underreporting, limited biomonitoring in low- and middle-income settings, and inconsistent community-level indicators. Strengthening surveillance, risk communication, integrated pest management, safer storage and disposal, protective regulation, and community-centered biomonitoring is essential to reduce pesticide-related health burdens. Full article

Background: Group Care (GC) is an antenatal/postnatal care model comprised of a stable group of pregnant people or parent–child dyads receiving care in two-hour group sessions that combine clinical care with interactive discussion and learning. Integrating GC into healthcare systems organised for individual care poses challenges at both site and system levels. This study identified scheduling-related modifications across contexts to understand modification processes. Methods: We used an explanatory sequential design with mixed qualitative methods across seven GC implementation sites in Belgium, Kosovo, and the United Kingdom. A qualitative survey based on the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) was completed at each site by multiple stakeholders. Subsequently, in-depth interviews were conducted to further explore modification processes and examine whether changes were sustained or discontinued up to three years post-implementation initiation. Results: Two modifications were identified across countries: (1) combining GC sessions with individual consultations, and (2) integrating GC into digital booking and medical record systems. Guided by FRAME, we identified similarities and differences in the goals, drivers, and impact of these modifications. The dominant one-to-one antenatal care model strongly influenced modifications, making it more difficult to implement GC as a stand-alone model in obstetrician-led systems (Belgium and Kosovo) compared to a midwifery-led system (UK). In both contexts, the dominant model negatively influenced the perceived value of GC, with GC sessions viewed only as education and individual consultations seen as the actual care. Integration in the booking system appeared essential for payment and scheduling arrangements. Conclusions: Integrating GC scheduling into existing care pathways is challenging in systems where one-to-one care is the predominant model. Sustainable integration of GC requires early coordination and shared ownership across areas, including clinical, administrative, and IT. Full article

Background/Objectives: Pregnant and breastfeeding people require special considerations for enrollment in clinical trials. However, the baseline proportion of cardiovascular clinical trials including pregnant and breastfeeding people remains unclear. The objective of this study was to characterize the representation of pregnant and breastfeeding people in cardiovascular randomized clinical trials (RCTs) and to determine whether inclusion has increased following the 2018 removal of pregnancy from the FDA’s “vulnerable population” designation. Methods: We screened eight high-impact general medicine and specialty journals for cardiovascular RCTs published between 1 January 2019 and 31 December 2023. We included RCTs examining pharmacological, behavioral, educational, device, or procedural interventions. We excluded RCTs that recruited exclusively male, pediatric, geriatric, or postmenopausal populations, and those specifically designed for obstetrical populations. We also excluded publications reporting follow-up or subgroup, pooled, or secondary analyses of previously published trials. Data from RCTs were independently extracted in duplicate following the PRISMA guidelines. We examined each RCT for pregnancy and breastfeeding inclusion criteria, rationale for exclusion, and contraception requirements. Results: Of 3764 citations identified, 586 met the inclusion criteria. In total, four (0.7%) RCTs permitted inclusion of pregnant people, 382 (65%) explicitly stated their exclusion, and 200 (34%) did not provide specific enrolment criteria for them. The few studies that explicitly stated exclusion of pregnant people (31/382, 8.1%) provided a rationale. 225 (38%) RCTs explicitly stated exclusion of breastfeeding people, and none explicitly permitted inclusion. There was no significant difference in the proportion of pregnant or breastfeeding people included or excluded from RCTs that began enrollment before 2018 versus after 2018. Conclusions: Pregnant and breastfeeding people are primarily excluded from cardiovascular RCTs, and the justification for their exclusion is rarely provided. Full article

Fetal growth restriction (FGR) is frequently defined as the failure of the fetus to reach its genetically predetermined growth potential. Heat shock proteins (HSPs) are extreme-temperature-resistant molecules that help proteostasis. The aim of this prospective case–control immunohistochemistry study is to evaluate the expression of HSP90 and HSP70 in the placentas of pregnancies complicated with FGR and compare their levels with the control placentas of normal-growth pregnancies. A prospective case–control study was conducted including people undergoing singleton pregnancies who gave birth in a tertiary university hospital in Central Greece. Participants were divided into two equal groups: an FGR pregnancy group and a control group with normal growth. Immunohistochemistry of placental samples was assessed using anti-HSP90 alpha/beta antibody (clone F-8, Santa Cruz Biotechnology, Dallas, TX, USA) and anti-HSC70/HSP70 antibody (clone W27, sc-24, Santa Cruz Biotechnology, Dallas, TX, USA). A scoring system was created to quantify the expression of HSP90 and HSP70 in each sample, and the grade of staining was measured at four points. A total of 80 pregnant people were prospectively enrolled in our study, with 40 in each group. Both constitutive (HSP90β and HSC70/HSPA8) and stress-inducible (HSP90α and HSP70/HSPA1A/B) isoforms were analyzed. When comparing the total score of HSP expression, a statistically significant difference was observed for both HSP90 and HSP70. For HSP90 expression, only the Hofbauer cell’s stain was identified as a statistically significant independent factor, meaning that its positive expression was observed in Hofbauer cells. For HSP70 expression, only the staining of syncytiotrophoblasts was identified as an independent factor. FGR is a common pregnancy complication and a leading cause of stillbirth, neonatal mortality, and short- and long-term neonatal morbidity worldwide. Based on our findings, the lower expression levels of both HSP90 and HSP70 are associated with FGR, revealing a possible association with stress response in FGR pathophysiology. However, more robust data from larger-scale prospective studies are needed to elucidate the possible role of HSPs as potential FGR biomarkers. Full article

Hepatitis E virus (HEV) is an emerging zoonotic pathogen of increasing concern in developed regions and represents a major cause of acute viral hepatitis worldwide, primarily transmitted via the fecal–oral route. Although most infections are self-limiting, immunocompromised individuals, such as people living with human immunodeficiency virus (PLWH) and pregnant women, are at risk of severe outcomes, including chronic infection and fatal liver failure, respectively. This study was aimed at evaluating the prevalence and genetic diversity of HEV in PLWH and relevant ecological niches (swine and wastewater) in Venezuela. A total of 417 serum samples from PLWH, 85 wastewater samples, and 67 swine fecal samples were tested for serological or molecular HEV markers. The seroprevalence of anti-HEV antibodies among PLWH was 0.2% for IgM and 5.5% for IgG. HEV RNA was not detected in samples from PLWH or wastewater; however, a 1.5% prevalence of active infection was identified in swine. Phylogenetic analysis of a complete HEV genome revealed an unassignable subtype within genotype 3, tentatively designated as 3p. To the best of our knowledge, this study provides the first molecular characterization and report on HEV frequency in PLWH, wastewater, and swine in Venezuela. Full article

Toxoplasmosis is a cosmopolitan zoonosis that particularly threatens pregnant women, their fetuses and immunocompromised individuals. Among people living with HIV, Toxoplasma gondii may invade the central nervous system, producing neuropathological effects associated with mental and psychiatric disorders. We assessed the seroprevalence of anti-T. gondii IgG in HIV-infected and HIV-uninfected residents of Iquitos, Peru, and evaluated an in-house ELISA based on total lysate antigen (TLA) and recombinant GRA1 (rGRA1), with ELISA-TLA compared against a commercial kit. In this observational cross-sectional study, 151 participants were enrolled: 92 HIV-positive and 59 HIV-negative. ELISA-TLA showed a seroprevalence of 88.08% (133/151), reaching 91.30% (84/92) in the HIV-positive group and 83.05% (49/59) in the HIV-negative group. ELISA-rGRA1 showed a similar epidemiological pattern but lower overall seroprevalence, 81.46% (123/151), with 84.78% (78/92) in HIV-positive and 74.58% (44/59) in HIV-negative participants. Taken together, both TLA and rGRA1-based ELISAs showed similar epidemiological patterns, supporting the consistency of the serological findings. These results also indicate very high exposure to T. gondii in Iquitos, particularly among HIV-positive individuals, in whom prior exposure is clinically relevant because of the risk of reactivation under immunosuppression. Serological screening and preventive counseling may therefore be warranted in high-burden Amazonian communities. Full article

Background/Objectives: Vaccination is an important strategy to protect pregnant people, fetuses, and infants from severe influenza and COVID-19. However, as of April 2025 in the United States, only 14% of pregnant women had received the 2024–2025 COVID-19 vaccine, while influenza vaccine uptake among pregnant women was 38% compared to 57% in 2020. Our study assessed the perceived safety of receiving these vaccines during pregnancy within a community-based national cohort. Methods: Participants reported safety perceptions of vaccination during pregnancy and were categorized as (1) endorsing the safety of both COVID-19 and influenza vaccines, (2) endorsing the safety of only the influenza vaccine, (3) endorsing the safety of only the COVID-19 vaccine and (4) endorsing the safety of neither vaccine during pregnancy. We examined sociodemographics, behaviors, and beliefs correlated with these four categories. Log-binomial models were used to estimate the prevalence ratios of (a) endorsing the safety of only influenza vaccine versus endorsing the safety of both COVID-19 and influenza vaccines during pregnancy, and (b) endorsing safety of neither versus both vaccines during pregnancy. Results: In total, 40% of adults (N = 1725) endorsed the safety of both vaccines during pregnancy, 18% (N = 751) endorsed the safety of only the influenza vaccine, 4% (N = 183) endorsed the safety of only the COVID-19 vaccine, and 38% (N = 1621) did not endorse the safety of either vaccine during pregnancy. Participants who were non-Hispanic Black, reported inconsistent vaccination habits, and expressed low trust in government and healthcare providers were more likely to endorse the safety of only the influenza vaccine or neither vaccine compared with endorsing both vaccines. Conclusions: These findings highlight the need to build trust in the medical system, reduce access barriers, and use equitable, community-driven messaging to strengthen confidence in the safety of receiving the COVID-19 and influenza vaccines during pregnancy. Full article

Social capital has been well established to have beneficial effects on a variety of behavioral, developmental, and health outcomes across the life course. In particular, social capital has been proven to be a protective factor benefiting health, particularly among young people. However, we know little about whether or how social capital might provide a protective effect against a very specific mental health challenge of young and mid-adult life: experiencing postpartum depression. Using linear regression models and restricted-use data from the National Study of Adolescent to Adult Health (five waves conducted beginning in 1995 when respondents were in grades 7–12 and following them into adulthood) on women who gave birth during early adulthood, and controlling for a variety of demographic factors (such as race, parental and partner social capital, SES), we aim to understand potential associations between social capital derived from families and romantic partners and postpartum depression symptomology. Our findings suggest the need for approaches that help pregnant women build and maintain key social connections and resources with fathers and partners. Full article

Children and young people with a parent in contact with the justice system rarely receive the support they need; many are judged and stigmatised. Child Impact Assessments were developed by the Prison Reform Trust in collaboration with 28 children and young people from across the United Kingdom with experience of parental imprisonment, who said in interviews, focus groups, and an online survey that they want to be seen, listened to, and considered at all stages of a parent’s journey through the justice system: arrest, court, and sentencing, prison or community sentence, and prior to a parent’s release. They want to be supported, and they want to be included in decisions about that support. This paper lays out why Child Impact Assessments are needed; what they are; and crucially how they can be used in practice to ensure the right support is offered to meet a child’s needs at the earliest opportunity. The paper will provide evidence of how Child Impact Assessments can improve children’s wellbeing and will give an overview of recent developments to the resources. The authors will also explore future developments, including adapting the resources to understand the impact on unborn babies, babies, and very young children (the first 1001 days) when a pregnant woman or mother is in contact with the justice system. Full article

Objective: Bacterial vaginosis is a dysbiosis of the vaginal microbiome, typically characterized by a loss of Lactobacillus. Lactobacillus plays a crucial role in vaginal immunity and protection against sexually transmitted infections. Herpes simplex virus 2, the primary cause of genital herpes, impacts 13% of people worldwide. We undertook this systematic review and meta-analysis to examine the risk of herpes simplex virus 2 acquisition in women with bacterial vaginosis. Secondarily, we examined the impact of bacterial vaginosis on herpes simplex virus 2 shedding, reactivation, and symptoms. Data sources: We searched PubMed, EMBASE, Cochrane, Web of Science, Google Scholar, and ClinicalTrials.gov for articles published before 1 July 2023 for microbiome and herpes simplex virus type 2. Studies were limited to human subjects and the English language. An updated search was performed in January 2026. This study was registered on PROSPERO (CRD42023439139). Methods of study selection: Studies on non-pregnant, reproductive-aged cisgender women that diagnosed bacterial vaginosis by Amsel Criteria, Nugent Scoring or used molecular techniques, and those that detected herpes simplex virus 2 by serological assay or PCR testing were included. Our search identified 863 results with four publications eligible for inclusion. For our secondary outcomes, 40 results were identified regarding herpes simplex virus 2 shedding, with two publications eligible for inclusion, which did not meet our threshold for meta-analysis. There were 21 results identified for herpes simplex virus 2 reaction and 115 results for herpes simplex virus 2 symptoms, with no articles being eligible for inclusion. Tabulation, integration, and results: Quality assessment was performed following data extraction using the quality assessment scales from the Joanna Briggs Institute. Results were extracted, and the pooled hazard ratio was calculated with 95% confidence interval. A total of 1906 women were included in this analysis, and 255 acquired herpes simplex virus 2. The pooled unadjusted hazard ratios produced an effect size of 1.91, (95% confidence interval 1.4649–2.4980), and a p-value of <0.0001, while the pooled adjusted hazard ratios produces an effect size of 1.85, (95% confidence interval of 1.3556–2.5162), and a p-value of 0.0001 indicating that bacterial vaginosis is associated with a increased risk of herpes simplex virus 2 acquisition. Conclusions: This systematic review with meta-analysis indicates that bacterial vaginosis is associated with a significantly increased risk (91% unadjusted, 85% adjusted) of herpes simplex virus 2 acquisition, indicating that bacterial vaginosis treatment may reduce herpes simplex virus 2 acquisition. A notable limitation of these findings is the relatively small number of studies eligible for inclusion in this systematic review and meta-analysis. Full article

Pregnant people in U.S. jails experience high rates of opioid use disorder (OUD), yet access to medications for opioid use disorder (MOUD) remains inconsistent. This mixed-methods study examines how jail policies, treatment infrastructure, and political context shape MOUD provision for pregnant incarcerated individuals. We conducted a secondary analysis of a national survey of 2885 U.S. jails (analytic sample = 836). Logistic regression models assessed associations between MOUD provision and telemedicine capacity, community MOUD availability, state Medicaid expansion, and 2020 presidential voting outcomes. Qualitative responses characterized barriers to care. Findings confirm that MOUD access for pregnant incarcerated individuals remains limited and structurally patterned. Fewer than half of jails continued methadone or buprenorphine for pregnant individuals already in treatment, and initiation was uncommon. MOUD provision was more likely in Democrat-won states, jails with telemedicine capacity, and jails located in communities with MOUD providers, while limited community availability reduced odds of provision. Qualitative themes highlighted restrictive jail policies, provider discretion, diversion concerns, and misconceptions regarding fetal harm. These findings underscore persistent structural barriers to evidence-based perinatal OUD treatment in carceral settings and highlight the importance of telemedicine expansion, community treatment capacity, and standardized correctional policies to advance perinatal health equity. Full article

Over the past two decades, escalating climate crises, geopolitical conflicts, and pandemics have intensified the frequency and severity of disasters, exposing severe vulnerabilities in global food systems. In this pressing context, disaster nutrition emerges as a vital domain of intervention. However, existing academic literature and field practices often address this topic through fragmented, single-axis perspectives. Nutritional physiology, food technology, humanitarian logistics, and policy–ethics frameworks tend to progress in parallel yet disconnected tracks, which results in a lack of holistic models that adequately reflect field realities. The urgency of this issue is underscored by the latest global data. In 2023 alone, disasters resulted in over 86,000 deaths, a significant increase from the preceding two-decade annual average. Furthermore, the 2025 Global Report on Food Crises reveals that 295.3 million people faced high levels of acute food insecurity in 2024, marking the sixth consecutive year this number has risen. This escalating crisis highlights the inadequacy of fragmented approaches and necessitates the development of an integrated framework for disaster nutrition. To address this fragmentation, this study redefines disaster nutrition as a multi-layered, integrated food system challenge. Based on a comprehensive literature analysis, it proposes an “Integrated Disaster Food System Model” that brings these different dimensions together within a common framework. The model is built on four main components: (i) nutritional requirements and vulnerable groups (such as infants, older adults, pregnant individuals, and populations with chronic diseases requiring special diets); (ii) product design, technology, and packaging (balancing shelf life, nutritional value, cultural acceptability, and sensory attributes, including innovative components such as microalgae and fermented foods); (iii) logistics, storage, and distribution systems (centralized storage versus localized micro-warehouses, as well as the use of drones and digital traceability technologies); and (iv) policy, regulation, ethics, and sustainability (the applicability of the Sphere Standards, fair distribution, food waste, and environmental impact). By emphasizing the bidirectional and dynamic interactions among these components, the model demonstrates how decisions in one domain affect others (for example, how more durable packaging can increase both logistics costs and carbon footprint). The study highlights the risks and cultural mismatches associated with a “one-size-fits-all high-energy food” approach for vulnerable groups and argues for the necessity of localized, context-specific, and sustainable solutions. In conclusion, the article posits that the future of disaster food systems can only be shaped through a holistic approach in which interdisciplinary collaboration, technological innovation, and ethical–environmental principles are integrated into the core of policy-making. Full article

Background: During pregnancy, mothers and their infants are at increased risk for complications due to COVID-19 infection, influenza, and pertussis. At the time of writing, the previous advisory committee on immunization practices (ACIP) recommended that pregnant women receive the COVID-19 vaccine, influenza, tetanus-toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine, as well as respiratory syncytial virus vaccinations during pregnancy. The COVID-19 pandemic greatly impacted routine vaccinations especially among medically underserved women in the South. The barriers to recommended vaccinations during pregnancy for medically underserved women in the South are unclear and require further investigation. The purpose of this study is to examine the attitudes, opinions, and beliefs of a multiracial pregnant cohort from diverse backgrounds in Central Tennessee about their experiences with the vaccines that are recommended during pregnancy. The vaccines included in the study are COVID-19, flu, and Tdap because RSV was not yet FDA-approved for pregnant women at the launch of this study. Methods: In this study, we focus on medically underserved women in Nashville, Tennessee, and the surrounding rural counties regarding vaccine acceptance and initiation of the COVID-19, influenza, and the Tdap vaccines. This study involved 208 pregnant people (100%) aged 18–49 years. All respondents were pregnant at the time of the study. The study consisted of a 26 question Redcap survey about participants’ beliefs, attitudes, opinions, and experiences with the COVID-19, flu, and Tdap vaccines during their pregnancy. Results: The randomly selected participants in the cohort were 40.4% White, 31.7% Black, 21.6% Hispanic, and 6.3% other race/ethnicity. The mothers in the cohort were young, with an average age of 27 years, most were married, and 52.8% had an annual household income before taxes of less than USD 35,000. Only 19.2% of the mothers in this study were very confident of the safety of the COVID-19 vaccine, compared to 32.7% for both the flu and Tdap vaccines. Overall, primary care providers were identified as the most trusted messengers for both disease and vaccine information for COVID-19, flu, and Tdap. However, only 11 participants out of 208 received all three of the ACIP recommended vaccines during their pregnancies in the study, barring the time-dependent vaccination for Tdap. The most common reasons for not receiving these vaccines involved concerns for the safety of themselves and their babies and a fear of needles. Conclusions: Education and awareness of ACIP-recommended vaccines during pregnancy needs improvement, and the support of primary care providers as the main driver of pregnancy vaccine initiation is essential. Full article

Mycobacterium tuberculosis (TB) antigen-based skin tests, known as TB-specific skin tests (TBSTs), have been recommended by the World Health Organization (WHO) to test for TB infection (TBI). In light of these new recommendations, we conducted a situational analysis and market assessment to evaluate the utility of testing for TBI in general and of the new TBSTs in South Africa. We found the following barriers to acceptability of testing for TBI overall, regardless of the test: the perceived high prevalence of TBI; prior experiences of poor TB preventive treatment (TPT) uptake, which has led to the removal of TBI tests from the current TPT guidelines; and a poor sensitivity of previous TBI tests in people living with HIV (PLHIV). In addition, further barriers to the new TBSTs in particular were as follows: patient level barriers linked to repeat visits; the need for cold chains; and the need for a strong laboratory system, which reduces the need for point-of-care options. TBI testing was thought to be potentially useful to determine the eligibility for TPT in these use cases: healthcare workers, pregnant women living with HIV and prisoners. One other use case was in the TB diagnoses of children, where it was thought that a positive immunological test (TST/IgRA/TBST) could indicate a TB contact and serve as a ‘rule in’ test to strengthen the evidence for TB disease as a cause. Full article