Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-facialeChunlin Liu, Andrea J MacNeill, Julie E Strychowsky, Neil K Chadha, Brian D Westerberg
Planetary health is a framework that emphasizes the interdependence between human and environmental health. Principles of planetary health are increasingly relevant to Otolaryngologists, who both contribute to climate change and face its consequences for their patients' health. This commentary applies these principles to Otolaryngology-Head and Neck Surgery, offering recommendations at 3 levels of change: the individual Otolaryngologist, the institution, and the broader system. These recommendations are grounded in 3 principles: reducing demand for care through health promotion and disease prevention, ensuring appropriateness of care by addressing overuse and underuse, and reducing healthcare pollution through adoption of circular economy principles. By embracing planetary health as a guiding principle, Otolaryngologists can reduce their footprint while advancing patient and community health.
PURPOSE: The Guangxi Eco-Environmental Health and Aging Study (GEHAS) was established to investigate the interplay between eco-environmental exposome, multi-omics profiles, and healthy ageing in a multi-ethnic subtropical population. This prospective cohort was designed to address knowledge gaps regarding how eco-environmental and lifestyle factors influence ageing trajectories. PARTICIPANTS: GEHAS enrolled 5645 participants (59.8% women; mean age 62.51 years) from Guilin, Guangxi, at baseline, with Yao and Han participants accounting for 60.3% and 36.2% of the cohort, respectively. Baseline data (2018-2022) included questionnaires, physical examinations, biological specimens (blood, urine, hair and nails). Two subsequently established longevity and circadian rhythm sub-cohorts (n=276 and n=596) underwent multi-omics profiling (genomics, epigenomics, proteomics, metabolomics and exposomics). Follow-up in this open cohort includes active surveys approximately every 5 years and annual passive surveillance through government health registries. FINDINGS TO DATE: Recent analyses highlight that improvements in air quality can mitigate frailty progression in older adults, with DNA methylation emerging as a promising biomarker that captures the biological imprint of environmental policy interventions and ageing dynamics. In parallel, local specialty foods and traditional dietary practices have been implicated as potential contributors to reducing the risk of ageing-related diseases, as demonstrated by multiple studies using baseline data. For instance, oil tea consumption has shown potential protective effects against dyslipidaemia and type 2 diabetes, while region-specific dietary patterns were associated with favourable health outcomes in middle-aged and older adults. Specifically, a dose-dependent association was observed between diets rich in vegetables and mushrooms and enhanced cognitive performance, and antioxidant-rich dietary patterns were found to attenuate biological ageing through modulation of redox homeostasis. Moreover, GEHAS studies also explored the interactions between genetic factors and heavy metal exposures in age-related diseases, underscoring the complex interplay between genetic susceptibility and environmental influences in the ageing process. FUTURE PLANS: GEHAS will continue active follow-up surveys every 5 years, supplemented by annual passive surveillance for morbidity and mortality through health registries. The first active follow-up was initiated in 2023 and will continue until 2026/2027, with subsequent rounds planned thereafter. In addition, targeted sub-cohorts, including longevity and circadian rhythm groups, will undergo repeated assessments to capture long-term changes in health, exposures and biological ageing.
International healthCarmen H Logie, Zerihun Admassu, Aryssa Hasham, Julia Kagunda, Humphres Evelia, Rachel Leggett, Clara Gachoki, Mumbi Mwangi, Lesley Gittings, Caetano Dorea, Ja…
OBJECTIVES: Kenya's 2024 heavy rains and flooding resulted in agricultural devastation and displacement. We assessed resource insecurity, sexual health, and mental health differences across two time points, during this heavy rain/flooding and at 6-month follow-up under dry conditions, among adolescent girls and young women (AGYW) in Kenya. METHODS: We conducted surveys at Time 1 (T1) (heavy rains/flooding, June 2024) and Time 2 (T2) (dry conditions, November 2024) with a non-random sample of AGYW aged 16-24 years in Nairobi and Kisumu. We conducted longitudinal analyses using generalized estimating equations to assess differences over time in resource insecurities (food, water, sanitation, menstruation), sexual health (transactional sex, sexual relationship power (SRP), condom use self-efficacy (CUSE)), and mental health (depression, eco-anxiety), adjusting for sociodemographics and baseline scores, and tested motherhood and traumatic exposure severity as moderators. RESULTS: Among 586 participants (mean age 20.13 (SD 2.5) years) at follow-up (98.2% retention) vs baseline across sites we found significant resource insecurity reductions (food, sanitation), sexual health improvements (reduced transactional sex, increased SRP), and reduced eco-anxiety. Depression and CUSE changes varied across sites. CONCLUSION: Participants reported differences over time in resource insecurity and sexual and mental health. The findings signal the importance of weather-informed health research with AGYW in Nairobi and Kisumu.
Environmental science & technologyMichael Vogel, Linda Strande
Nearly half of the world's population relies on nonsewered sanitation, and in urban areas, intermittent onsite storage of wastewater prior to road-based transport to treatment is common. Anerobic biological activity during storage generates methane, contributing to greenhouse gas emissions and posing challenges for climate mitigation. Current estimates of methane emissions rely on methane correction factors (MCFs) in the Intergovernmental Panel on Climate Change (IPCC) guidelines that are based on theoretical assumptions and increasingly viewed as not valid. In this Perspective, we use 1349 data points from onsite storage of wastewater in 11 cities to show that obtaining accurate city-wide estimates is complicated by highly variable properties of in situ wastewater and storage conditions and hence biological production of methane. When it comes to greenhouse gas emissions from nonsewered sanitation, the sector has so far focused on storage, but as evidence suggests these estimates are too high, we propose that emphasis should in fact be placed on the entire service chain.
INTRODUCTION: The State of Texas has the highest number of maternal deaths in America, and maternal health outcomes are worsened by a shortage of maternal health providers. METHODS: We designed four training modules in pharmacy practice, environmental health science, and community health to train a cohort of high school students in a university-based summer research program. The training modules consisted of four self-paced online lessons, followed by a one-month period of small-group, hands-on research projects guided by research staff, and a cumulative poster presentation. The training was offered as part of the 8-week Maternal Health High School Summer Research Program at Texas Southern University. We assessed students' knowledge through quiz scores and student surveys. RESULTS: 20 students participated, of whom 19 completed the modules. The report indicated that students' engagement and performance were high across the four lessons, with participation ranging from 83 to 100%, and participants correctly answering 80 to 97% of the questions. Student feedback further indicated that the program supported early-career exploration, increasing students' interest in maternal and child health and healthcare-related career pathways. DISCUSSION: Our experience demonstrates a model for introducing health-related disciplines to high school students early in their career exploration years. Early education on maternal health may increase awareness of public health issues and encourage exploration of careers in public health and maternal health.
Maternal & child nutritionSaira Parveen Jolly, Regien Biesma, Robert Lensink, Md Khayrul Bhuyan, Kaosar Afsana, Jurjen van der Schans
Despite socio-economic progress, prevalence of childhood stunting remains high in South Asia-a phenomenon often referred to as the "Asian Enigma." This paradox stems from suppressed women's empowerment, poor water, sanitation, and hygiene (WaSH) conditions and inadequate child-feeding. Evidence shows that women's empowerment improves these underlying factors associated with improved stunting. We examined how domains of women's empowerment relate to the risk of childhood stunting in South Asia directly and indirectly in interaction with household improved WaSH facility and age-appropriate food consumption. Using recent Demographic and Health Survey data from Bangladesh, India, Nepal, and Pakistan, we analyzed a sample of 37,620 married women, aged 15-49 years, currently cohabiting with husbands and having an under-five child. We constructed three domains of survey-based women's empowerment index-global: social independence, intrinsic agency, and instrumental agency, by confirmatory factor analysis, using generalized structural equation modelling. We developed three different models by using generalized linear mixed-effects models with robust error variance to estimate the relative risk (RR) of stunting with 95% confidence interval (CI). We found social independence [RR: 0.86, 95% CI: 0.83, 0.90], intrinsic agency [0.98 (0.97, 0.99)] and instrumental agency [0.99 (0.98, 0.99)] were associated with reduced risk of stunting in South Asia. Though interaction between social independence and WaSH was associated with reduced risk [0.92 (0.86, 0.99)], interaction between social independence [1.12 (1.07, 1.17)] and instrumental agency [1.03 (1.01, 1.05)] and food consumption increased risk of stunting in South Asia. Interactions between women's empowerment and WaSH and food consumption reveal complex effects including both synergy and trade-offs, highlighting the need for integrated strategies combining women's empowerment, WaSH improvements, and targeted nutrition specific interventions in South Asia.
African journal of primary health care & family medicineEsther Adekunle, Ferdinand Ottoh, Goddy Osimen, Adedotun O Akinola
Access to safe water, sanitation and hygiene (WASH) is a human right and a main driver of social well-being, economic progress and public health. This study presents a narrative review on the prospects, challenges, stakeholders and strategies regarding WASH implementation in developing countries. A literature search approach, fully dependent on the availability of data from secondary sources, has been adopted for the study. Improved sanitation and hygiene education from WASH boost health, learning and school attendance. However, equity, cost and maintenance are some of the barriers to WASH. Furthermore, success requires long-term investment, community engagement, collaboration across sectors, schools with infrastructure to support WASH, health education, monitoring of water quality and funding for sustainability mechanisms. This study contributes to the literature by revealing the prospects, challenges, stakeholders and strategies for the implementation of WASH in developing countries. This study will provide empirical data for researchers and policymakers towards achieving Sustainable Development Goal 4.
BACKGROUND: This study investigates the transmission dynamics of typhoid fever and assesses the impact of environmental factors and public health interventions on disease spread. Typhoid fever, caused by Salmonella Typhi, remains a major public health concern in regions with poor sanitation, high population density, and limited access to clean water. Although environmental contamination plays a critical role in sustaining transmission, its contribution is often under explored in mathematical modeling studies. METHODS: We developed a deterministic compartmental model incorporating environmental transmission pathways to better understand the role of contaminated water sources and human-environment interactions in the spread of typhoid fever. The model is formulated as a system of nonlinear ordinary differential equations. The basic reproduction number, R0 was derived using the next-generation matrix approach to determine the threshold conditions for disease persistence. We analyzed the existence and stability of the disease-free and endemic equilibrium points, establishing local and global stability results for [Formula: see text] and R0 > 1, respectively. Sensitivity analysis on the reproduction number and the endemic equilibrium was conducted to identify parameters with the greatest influence on disease transmission. Furthermore, the model was extended to an optimal control framework incorporating two intervention strategies: public health education campaigns and treatment of contaminated water bodies. Pontryagin's Maximum Principle was applied to characterize the optimal controls and derive the associated optimality system. Model parameters were estimated using reported typhoid fever data from Ethiopia obtained through the World Health Organization. Numerical simulations were performed to evaluate the impact of individual and combined intervention strategies. RESULTS: Simulation results indicate that the combined implementation of environmental sanitation measures and educational interventions significantly reduces disease burden, particularly during outbreak periods. CONCLUSION: These findings highlight the importance of integrating environmental management and community-based public health strategies in typhoid control programs.
Frontiers in public healthFanantenana Raholiarimanana, Henintsoa Felamboahangy Rasoarahona, Solomon Bizuayehu Wassie, Akira Ishida
BACKGROUND: The pervasive child undernutrition in Southern Madagascar is exacerbated by inadequate water, sanitation, and hygiene (WASH) infrastructure. Although public-works programs such as high-intensity manual labor (HIMO) have been implemented to develop infrastructure and sustain livelihoods, the multi-dimensional associations between these programs and household-level health and hygiene outcomes remain poorly quantified. This study examined the association of workfare participation with child nutritional status and the role of household WASH conditions as a mediating factor. METHODS: Data were integrated from the 2018 Madagascar Multiple Indicator Cluster Survey (MICS6) and 2021 Demographic and Health Survey Spatial Covariates. To address the potential endogeneity in program participation and in the WASH mediators, we employed a potential-outcomes framework combined with instrumental variable (IV) regressions. This approach allowed for the estimation of both total and mediator-adjusted associations between HIMO participation, WASH practices, and child anthropometric outcomes (Z-scores). Furthermore, a mediation analysis was used to quantify the proportion of this association that could be statistically explained by improvements in WASH infrastructure. RESULTS: Participation in the HIMO program was significantly associated with higher household access to improved sanitation and with shorter water-collection travel time (under 30 min). These improvements were associated with significant increments in the height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ) Z-scores. Mediation analysis indicated that 12%-14% of the program's total association with the HAZ and WAZ could be statistically explained by improved sanitation infrastructure. Shorter water-fetching time accounted for the largest mediated share of the association between HIMO participation and WHZ, representing approximately 36% of the total association. CONCLUSIONS: This study provides evidence that HIMO participation is associated with better child nutrition in Southern Madagascar, with improved access to water and sanitation as potential mediating pathways. If subsequent longitudinal or experimental evidence confirms these patterns, public works could be designed as nutrition-sensitive interventions that prioritize essential infrastructure. Expanding these projects also offers a sustainable pathway to closing basic-service gaps and reducing regional malnutrition rates.
International journal of environmental research and public healthCelestin Banamwana, David Musoke, Theoneste Ntakirutimana, Esther Buregyeya, John Ssempebwa, Gakenia Wamuyu Maina, Charles Drago Kato, Lordrick Alinaitwe, Patr…
Reuse of human excreta and derivatives is becoming a common practice in areas with agricultural predominance. While in situ treated faeces through ecological sanitation (Ecosan), known as "faecal by-products" are being used to sustain soil nutrients and improve on-site sanitation, the concern remains about the health risks related to the survival of pathogens in these by-products in the community of farmers. This study assessed the survival of faecal pathogens and estimated microbial risks associated with the use of Ecosan faecal by-products in agriculture. The quantitative microbial risks assessment (QMRA) framework was used to estimate the risks posed by each faecal pathogen in solid and semi-solid faecal by-products under the probabilistic model of Monte Carlo simulation. Ascaris lumbricoides (6.5 eggs/gr), Taenia species (0.3 egg/gr), Schistosoma species (9.3 cercariae/gr), Entamoeba species (4.4 cysts/gr), and Escherichia coli (451 Cfu/gr) were detected in semi-solid faecal products. Exposure scenarios were observed throughout four critical points: vault faecal by-products removal/unloading, transport, collection, and application of faecal by-products in the gardens. Due to the presence of eggs and cysts, an estimated annual risk of infections was found in semi-solid faecal by-products with Schistosoma species (88%) and Ascaris lumbricoides (90%). Both concentrations were above World Health organisation (WHO) standards of associated infective risks of 0-10% of helminths in faecal sludge applied in the gardens. The users of faecal by-products, particularly farmers are exposed not only to high concentrations of helminth eggs but also to protozoa and bacteria with infective risks of Entamoeba species (99%) and E. coli species (62%). A stepwise implementation of faecal pathogens die-off during treatment of faecal by-products in compliance with the WHO's 2018 guidelines can prevent the use of unsanitary faecal by-products. According to these findings, the proper control of intestinal protozoa and soil-transmitted helminths (STHs) should be enforced through personal protective measures in Burera district, Rwanda.
Journal of water and healthSewwandi Bandara, Wakana Oishi, Mohan Amarasiri, Tomonori Nochi, Mayuko Saito, Aya A Mitani, Thanh H Nguyen, Daisuke Sano
The One Health framework emphasizes the interconnection between human, animal, and environmental systems in shaping infectious disease dynamics. Multiple environmental, social, and economic determinants jointly influence disease transmission, operating through interconnected pathways within this system. However, the causal mechanisms linking these determinants to infectious disease outcomes remain poorly understood. This study systematically reviews and synthesizes evidence on the causal interrelationships among key determinants to better elucidate their contributions to infectious disease incidence. Drawing on literature across urbanization, climate change, land-use change, population mobility, and water, sanitation, and hygiene (WaSH) conditions, we examine how these factors interact to influence transmission dynamics through complex environmental and socioeconomic pathways. Our findings indicate that no single determinant independently drives disease transmission; rather, overlapping exposures and interactions create complex feedback loops that amplify public health vulnerabilities, particularly in resource-constrained settings. We advocate for the integration of causal inference to move beyond traditional correlation-based analyses and to identify the pathways through which these determinants influence disease dynamics. Embedding causal reasoning within the One Health framework can strengthen evidence-based policy and support the design of targeted, context-specific, and resilient public health interventions aimed at reducing the burden of infectious diseases.
Environmental health perspectivesJeanette A Stingone, H C Bledsoe, Grace Cooney, Mireya Diaz-Insua, Elaine Faustman, Karamarie Fecho, Ramkiran Gouripeddi, Philip Holmes, David Kaeli, Oswaldo L…
BACKGROUND: The field of environmental health sciences increasingly demands comprehensive and diverse data sets, particularly in response to emerging research areas such as climate change, mixtures, and exposomics. The data needed to address the complexity of environmental health research questions often extend beyond the boundaries of a single study or data resource. Traditional data management approaches struggle to harmonize the ever-expanding and heterogeneous data sources needed for research in the environmental health sciences. Harmonization may help address this issue as it involves aligning and standardizing various elements of data to allow comprehensive analysis, data pooling, and interpretation across studies. OBJECTIVES: The primary objective is to inform researchers about the transformative potential of embracing harmonization methodologies and to motivate contributions to ongoing efforts, thereby fostering advancements. METHODS: Using the Environmental Health Language Collaborative's Data Harmonization Use Case, we provide a practical illustration of existing data harmonization approaches, identify gaps, and emphasize future research and application directions. We selected two publicly available environmental epidemiology studies on the topic of childhood asthma and three studies on the topic of biomarkers of metals exposure during pregnancy and birth outcomes and applied several existing harmonization approaches to assess interoperability. DISCUSSION: Our process revealed the potential limitations of many existing harmonization approaches, with notable failures to identify common variables across independent data sets and lack of agreement between human and computer-based approaches. This use case identified various challenges with existing approaches, including reliance on often incomplete data documentation and large amounts of manual effort. To address these challenges, we recommend the continued advancement and dissemination of community data standards, the development of software and tools to facilitate harmonization through automation, and strategic efforts to promote engagement in data harmonization within the environmental health sciences community. Collaborative science is needed to advance our understanding of environmental contributors to health, and realizing the harmonization potential of our scientific data is a step toward improved collaboration.
Igiene e sanita pubblicaGiangiacomo Marchesan, Lorenzo Visentin, Giovanni Beghetto, Mauro Busolin, Greta Siviero, Maria Luisa Franchina, Erica Artosi, Flavio Del Bianco, Mirko Mazzura…
BACKGROUND: The Prevention Department represents the technical and functional structure of the Italian National Health Service responsible for implementing collective prevention and public health activities. Ensuring the appropriate allocation of qualified healthcare workers (HCWs) within this setting is fundamental to guarantee the delivery of essential services, maintain system efficiency, and address emerging public health challenges. METHODS: This study proposes a methodological framework for estimating the annual workable hourly rate of Environmental Health Officers operating within Prevention Departments. The model integrates multiple parameters including, for the workplace safety topic, the size of the working population subject to territorial control activities, the number of companies intended for checks according to national and regional planning, contributing to the calculation of effective working time based on Full-Time Equivalent (FTE) hours. Additional corrective factors are incorporated to account for absenteeism, indirect activities, travel time related to territorial characteristics, and specific targeted prevention programs. The approach was informed by institutional standards, European policy recommendations, and data derived from a Local Health Authority located in the Veneto Region. RESULTS: The proposed model combines two main reference indicators: one Environmental Health Officer per 10,000 workers in the sector within the territorial jurisdiction and an additional professional per 400 companies. The calculation of effective workforce availability considers an estimated average of 1,408 working hours per year per FTE, adjusted for absenteeism and indirect activities. These parameters allow for a more realistic estimation of programmable activities based on standard average times to ensure adequate inspection, surveillance, and other prevention activities. CONCLUSIONS: The investigated methodology could provide a structured approach to workforce planning within Prevention Departments, supporting evidence-based staffing decisions and improving the alignment between service demand and human resources. In a context characterized by evolving public health needs, workforce shortages, organizational transformation, and flexible allocation of HCWs, useful policies for effectively managing human capital will be essential to ensure the sustainability and effectiveness of prevention services within the public health system.