Environmental Health Insights最新文献

Climate change is becoming a recognized health concern in the scientific community, as heat exposure poses escalating health risks to outdoor occupational groups, particularly construction workers. Heat stress and climate change may lead to adverse physical health outcomes and reduced workability among construction workers. This systematic review and meta-analysis aimed to (1) examine the prevalence of physical health outcomes of construction workers in relation to heat exposure and (2) analyze the association between physical health outcomes of heat exposure and work performance by sex and age. Following the PRISMA guidelines and using a PICO framework, we conducted a comprehensive search across APA PsycINFO, MEDLINE, Embase, CINAHL, and Web of Science. Seventeen studies met our inclusion criteria. Outcomes were grouped into dehydration, heat-related illnesses (HRI), kidney function impairments, and heat-related deaths. Random-effects models were used for the meta-analysis, and subgroup analyses were performed using demographic variables. Pooled meta-analysis and heterogeneity statistics are only provided for the HRI outcome, as all other outcomes are only represented by single eligible studies. Dehydration demonstrated the highest single-study prevalence (0.97, 95% CI: 0.88, 1.00), contrasting with HRI pooled prevalence (0.40, 95% CI: 0.24, 0.58) and kidney function impairment single-study prevalence (0.17, 95% CI: 0.05, 0.39), which showed much lower estimates. High heterogeneity was present in the HRI symptoms category (I ² > 95%). Meta-regression revealed that males reported lower heat disorder prevalences in studies with both sexes (ß = -2.09, P = .049). Heat exposure significantly impairs the physical health of construction workers, particularly through dehydration and heat-related illnesses. Sex-responsive, psychological, and intervention-based studies are essential for protecting this vulnerable occupational group from accelerating climate change.

Introduction: Household air pollution (HAP) from solid fuel combustion is a major global public health issue with a particularly high burden in sub-Saharan Africa. In Somalia, the extent and predictors of household smoke exposure risk (SER) remain underexplored due to data scarcity and analytical limitations. This study applies machine learning (ML) models to identify and predict SER in Somali households using the first Somalia Demographic and Health Survey (SDHS) and interpretable artificial intelligence (AI) techniques.

Methods: A nationally representative sample of 15 838 households from the 2020 SDHS was analyzed using multivariate logistic regression. The SER was defined based on the cooking fuel type and location. Six supervised ML models (Logistic Regression, K-Nearest Neighbors, Decision Tree, Support Vector Machine, Random Forest, Gradient Boosting) were trained using an 80/20 train-test split. The performance was evaluated using accuracy, precision, recall, F1-score, and AUROC. Feature importance was assessed using Gini, permutation, and SHAP (SHapley Additive explanation) values.

Results: The prevalence of household smoking exposure was 70.0%. Place of residence, region, and wealth were the dominant predictors. Gradient Boosting outperformed other models (AUC = 81% [95% CI: 79.11%-82.17%], F1 = 81%), followed by Random Forest. SHAP analysis confirmed that geographic and socioeconomic factors were the most impactful features. Notably, higher exposure was paradoxically associated with urban residence and higher wealth, diverging from the traditional patterns observed in similar settings.

Conclusion: This is the first national study to apply machine learning to predict SER in Somalia, revealing urban and wealth-linked vulnerabilities that challenge conventional assumptions about poverty. These findings highlight the need for targeted clean cooking interventions in urban and peri-urban communities, alongside data innovations for real-time monitoring. ML-informed risk stratification may support more effective and equitable health policies in fragile states.

Valorisation of cashew apples (Anacardium occidentale L.) offers an opportunity to address food waste in Ghana, where approximately 90% of these edible fruits remain unutilised despite the country's position among global leaders in cashew production. This study examined the development of mycotoxins in cashew apple-wheat composite flour systems during ambient tropical storage (25 ± 2°C, 65 ± 5% RH) over 14 days. Three composite flour formulations were prepared for subsequent bread production, with cashew apple flour substituting wheat flour at 5%, 10%, and 15% (w/w) levels. The storage stability of these pre-mixed flour blends was evaluated, as they represent the critical phase when processors store prepared formulations prior to baking. Monitoring of moisture content, fungal growth, and aflatoxin B1 levels was conducted using standardised AOAC and ISO methods. An increase in moisture was observed across all formulations, with the 5% substitution reaching a moisture content of 13.21% by day 14. Fungal populations increased exponentially (10²-10⁴ CFU/g) and showed a strong positive correlation with moisture content (r = .87, P < .001). Aflatoxin B1 was detected on day 7, rising to 8.7 μg/kg in the 5% formulation by day 14, exceeding European Union safety limits (2 μg/kg) for cereal-based products. However, higher cashew apple substitution (15%) demonstrated dose-dependent antimicrobial effects, resulting in significantly lower fungal counts (6.8 × 10³ CFU/g) and aflatoxin levels (4.1 μg/kg), likely due to naturally occurring phenolic compounds and other bioactive substances. While incorporating cashew apple flour offers considerable potential to reduce food waste and enhance nutrition, the current formulations pose unacceptable food safety risks under uncontrolled tropical storage conditions. For commercial viability, strict moisture control (⩽13%) and temperature regulation are essential to meet international food safety standards.

The health risk of exposure to the Akaki River water remains an underrecognized issue among irrigation farmworkers at Gelan Farm Sites. To show the risk, this study assessed the prevalence and determinants of acute gastrointestinal illness (AGI) among these workers. A cross-sectional survey study was conducted between December 13, 2023, and January 8, 2024, within 296 randomly selected farmworkers aged 18 years and above who had been actively engaged in irrigation farming for at least a month. Totally, the prevalence of AGI was about 23% (95% CI: 18.2%-27.8%). In this study, factors such as being married, older age, higher education level, farming experience, and handwashing awareness were protective. The interaction between farming experience and safe water sources, were also protective. On the other hand, residing on the farmland, using untreated river water for cooking, unintentional ingestion of irrigation water, and interaction of river water use with limited access to clean water were AGI-exacerbating factors. For intervention, access to clean water, sanitation facilities, and health education are needed to protect the health and productivity of the workers.

Background: Low-income countries such as Ethiopia face significant food safety challenges due to weak regulatory enforcement, limited infrastructure, and rapid urbanization. In addition, the rising incidence of foodborne illnesses and emerging bioterrorism threats underscore the urgent need for robust legislation, effective regulation, and coordinated food safety measures.

Objectives: This review aimed to assess the food safety regulatory framework, standards implementation, and on-the-ground practices in the context of Ethiopia.

Methods: This scoping review included peer-reviewed articles and gray literature, such as institutional reports and unpublished documents. Data were retrieved from Google Scholar, Scopus, PubMed, and relevant organizational websites. The review was conducted in accordance with the PRISMA-ScR 2020 checklist, with document selection guided by the SPIDER framework.

Results: Ethiopia has adopted a multi-agency food safety governance model involving several sectoral institutions, notably the Ethiopian Food and Drug Authority and the Ministries of Health, Trade and Industry, and Agriculture. Despite this institutional architecture, implementation is constrained by weak enforcement, poor intersectoral coordination, limited adoption of internationally recognized food safety certification systems, and inadequate foodborne disease surveillance, resulting in persistent deficiencies in food safety and handling practices across the food supply chain.

Conclusion: Despite the presence of food and nutrition policies, food safety regulations, standards, and a formal regulatory framework, this scoping review, among the first to comprehensively map Ethiopia's food safety governance, identifies a substantial gap between policy design and practical implementation. Although government and non-governmental organizations have provided training on good hygiene practices, good manufacturing practices, and hazard analysis and critical control points, these efforts have not produced sustained improvements due to weak enforcement, fragmented institutional coordination, and limited surveillance capacity. The findings underscore the need to shift from policy development to implementation-focused reforms, strengthened accountability, and integrated regulatory action to improve food safety outcomes in Ethiopia and similar low-income settings.

Introduction: Workplaces are vital for Occupational Safety and Health (OSH) knowledge dissemination. This study examines OSH knowledge, attitudes, and practices among formal and informal sector workers in Freetown, Sierra Leone, and their associations with workplace characteristics.

Methods: A cross-sectional survey was conducted using a validated, semi-structured questionnaire to collect data on sociodemographic characteristics, workplace safety factors, and occupational safety indicators. The survey assessed 3 primary outcomes variable adequate knowledge, good attitude, and good practice. Multivariable analyses were used at significant level (P < .05) to examined associations between independent and outcomes variables.

Results: The study included 516 respondents, predominantly were male (84.3%). Educational attainment varied, with 23.6% having tertiary education and 4.7% non-formal education. Literacy rates showed 76.6% were literate. Significant disparities emerged between sectors: formal sector workers demonstrated higher rates of adequate knowledge (60.7%), good attitudes (54.9%), and good practices (77.3%) compared to informal workers. Formal sector employment was significantly associated with better OSH outcomes, including knowledge (aOR = 2.4, 95%CI: 1.43-4.15, P < .001) and practices (aOR = 16.2, 95%CI: 2.80-95.81, P < .002). These findings highlight substantial sector-based differences in occupational safety and health indicators.

Conclusion: This study reveals substantial and significant disparities in occupational safety and health (OSH) between formal and informal sector workers. Formal sectors employment is strongly associated with better OSH outcomes, particularly safer practices, thus, underscoring an urgent need for targeted policy, tailored training programmes, gender-sensitive interventions, and regulatory interventions to protect vulnerable informal workers.

Background: Atrial fibrillation (AF) is the most common arrhythmia globally and is increasingly recognized as being influenced by environmental exposures. While air pollution is a well-established risk factor for cardiovascular disease, its specific relationship to AF remains undetermined. This systematic review aims to synthesize current evidence on the association between air pollution and AF, identifying key pollutants, exposure patterns, and population vulnerabilities.

Methods: Following PRISMA guidelines, a comprehensive search of PubMed, Embase, CINAHL, Web of Science, and other databases was conducted to identify cohort, case-crossover, and time-series studies examining the effects of ambient air pollutants (PM_2.5, PM₁₀, NO₂, SO₂, CO, and O₃) on AF outcomes in adults. Data on study design, pollutant levels, AF metrics, and population characteristics were extracted and the Joanna Briggs Institute Critical Appraisal Checklist was used to evaluate the selected study quality.

Results: Thirty-one studies met inclusion criteria, encompassing over 63 million participants across North America, Europe, and Asia. PM_2.5 was the most studied and most consistently associated pollutant, with 21 of 29 studies showing significant positive associations with AF risk. Several studies identified elevated AF incidence even at pollutant levels below WHO air quality guidelines. Subgroup analyses revealed that individuals with comorbidities (eg, diabetes, obesity, hypertension), women, and older adults may be more vulnerable to pollution-related AF. Study methodologies varied widely in terms of pollutant measurement, AF detection, and temporal resolution, affecting comparability.

Conclusions: This review affirms a significant association between air pollution, particularly PM_2.5 and NO₂, and the risk of atrial fibrillation. The findings suggest that even pollutant concentrations deemed "safe" may increase AF risk, particularly in vulnerable populations. Future research should standardize exposure assessment and explore understudied pollutants and effect modifiers. These results underscore the importance of air quality regulations as a public health intervention to reduce AF burden and support cardiovascular health.

Environmental exposure to heavy metals during pregnancy may adversely impact fetal development, particularly in low- and middle-income countries (LMICs) with limited environmental regulation. This study aimed to assess the relationship between maternal exposure to lead (Pb), cadmium (Cd), and mercury (Hg) and fetal growth parameters in an Indonesian population. A cross-sectional study of 127 pregnant women in their second trimester was conducted. Maternal characteristics and exposure sources were obtained via structured questionnaires. Blood concentrations of Pb, Cd, and Hg were measured using inductively coupled plasma mass spectrometry (ICP-MS). Fetal biometry was assessed by ultrasonography, and z-scores were calculated. Generalized additive models (GAMs) and linear mixed models (LMMs) with restricted cubic splines (RCS) were used to evaluate non-linear associations, adjusting for maternal age and secondhand smoke exposure. Among the 127 pregnant women, the median age was 30 years (range: 20-40 years), and the median blood concentrations of Pb, Cd, and Hg were 6.6, 0.022, and 0.021 µg/L, respectively. Fetal growth Z-scores were as follows: BPD_z = -0.48 (range: -2.5 to 2.5), HC_z = -0.38 (range: -2.0 to 2.0), AC_z = -0.56 (range: -2.5 to 2.0), FL_z = -0.62 (range: -2.5 to 2.5), and EFW_z = -0.75 (range: -3.0 to 2.0). Using linear mixed models with restricted cubic splines (RCS), Cd and Hg exposures were significantly associated with increased fetal Z-scores (Cd: β = 1.48, P < .001; Hg: β = .99, P < .001), while Pb showed a negative association (β = -.93, P < .001). Non-smokers exhibited more favorable fetal growth responses compared to those exposed to secondhand smoke. Maternal exposure to heavy metals showed non-linear effects on fetal growth. The findings underscore the need for environmental health monitoring and preventive measures during pregnancy.

Background: Sustainable injectable drug delivery devices, such as prefilled syringes, multi-chamber syringes, and reusable systems, are gaining attention due to their potential to decrease resource use and waste. Despite these considerations, the integration of sustainability metrics into healthcare systems and pharmaceutical manufacturing is inconsistent, necessitating a systematic review of existing practices and outcomes.

Methods: To address this gap, a systematic literature review (SLR) was conducted in June 2024, utilizing the databases of PubMed/MEDLINE and Embase. The studies were examined for sustainability outcomes related to environmental impact, economic efficiency, and public health benefits of injectable drug delivery systems. Cost adjustments were standardized to their respective 2024 currency along with U.S. dollars using price indices for the United States, United Kingdom, Netherlands, and Italy.

Results: The literature search returned 2384 unique articles, with 24 studies meeting the inclusion criteria. The reviewed studies highlighted some of the potential benefits of sustainable injectable drug delivery devices. Environmental assessments reported reductions in waste and CO₂ emissions, with examples from hospital implementations of prefilled syringes cutting waste by 26% to 86%, and modular insulin pumps showing a 44% increase in recycling efficiency compared to conventional systems. Economic evaluations revealed potential cost reductions of up to 26% of total drug expenditures, attributed to inefficient drug preparation processes and unused medications. Public health outcomes ranged from identified challenges in disposal practices to safer sustainable strategies, including a 57% reduction in hazardous waste that enhanced safety in a resource-limited setting. While the included studies varied in methodological rigor, most were rated as fair quality, with 2 studies rated as poor - indicating a need for more robust evidence to strengthen future evaluations.

Conclusion: This review suggests that sustainable injectable drug delivery devices can reduce environmental impact, improve economic efficiency, and contribute to public health. By limiting waste, reducing carbon emissions, and supporting safety, these devices can offer measurable contributions for advancing sustainability in healthcare. However, the lack of clear sustainability standards and guidance from health systems and governments remains a key barrier to broader adoption.

Valorisation of cashew apples (Anacardium occidentale L.) offers an opportunity to address food waste in Ghana, where approximately 90% of these edible fruits remain unutilised despite the country's position among global leaders in cashew production. This study examined the development of mycotoxins in cashew apple-wheat composite flour systems during ambient tropical storage (25°C ± 2°C, 65 ± 5% RH) over 14 days. Three composite flour formulations were prepared for subsequent bread production, with cashew apple flour substituting wheat flour at 5%, 10%, and 15% (w/w) levels. The storage stability of these pre-mixed flour blends was evaluated, as they represent the critical phase when processors store prepared formulations prior to baking. Monitoring of moisture content, fungal growth, and aflatoxin B1 levels was conducted using standardised AOAC and ISO methods. An increase in moisture was observed across all formulations, with the 5% substitution reaching a moisture content of 13.21% by day 14. Fungal populations increased exponentially (10²-10⁴ CFU/g) and showed a strong positive correlation with moisture content (r = .87, P < .001). Aflatoxin B1 was detected on day 7, rising to 8.7 μg/kg in the 5% formulation by day 14, exceeding European Union safety limits (2 μg/kg) for cereal-based products. However, higher cashew apple substitution (15%) demonstrated dose-dependent antimicrobial effects, resulting in significantly lower fungal counts (6.8 × 10³ CFU/g) and aflatoxin levels (4.1 μg/kg), likely due to naturally occurring phenolic compounds and other bioactive substances. While incorporating cashew apple flour offers considerable potential to reduce food waste and enhance nutrition, the current formulations pose unacceptable food safety risks under uncontrolled tropical storage conditions. For commercial viability, strict moisture control (⩽13%) and temperature regulation are essential to meet international food safety standards.