Healthcare associated infections (HAIs) lead to tens of thousands of deaths annually, with 21.6 % being caused by water, according to Collier S, Deng L, Adam E, Benedict K, Beshearse E, Blackstock A, et al. Estimate of burden and direct healthcare cost of infectious waterborne disease in the United States. Emerging Infect Disease J 2021;27:140. This is partially due to Opportunistic Premise Plumbing Pathogens (OPPPs); which may exhibit resistance to disinfection and thrive in pipe biofilms. Evidence found in literature indicates the rate of infections caused by OPPPs are going to increase with time, highlighting the need for better understanding of their detection and mitigation. The aim of this review is to provide insight on the latest status of OPPP research and highlight areas that need further investigation. It also emphasizes the importance of proactive surveillance, extensive water management protocols, and advanced detection technologies in reducing waterborne healthcare-associated infections. Ultimately, it was found there is still extensive research needed to fully mitigate and prevent pathogenic outbreaks.
In recent decades, airborne microplastics (MPs) and nano plastics have emerged as critical environmental pollutants, posing potential human health risks including respiratory issues such as asthma, alveolitis, and chronic bronchitis. This systematic review and meta-analysis investigated the distribution, characteristics and concentrations of airborne MPs in indoor and outdoor environments based on studies published up to October 2023. Following PRISMA guidelines, 27 eligible studies across 16 countries were selected, with 21 providing sufficient quantitative data for meta-analysis. Due to extreme, robust heterogeneity across the studies (I2>99 %), a random-effects model was applied. Sensitivity analyses confirmed these findings were stable and not driven by individual outliers. The results demonstrated that indoor environments were more polluted than outdoor settings. For example, moderately polluted indoor environments exhibited mean concentrations of 1,380.28 MP/m3 compared to 102.45 MP/m3 outdoors. However, these findings are presented as a descriptive summary of the literature to highlight methodological variability. Consistent with this, moderator analyses revealed that the most significant contributor to inter-study variability was the type of detection instrument used, with FTIR consistently reporting higher concentrations than microscopy or Raman spectroscopy. Sampling duration also significantly influenced the results. Additionally, indoor healthcare centers and outdoor urban areas were identified as the most heavily contaminated sub-environments. These findings highlight the urgent need for standardized sampling and detection protocols, while emphasizing the critical importance of monitoring and mitigating indoor air quality to reduce human exposure to airborne MPs.
INTRODUCTION:Ambient air pollution is a modifiable environmental exposure that may contribute to early cardiovascular risk. Although long-term exposure has been linked to blood pressure (BP) dysregulation, research on its effects in children remains limited, despite their particular vulnerability during critical periods of cardiovascular development. This updated systematic review and meta-analysis aimed to estimate pollutant-specific associations of long-term air pollution exposure with BP and hypertension in children and adolescents. CONTENT:Following PRISMA guidelines, studies were identified from prior systematic reviews and meta-analyses as well as an updated PubMed and Web of Science searches through March 27, 2025. Twenty-one studies, including 990,157 participants, were included in the systematic review evaluating air pollutants, including PM1, PM2.5, PM10, NO, NO2, NOx, SO2, O3, and CO. Meta-analysis was limited to PM2.5, PM10, and NO2 because cohort data for other pollutants were limited, and exposure increments and hypertension definitions varied across studies. SUMMARY:Long-term PM2.5 exposure showed the most consistent association with higher systolic BP (0.59 mmHg per 10 μg/m3; 95 % CI: 0.28-0.90). PM10 was initially associated with higher systolic (0.28 mmHg per 10 μg/m3; 95 % CI: 0.25-0.31) and diastolic (0.27 mmHg; 95 % CI: 0.24-0.30) BP, but these associations were not sustained in sensitivity analyses. NO2 showed no significant association with systolic or diastolic BP. Several pollutants, including PM2.5, PM10, SO2, O3, and CO, were associated with increased odds of hypertension. OUTLOOK:Current evidence suggests that exposure to fine particulate matter may contribute to early-life elevation in blood pressure; however, given the paucity of longitudinal data and the complexity of multipollutant exposures, further research employing standardized exposure metrics, harmonized outcome definitions, and multipollutant models are needed to clarify independent pollutant effects.
Water pollution caused by organic and inorganic contaminants, particularly dyes and pharmaceuticals, represents a major environmental challenge. Advanced oxidation processes based on photocatalysts have emerged as efficient and sustainable approaches for water and wastewater treatment. Copper ferrite (CuFe2O4) is considered a promising photocatalyst owing to its narrow bandgap, visible-light activity, chemical stability, and magnetic properties. Despite extensive experimental investigations, a comprehensive systematic comparison of CuFe2O4-based photocatalysts under diverse operational conditions has remained limited. In this study, a systematic review following PRISMA guidelines was conducted using studies published between January 2014 and November 2025 indexed in Scopus, PubMed, Web of Science, and ScienceDirect. From an initial pool of 397 studies, 98 articles met the inclusion criteria. Key parameters - including pollutant type, pH, catalyst dosage, initial pollutant concentration, irradiation time, light source, and degradation efficiency - were quantitatively compared to identify performance trends and operational optima. The results demonstrate that CuFe2O4-based nanocomposites, particularly heterojunction, Z-scheme, and S-scheme architectures combined with TiO2, g-C3N4, graphene, and metal oxides, achieve high degradation efficiencies (often >90 %) for a wide range of organic pollutants and selected inorganic contaminants (e.g., Cr(VI)). Enhanced charge separation and suppressed electron-hole recombination were identified as the primary factors contributing to improved photocatalytic activity. In addition, the intrinsic magnetic properties of these nanocomposites enable facile catalyst recovery and reuse. In conclusion, CuFe2O4-based nanocomposites, especially those incorporating advanced heterojunction architectures, emerge as highly efficient and magnetically recoverable photocatalytic platforms for sustainable water and wastewater treatment, with strong potential for scalable implementation and real-wastewater applications.
Inorganic arsenic (iAs) is a toxic environmental pollutant linked to serious health risks, prompting global regulatory efforts. This study identifies major health conditions associated with iAs exposure using text network analysis, and assesses health risk assessments through an umbrella review and dose-response analysis. It synthesizes previous systematic reviews to offer a broader perspective on iAs-related health effects. An optimized text network analysis-based search strategy was applied across multiple databases to identify relevant systematic reviews. An umbrella review framework was employed to synthesize and reinterpret findings across systematic reviews. The methodological quality of included systematic reviews was assessed using the A MeaSurement Tool to Assess systematic Reviews 2 tool. Extracted data on study characteristics, exposure levels, and risk estimates were analyzed to evaluate the dose-response relationship between iAs exposure and health outcomes. From 922 systematic reviews, 36 were included and categorized into 10 health condition groups. For example, seven SRs found a significant dose-response relationship between iAs and bladder cancer, with one systematic review reporting relative risks of 2.70, 4.20, and 5.80 at 10, 50, and 150 µg/L, respectively. Individual study analysis further showed that each 10 µg/L increase in iAs raised bladder cancer risk by 3.11 % (p=0.003). iAs exposure is associated with hypertension, diabetes, cardiovascular disease, and adverse fetal outcomes. Dose-dependent increases in bladder cancer, lung cancer, and hypertension risks were observed. These findings support more precise health risk assessments and regulatory strategies.
INTRODUCTION:Dengue virus (DENV) and chikungunya virus (CHIKV) are Aedes-borne arboviruses with overlapping clinical manifestations, shared vectors, and substantial diagnostic challenges in co-endemic settings. This systematic review and meta-analysis synthesized published evidence on molecular detection, serological positivity, and DENV-CHIKV dual positivity/co-infection in human clinical, surveillance, and community-based study populations. CONTENT:Following PRISMA 2020 guidance, five bibliographic databases (PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, and Google Scholar) and supplementary grey-literature/preprint sources were searched for English-language studies published from 1 January 1980 to 31 December 2024. No prospective PROSPERO or OSF protocol registration was available. Eligible records reported extractable numerators and denominators for DENV and/or CHIKV in humans using recognized molecular or serological assays. A total of 196 studies comprising 158,608 tested or suspected participants were included in the extraction table. The pooled CHIKV estimate was 14.0 % (95 % CI: 12.0-16.4; I2=97.5 %), with molecular and serological estimates of 9.8 and 15.7 %, respectively. The pooled DENV estimate was 13.8 % (95 % CI: 10.9-17.3; I2=99.0 %), with molecular and serological estimates of 13.1 % (95 % CI: 7.9-21.0) and 14.3 % (95 % CI: 10.2-19.8), respectively. DENV-CHIKV dual positivity/co-infection was 52.9 % (95 % CI: 48.7-57.1) among studies that tested and reported both outcomes. Country-level estimates varied widely and should be interpreted as summaries of available studies rather than nationally representative burden estimates. Funnel-plot asymmetry was statistically significant in DENV analyses but not in the overall CHIKV analysis. SUMMARY:Available evidence indicates extensive but highly heterogeneous DENV and CHIKV positivity across selected clinical and surveillance populations. The pooled estimates should be interpreted cautiously because of substantial between-study heterogeneity, diagnostic variability, outbreak-period sampling, and uneven geographic representation. OUTLOOK:The findings support integrated arboviral surveillance, multiplex diagnostics, and vector-control preparedness in co-endemic regions.
The global surge in Autism Spectrum Disorder (ASD) cases, coupled with evidence linking prenatal Particulate Matter (PM) exposure to developmental disruption, demands a comprehensive review to design targeted health interventions. This systematic review and meta-analysis aim to evaluate the strength and consistency of evidence linking prenatal PM exposure to ASD across studies, quantifying this relation to identify actionable environmental risk thresholds. This study employed PRISMA protocols to systematically extract and evaluate evidence from PubMed, Web of Science, Scopus, and ScienceDirect (2010-2024), and screened 4,013 articles to identify qualified case-control and cohort studies (n=29). Data synthesis employed random-effects modeling, accompanied by comprehensive assessment through I2 statistics, Q-tests, funnel plots, Duval and Tweedie's trim-and-fill analysis, and Egger's regression, to ensure validity. A meta-analysis of 16 case-control studies revealed a 34 % increased risk of ASD associated with prenatal PM exposure (pooled OR=1.34; 95 % CI: 1.13-1.54), despite substantial between-study heterogeneity (I2=94.02 %, p<0.001). Publication bias was not significant (Egger's test p value=0.114). Critical trimester-specific analysis uncovered that third-trimester exposure significantly increased ASD risk (OR=1.17; 95 % CI: 1.01-1.34), while first-trimester (OR=1.02; 95 % CI: 0.92-1.11; I2=49.18 %, p<0.10) and second-trimester exposures (OR=1.13; 95 % CI: 0.88-1.38; I2=92.59 %, p<0.001) showed non-significant associations. This review identified prenatal and early life exposure to PM as a risk factor for ASD, indicating a trimester-specific vulnerability. It highlighted the necessity of focused air quality interventions and targeted guidance to reduce prenatal PM exposure to alleviate ASD risk during the critical-window.
Extreme weather events increasingly disrupt healthcare delivery and services provided to patients with chronic kidney disease (CKD), a population reliant on continuous access to dialysis, medications and healthcare infrastructure. This scoping review assessed the impact of such events on CKD care, with a particular focus on Australia, and identified key gaps in disaster preparedness and healthcare resilience. Primary research articles published in English between 2004 and 2024 were systematically searched across MEDLINE, CINAHL, EMBASE, ProQuest and Web of Science, following the JBI methodology and PRISMA-ScR guidelines. Twenty-two studies from the United States of America (USA), Australia, India, Japan and Taiwan were included. Commonly reported disruptions included dialysis service interruptions due to power outages, medication shortages, transportation barriers and strained emergency communication systems. These challenges highlight the vulnerability of patients with CKD during climate-related disasters and the urgent need for robust, scalable and context-specific preparedness strategies. Recommended interventions include early dialysis protocols, backup power systems and wider adoption of peritoneal dialysis to improve continuity of care. The review also identified research gaps in communication networks and health infrastructure supporting dialysis services. Strengthening disaster preparedness frameworks is essential to mitigate health risks and ensure uninterrupted CKD care in the face of escalating extreme weather events.
The built environment, comprising homes, buildings, roads, public spaces, infrastructure, land use, civic design, and amenities, has a considerable influence on occupational health. In India's tea plantations, where women comprise majority of the workforce, the built environment plays a crucial role in determining occupational health. The aforementioned point can be explained by the co-occurrence of living and working conditions, which often coexist in tea plantations, further resulting in vulnerabilities to the health of women workers. Therefore, to understand the influence of built environment on the occupational health of women workers in tea plantations of India, the present paper employs a systematic review using the PRISMA 2020 framework. In the first search, 421 studies were identified, of which 21 studies met all the inclusion criteria. A quality appraisal and risk of bias of the included studies have been undertaken. The results identified that musculoskeletal disorders (MSDs) are the most prevalent occupational health consequence, affecting over 80 % of the women workers in Indian tea plantations, substantiated by a range of estimates in the studies reviewed. Gendered disparities in wage earning, self-autonomy, and dual responsibilities often lead to emotional distress, as delineated in minimal of the reviewed studies, grounded on self-disclosed or qualitative analysis. Further, deprived housing conditions and other facilities across the reviewed studies reflect institutional negligence. Therefore, by conducting a systematic synthesis of occupational health of women workers in the Indian tea plantation sector through the lens of the built environment, prior accounts have been extended. Addressing these issues is essential for safeguarding women workers, which will ensure the longevity of the Indian tea industry.
In China, waterborne transmission is a relatively rare route for norovirus outbreaks; however, once it occurs, the outbreaks tend to be large in scale, prolonged in duration, and difficult to control. This systematic review characterizes the epidemiological features of such outbreaks in China. We searched the WANFANG, CNKI, PubMed, and Web of Science databases for literature on waterborne norovirus outbreaks published up to November 2023. From 2000 to 2022, a total of 112 outbreaks were reported in China among the 97 articles included. These outbreaks involved approximately 19,796 cases and 565,485 exposures, median of 98 cases per outbreak, with a median attack rate of 6.09 %. Most outbreaks occurred in southern regions, particularly in coastal provinces, with schools (59, 52.68 %) and towns or villages (25, 22.52 %) being the most common settings. The highest number of outbreaks was reported in February and the lowest in July, with an average of 8.25 outbreaks per month. Higher attack rates were associated with outbreaks occurring in winter, in primary schools, and in southern regions of the Qinling-Huaihe line. Contamination of barreled water and self-provided wells was the primary risk factor for waterborne norovirus outbreaks. Although waterborne transmission is a relatively rare route for norovirus outbreaks in China, it can cause large-scale outbreaks in a short period. Consequently, it is still necessary to enhance protection of water sources, rigorous water quality monitoring, and public health education on water sanitation.
The gut microbiota plays a central role in maintaining gastrointestinal (GI) health through its metabolic, immune-modulating, and barrier-supporting functions. Diet is among the most influential modifiable determinants shaping microbial composition and activity, thereby influencing susceptibility to GI disorders, particularly irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). This review synthesizes current evidence on the interplay between dietary patterns, gut microbiota, and the pathogenesis and management of IBS and IBD. The Mediterranean diet and plant-based dietary patterns were consistently associated with enrichment of short-chain fatty acid (SCFA)-producing taxa, including Faecalibacterium prausnitzii, Roseburia, and Bifidobacterium species, alongside enhanced intestinal barrier integrity, reduced systemic inflammation, and improved clinical outcomes in both IBS and IBD. The Low FODMAP (fermentable oligo-, di-, monosaccharides, and polyols) diet provided effective symptom relief in IBS, although its impact on microbial composition was modest and inconsistent. In contrast, the Western diet, ultra-processed foods, and the ketogenic diet were linked to dysbiosis, depletion of beneficial taxa such as Akkermansia muciniphila, increased intestinal permeability, and pro-inflammatory cytokine profiles that contributed to IBS symptomatology and IBD pathogenesis. The gut-brain axis emerged as a key mediator of bidirectional signaling between the microbiota and the central nervous system, with relevance to both gastrointestinal and psychological manifestations of IBS and IBD. In conclusion, dietary patterns substantially modulate gut microbial composition and gastrointestinal health, and the Mediterranean diet represents the most favorable pattern for both IBS and IBD. Integration of dietary counseling into clinical management, alongside long-term randomized controlled trials combining microbiome profiling with clinical endpoints, is recommended to advance personalized, microbiota-targeted nutritional strategies.
Triclosan (TCS) is a common chemical antibacterial agent widely used in personal care and medical products. With its increasing application, TCS is continuously released into the environment, and its impacts on ecological systems and human health have garnered growing attention. In this study, research progress on triclosan was comprehensively reviewed through bibliometric methods. All relevant articles and reviews published between 2014 and 2024 were retrieved from the Web of Science Core Collection (WoSCC). Bibliometric analyses were conducted using VOSviewer, CiteSpace, and Bibliometrix software. The results revealed a total of 4,019 articles in the field of TCS research, involving 17,346 researchers from 435 institutions across 98 countries/regions, and were published in 891 journals. The annual output of TCS-related literature showed an increasing trend, with China and the United States publishing the largest number of articles. "Science of The Total Environment" was the most productive journal, publishing 316 articles, while "Environmental Science & Technology" received the highest number of citations (8,637 times). Current research focuses on the interactions between TCS and other environmental pollutants (e.g., microplastics and heavy metals), as well as its impacts on organismal health and removal/degradation mechanisms. These findings are expected to enhance the understanding of TCS research characteristics and provide guidance for future research directions.
Contamination of aquatic environments with diazinon, one of the most widely used organophosphate pesticides, has emerged as a critical global concern due to its high mobility, environmental persistence, and pronounced neurotoxicity. These characteristics highlight the urgent need for efficient and sustainable treatment strategies. This systematic review synthesizes research published between 2014 and 2025 that investigates the performance of physical treatment technologies, with emphasis on adsorption and membrane-based filtration, for diazinon removal from aqueous media. The analysis reveals that low-cost, bio-derived adsorbents provide high removal efficiencies and offer strong potential for scalable applications. Additionally, nanofiltration membranes demonstrate notable selective separation performance driven by size- and charge-dependent mechanisms, although membrane fouling remains a significant operational challenge. Overall, the evidence indicates that physical treatment methods represent promising, cost-effective, and environmentally sustainable solutions for diazinon mitigation. This review identifies existing knowledge gaps and outlines future research directions toward developing advanced adsorbents and fouling-resistant membranes to enhance treatment efficiency in real-world water purification systems.
Lead exposure may contribute to harmful human health effects, but evidence of its carcinogenicity is limited. The International Agency for Research on Cancer (IARC) in 2006 classified lead as "probably carcinogenic" (Group 2A), based on limited evidence in humans and sufficient evidence in animals. To further synthesize evidence on lead's carcinogenicity, this review included a literature search and risk of bias assessment of 43 peer-reviewed epidemiological studies on lead exposure and cancer outcomes published between 2003 and 2020. Using the National Toxicology Program's Office of Health Assessment and Translation Risk of Bias approach, 13 Tier One studies (primarily low risk) and 30 Tier Two studies (low and high risk) were identified. These studies characterized lead exposure through biologic media (i.e., blood, urine, tissues, hair, nails), and/or work histories, and evaluated cancers of the biliary tract, brain and central nervous system, breast, digestive tract, head and neck, blood, mesothelium, reproductive organs, respiratory tract, skin, thyroid, and urinary tract. Notably, breast, thyroid, and head and neck cancers were not previously included in the IARC 2006 monograph. Across all site-specific cancers examined, at least one study reported an association with lead exposure except for skin cancer. Respiratory tract cancers had the most epidemiologic studies showing positive associations with lead exposure. Study limitations were commonly tied to risk of bias for confounding, exposure characterization, and outcome assessments. Taken together, future studies would benefit from robust experimental designs with thorough adjustments for confounders, large diverse populations, and standardized exposure assessments particularly for cancers with limited data.
Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic blood disorder that precedes multiple myeloma, and its etiology remains incompletely understood. Risk factors described in the literature include advanced age, male sex, Black race, a family history of plasma cell disorders, and the presence of chronic inflammatory or autoimmune conditions. Furthermore, direct exposure to pesticides has been proposed as a potentially modifiable risk factor. Accordingly, this study aimed to synthesize and evaluate the available evidence on MGUS prevalence and its possible relationship with occupational pesticide exposure among rural workers and pesticide applicators, including prevalence data when reported. A systematic review with meta-analysis was conducted according to Cochrane recommendations. Literature searches were conducted in October 2024 using the Medline (PubMed), Scopus, and Cochrane Library databases to identify relevant primary studies. Four eligible observational studies evaluating MGUS in participants directly exposed to pesticides were included. The studies reported positive associations between specific pesticides, such as aldrin, dieldrin, a carbon tetrachloride/carbon disulfide mixture, chlorothalonil, petroleum-derived products, and permethrin, and the occurrence of MGUS among rural workers. These findings were analyzed qualitatively due to methodological heterogeneity that precluded pooling of risk estimates. The meta-analysis, restricted to prevalence outcomes, showed that MGUS prevalence increases with age, suggesting age as an important risk factor. The scarcity of published studies and methodological heterogeneity highlight the need for further investigations to better characterize environmental and occupational risks associated with MGUS, which may inform future preventive strategies in higher-risk populations.
"Santé en 2050" is the first medical conference in France dedicated to the adaptation of healthcare systems to environmental constraints. Organized in 2024 and 2025 by healthcare professionals within The Shifters, a non-profit association committed to raising public awareness of the dual carbon challenge, the conference provided both a scientific platform for research on mitigation and adaptation in health and a forum to enhance professional competencies on these cross-cutting issues. Over its two successful editions, the event mapped the emerging disease landscape driven by environmental exposures and climate change, affecting both communicable and non-communicable diseases due to shifting temperatures, precipitation patterns, mass population movements, unhealthy lifestyles, and increasing pollution. Climate change also poses indirect threats to health by straining infrastructure, disrupting supply chains, and triggering crises that practitioners must address with ever-scarcer resources. The conference underscored the urgent need for a systemic overhaul of healthcare to build resilient, sustainable care pathways. It provided attendees with practical tools to integrate ecodesigned care, integrative medical approaches, and non-pharmacological interventions into their daily practice. The conference further explored pressing ethical and philosophical dilemmas, examining how technology, research priorities, and innovation must evolve in response to environmental constraints and the broader responsibility of medicine at a population level. Here we summarize the topics discussed during the two editions of the conference. By equipping healthcare workers with skills in epidemiology, disease prevention, and continuity of care amid accelerating environmental change, "Santé en 2050" aims to prepare the medical community for the challenges of tomorrow.
Air pollution continues to pose a critical global challenge, with profound implications for public health. This article examines the current state of air pollution in East Asia, analyzes the detrimental effects of air pollutants on multiple human physiological systems, and proposes actionable mitigation strategies. By synthesizing existing research, this review aims to enhance awareness among policymakers, institutions, and the public, advocating for collaborative efforts in pollution control and health protection. The outlook proposes the implementation of evidence-based interventions to address this urgent environmental and health crisis.
INTRODUCTION:There is a great deal of evidence that cadmium toxicity can have a significant impact on nutritional deficiencies, particularly iron deficiency. Therefore, in this study, we aimed to investigate the effect of cadmium toxicity on iron deficiency by meta-analysis method in order to clarify the previously obtained results. CONTENT:Web of Science, Scopus, and Pubmed databases were used for systematic search until December 17th, 2024. RevMan 5.4 software was used to perform meta-analysis. SUMMARY:Six studies were suitable for evaluating environmental/occupational cadmium exposure. In this analysis, serum cadmium levels were meaningfully higher in the cadmium-exposed groups (p=0.0005), while serum iron levels were meaningfully lower (p=0.0004). Forty-five studies were evaluated to include all diseases in which serum cadmium and serum iron levels were measured and included. According to this analysis, serum cadmium levels were meaningfully higher in case groups than in healthy controls (p<0.00001), while serum iron levels were meaningfully lower (p<0.00001). We also performed subgroup analysis exclusively for cancer patients and observed that serum cadmium levels were significantly elevated in cancer patients (p<0.00001), whereas serum iron levels were significantly decreased (p<0.00001). OUTLOOK:This is the first meta-analysis assessing the association between cadmium toxicity and iron deficiency. Our findings demonstrate that cadmium may be effective in triggering iron deficiency anemia and inflammation-induced anemia by impairing iron metabolism. However, it should be noted that more detailed studies are needed to clarify these effects of cadmium.
