International Journal of Environmental Research and Public Health

17 pages, 1011 KiB

Open AccessArticle

Satisfaction with Health Facility Personnel Among Older People with Disabilities in Chile: An Observational Study Based on the 2024 DISCA Survey

by Elena S. Rotarou, Dikaios Sakellariou and Rafael Pizarro-Mena

Int. J. Environ. Res. Public Health 2025, 22(7), 1103; https://doi.org/10.3390/ijerph22071103 (registering DOI) - 13 Jul 2025

Abstract

Achieving health equity for people with disabilities requires addressing the barriers that they face when accessing healthcare. Older adults with disabilities may experience compounded disparities, yet little research has explored their satisfaction with health facility personnel, including non-healthcare staff. This study examines differences [...] Read more.

Achieving health equity for people with disabilities requires addressing the barriers that they face when accessing healthcare. Older adults with disabilities may experience compounded disparities, yet little research has explored their satisfaction with health facility personnel, including non-healthcare staff. This study examines differences in satisfaction with health facility personnel between younger (18–59 years) and older (60+) adults with disabilities in Chile. Data from the 2024 Disability and Citizenship (DISCA) survey were analysed using chi-square tests to examine differences between younger and older people with disabilities with regard to their satisfaction with health facility personnel. Ordered logistic regressions were employed to predict high satisfaction, given socioeconomic and health-related variables. Findings indicated that a higher percentage of older adults with disabilities reported high satisfaction with health facility personnel compared to younger adults. Ordered logistic regressions confirmed that older adults had greater odds of reporting high satisfaction with doctors (OR: 3.83), other health professionals (OR: 4.66), paramedical technicians (OR: 4.31), and administrative staff (OR: 3.13). These results suggest that age influences satisfaction levels among people with disabilities, potentially due to varying expectations, experiences, or interactions with health facility personnel. Understanding the underlying reasons for these age-related differences is essential to inform policies and practices that ensure equitable, person-centred care for people with disabilities across the life course. Full article

(This article belongs to the Special Issue Addressing Healthcare Inequities for Older Adults: Challenges and Pathways to Equitable Healthcare Services)

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17 pages, 653 KiB

Open AccessArticle

Mobilizing for Health: A Case Study of Kazakhstan’s Vaping Ban Advocacy Campaign

by Jamilya Sadykova, Akerke Ayaganova and Kuanysh A. Yergaliyev

Int. J. Environ. Res. Public Health 2025, 22(7), 1102; https://doi.org/10.3390/ijerph22071102 (registering DOI) - 13 Jul 2025

Abstract

This article focuses on an advocacy campaign for a complete ban on vaping in Kazakhstan led by the Smokefree Kazakhstan Coalition. Initiated in 2021, the campaign aimed to address the growing public health concerns about vaping among adolescents, which was reflected in a [...] Read more.

This article focuses on an advocacy campaign for a complete ban on vaping in Kazakhstan led by the Smokefree Kazakhstan Coalition. Initiated in 2021, the campaign aimed to address the growing public health concerns about vaping among adolescents, which was reflected in a sharp increase in vape use among young people—from 1.6% in 2014 to 5.8% in 2022. Despite facing strong opposition from the vaping industry and political lobbyists, the Coalition gained support from key political figures, public health leaders, and NGOs. Over 32 months, the campaign achieved several key milestones, including the inclusion of criminal liabilities for those involved in the vaping industry, and, in 2024, it eventually joined a number of countries such as Thailand, Qatar, Japan, Singapore, and India in approving a vaping ban. The advocacy efforts relied on public engagement, social media, and coordinated civil society mobilization—including petitions, public meetings, awareness campaigns, and coalition-building among NGOs and health advocacy groups—to overcome industry resistance toward official vaping market ban approvals. This article uses the case study approach with the Power Prism framework to describe and evaluate the advocacy campaign’s strategic plan, its political challenges, and the significant impact of public health advocacy in shaping national health policy. The significance of the article lies in the success of the vaping ban in the Kazakhstani context, which may serve as a model for other countries facing similar public health issues, political instability, and industry resistance. Full article

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16 pages, 381 KiB

Open AccessReview

Crossing Borders: SRH Challenges Among Immigrant and Minority Adolescents

by Patience Castleton, Ahmed Shabbir Chaudhry, Negin Damabi, Salima Meherali and Zohra S. Lassi

Int. J. Environ. Res. Public Health 2025, 22(7), 1101; https://doi.org/10.3390/ijerph22071101 (registering DOI) - 12 Jul 2025

Abstract

The adolescent years are pivotal in reproductive and sexual development and maturation, yet the experience of migration can severely disrupt this period, inhibiting young immigrants’ knowledge, access, and engagement with sexual and reproductive health (SRH) services. Further, young immigrants and minority populations often [...] Read more.

The adolescent years are pivotal in reproductive and sexual development and maturation, yet the experience of migration can severely disrupt this period, inhibiting young immigrants’ knowledge, access, and engagement with sexual and reproductive health (SRH) services. Further, young immigrants and minority populations often face persistent intersectional barriers, including language difficulties, cultural stigma, and systemic exclusion, that result in adverse SRH outcomes. Recent advances in SRH care, particularly in digital health and community-based interventions, show promise in improving access to culturally appropriate SRH services and information. Co-designing SRH programs with families and young immigrants to adequately acknowledge the unique cultural norms and barriers in SRH is essential in ensuring a high outreach of interventions. Shifts in traditional health policies are needed to ensure that immigrant and minority adolescents are not overlooked and that SRH programs incorporate culturally relevant content that is easily and widely accessible. Despite positive shifts, several barriers remain: limited disaggregated data on diverse populations, inadequate policy attention, and the insufficient scalability and funding of promising interventions. Future research and promotional efforts must prioritise the co-creation of SRH interventions with stakeholders and affected communities, ensuring that services are sustainable, culturally appropriate, and accessible to all adolescents. Full article

(This article belongs to the Special Issue Promoting Adolescent Sexual and Reproductive Health in Immigrants and Minorities)

11 pages, 1220 KiB

Open AccessBrief Report

The Effect of Assistive Devices on the Accuracy of Fitbits in Healthy Individuals: A Brief Report

by John Jaworski, Brian Makowski, Michael Weaver, Michael Seils and Jennifer L. Scheid

Int. J. Environ. Res. Public Health 2025, 22(7), 1100; https://doi.org/10.3390/ijerph22071100 (registering DOI) - 12 Jul 2025

Abstract

Our study explored the accuracy of Fitbit recorded step count during the use of an assistive device (two-wheeled walker and standard cane) at various body positions (wrists, hips, and ankles). Participants (n = 11) ambulated an obstacle course (50 m total, including [...] Read more.

Our study explored the accuracy of Fitbit recorded step count during the use of an assistive device (two-wheeled walker and standard cane) at various body positions (wrists, hips, and ankles). Participants (n = 11) ambulated an obstacle course (50 m total, including turns and a step up/down) a total of three times (two-wheeled walker, standard cane, and a deviceless control trial). Fitbit generated step counts (at the wrists, hips, and ankles) were then compared to the individual’s “actual” step count captured through video analysis. During the cane trial and the deviceless trial, all positions were significantly correlated (r = 0.764 to 0.984; p < 0.006) with the actual step count. However, increased variability (demonstrated by increased limits of agreement) was observed when the Fitbit was worn on the wrist (compared to the hips or ankles). During the walker trial, the step count was significantly correlated to the actual step count at the ankle and hip positions (r = 0.669 to 0.888; p < 0.017) with an average error of 1.5%, while it was not statistically correlated at the wrist with a 31.2% average error. Our study suggests that Fitbits are a good predictor of actual step count, with the caveat that the location of the Fitbit should be considered if an assistive device (e.g., two-wheeled rolling walker and single-point cane) is being used. Full article

(This article belongs to the Section Global Health)

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13 pages, 973 KiB

Open AccessArticle

Perceptions and Willingness of Patients and Caregivers on the Utilization of Patient-Generated Health Data: A Cross-Sectional Survey

by Ye-Eun Park, Sang Sook Beck and Yura Lee

Int. J. Environ. Res. Public Health 2025, 22(7), 1099; https://doi.org/10.3390/ijerph22071099 - 11 Jul 2025

Abstract

Patient-generated health data (PGHD) enhance traditional healthcare by enabling continuous monitoring and supporting personalized care, yet concerns over privacy, security, and integration into existing systems hinder broader adoption. This study examined the perceptions, awareness, and concerns of patients and caregivers regarding PGHD and [...] Read more.

Patient-generated health data (PGHD) enhance traditional healthcare by enabling continuous monitoring and supporting personalized care, yet concerns over privacy, security, and integration into existing systems hinder broader adoption. This study examined the perceptions, awareness, and concerns of patients and caregivers regarding PGHD and assessed their willingness to share such data for clinical, research, and commercial purposes. A cross-sectional survey was conducted from 6 to 12 November 2023, involving 400 individuals with experience using PGHD. Participants completed structured questionnaires addressing health information management, PGHD usage, and attitudes toward its application. PGHD was most commonly used by patients with chronic conditions and guardians of minors, with tethered personal health record apps frequently utilized. Respondents identified improved self-management and better access to information as key benefits. However, significant concerns about data privacy and security emerged, especially regarding non-clinical use. Younger adults, particularly those in their 20s, showed lower willingness to engage with PGHD due to heightened privacy concerns. These findings suggest that, while support for clinical use of PGHD is strong, barriers related to trust and consent remain. Addressing privacy concerns and simplifying consent processes will be essential to promote equitable and responsible PGHD utilization across diverse patient populations. Full article

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Graphical abstract

9 pages, 231 KiB

Open AccessArticle

A Clinical Audit of the Use of CT Head Scan Post-Inpatient Falls in Hospitalised Older Adults Utilising a Post-Fall Clinical Pathway

by Isabel Watt, Ruth Devin, Joyita Bhattacharya, Frances Waldie, Emma Holden and Chiung-Jung (Jo) Wu

Int. J. Environ. Res. Public Health 2025, 22(7), 1098; https://doi.org/10.3390/ijerph22071098 - 11 Jul 2025

Abstract

Background: Older adults are at high risk of falls, and head injuries following these events can have devastating consequences. The In-Patient Post Fall Clinical Pathway is a tool utilised in many hospitals in Queensland, Australia, to guide the need for CT brain imaging [...] Read more.

Background: Older adults are at high risk of falls, and head injuries following these events can have devastating consequences. The In-Patient Post Fall Clinical Pathway is a tool utilised in many hospitals in Queensland, Australia, to guide the need for CT brain imaging post-inpatient fall. This audit aimed to assess the use of CT imaging following inpatient falls in older adults, evaluate adherence to the In-Patient Post Fall Clinical Pathway, and explore factors associated with serious head injury. Methods: A retrospective audit was conducted across two regional Queensland hospitals over 2.5 years. Falls involving patients aged over 65 years were included. Data were analysed using descriptive and bivariate statistical tests. Results: Among 874 eligible falls, the mean patient age was 80.4 years, and approximately two-thirds were male. While 90.6% of patients who had fallen met clinical pathway criteria for a CT head scan, only 50.1% of them received a scan. Serious head injuries were uncommon (2.25% of total falls), with subdural haematoma being most frequent. Only one patient underwent neurosurgical intervention. No missed serious injuries were identified. No individual characteristic was significantly associated with serious head injury, although trends were observed for unwitnessed falls, falls from bed, falls with a head strike, new symptoms four hours post-fall, and anticoagulant use. Conclusions: There is a gap between clinical pathway recommendations and imaging practices, with clinicians often relying on judgement over strict adherence to guidelines. Further research is needed to inform evidence-based and practical decision-making to balance imaging use with clinical risk. Full article

(This article belongs to the Special Issue Advancing Health Services and Systems for Vulnerable Populations including People with Chronic Conditions)

10 pages, 287 KiB

Open AccessArticle

Health Promotion and Diagnosis of Oral Diseases in Institutionalized Elderly People: An Experience Report

by Isadora Lima Pereira, Fabio Augusto Ito, Ademar Takahama Júnior, Tiago Carvalho dos Santos, Paulo Sérgio da Silva Santos, Camila Lopes Cardoso and Heliton Gustavo de Lima

Int. J. Environ. Res. Public Health 2025, 22(7), 1097; https://doi.org/10.3390/ijerph22071097 - 11 Jul 2025

Abstract

This study presents the findings of an academic extension project focused on promoting oral health and diagnosing oral lesions in institutionalized elderly individuals. The project involved visits by students and faculty to two nursing homes in southern Brazil. Data collection included extraoral and [...] Read more.

This study presents the findings of an academic extension project focused on promoting oral health and diagnosing oral lesions in institutionalized elderly individuals. The project involved visits by students and faculty to two nursing homes in southern Brazil. Data collection included extraoral and intraoral clinical examinations and educational activities such as lectures and the distribution of printed materials on oral and denture hygiene. According to caregiving staff, oral hygiene, including denture cleaning, was generally performed once daily during morning showers. A total of 118 older adults (68 males and 50 females; mean age 76.1 ± 8.6 years) were examined. Forty-nine used dentures, of whom only 24 (49%) reported satisfaction with their prostheses. In total, 42 oral lesions were identified, mainly angular cheilitis (8), inflammatory fibrous hyperplasia (7), irritation fibroma (7), frictional hyperkeratosis (7), prosthetic stomatitis (5), actinic cheilitis (3), traumatic ulcers (3), and leukoplakia (2). Educational sessions also targeted caregivers, offering practical guidance for improving hygiene practices. The results underscore the need for better oral care and improved access to dental services for institutionalized elderly populations. Academic extension activities play a valuable role in health promotion and in training future professionals in elderly care. Full article

(This article belongs to the Special Issue Oral Health and Quality of Life in Older Adults)

26 pages, 641 KiB

Open AccessSystematic Review

Achieving Family-Integrated Care for Older Patients with Major Neurodegenerative and Mental Health Conditions: A Systematic Review of Intervention Characteristics and Outcomes

by Shruti Jindal, Mohammad Hamiduzzaman, Harry Gaffney, Noore Siddiquee and Helen McLaren

Int. J. Environ. Res. Public Health 2025, 22(7), 1096; https://doi.org/10.3390/ijerph22071096 - 10 Jul 2025

Abstract

National and international aged care frameworks recommend family-integrated care to enhance care quality and outcomes, supported by evidence demonstrating improvements in patient and clinician experiences. Yet uncertainty remains about how to integrate family carers effectively in diverse healthcare models and settings for neurodegenerative [...] Read more.

National and international aged care frameworks recommend family-integrated care to enhance care quality and outcomes, supported by evidence demonstrating improvements in patient and clinician experiences. Yet uncertainty remains about how to integrate family carers effectively in diverse healthcare models and settings for neurodegenerative and mental health conditions. A systematic integrative review was conducted to answer two research questions: how do the studies describe the integration of family carers in health services design and delivery for older patients with neurodegenerative and mental health conditions? And what is the evidence for family-integrated care models impacting the health and wellbeing of these older patients? Structured and iterative searches of five databases (CINAHL, Medline (Ovid), Web of Science, PsycINFO, and ProQuest) and the Google Scholar search engine identified 2271 records. A Covidence screening process resulted in 14 studies for review, comprising randomised controlled trials, mixed methods studies, qualitative studies, and quasi-experimental designs. The following four themes emerged from the evidence synthesis: (1) family participation in service delivery, (2) health and wellbeing outcomes, (3) satisfaction with care, and (4) service dynamics in enabling family-integrated care successfully. This review highlights that while family-integrated care models contribute to positive health and wellbeing outcomes for older patients with neurodegenerative and mental health conditions, challenges remain for implementation due to the extent and variability in integration strategies, a lack of rigorous evaluation, and an absence of standardised frameworks. Full article

(This article belongs to the Special Issue Family Caregiving of Older Adults)

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16 pages, 506 KiB

Open AccessArticle

Effect of Demographic Characteristics and Personality Traits on Eating Patterns in the Context of Dietary Intervention: The EATMED Case Study

by Michele Ricci, Andrea Devecchi, Riccardo Migliavada, Maria Piochi and Luisa Torri

Int. J. Environ. Res. Public Health 2025, 22(7), 1095; https://doi.org/10.3390/ijerph22071095 - 10 Jul 2025

Abstract

There is a confirmed and ongoing need to encourage adherence to healthy dietary patterns in the general population in western societies, given their recognized positive impact in preventing non-communicable diseases (NCDs). A potentially very effective solution is the use of digital tools such [...] Read more.

There is a confirmed and ongoing need to encourage adherence to healthy dietary patterns in the general population in western societies, given their recognized positive impact in preventing non-communicable diseases (NCDs). A potentially very effective solution is the use of digital tools such as apps and web apps, which can reach a large number of people quickly. Still, to be effective, it is necessary to better understand how participant engagement in these interventions works, to identify the motivations that may lead them to drop out, and to evaluate the effectiveness of these interventions. In our study, an innovative web app designed to encourage adherence to the Mediterranean diet (EATMED) was tested in an intervention study, evaluating adherence to the Mediterranean diet before and after the use of the web app in a cohort of people, compared to a control group, using the MEDI-lite questionnaire. The Health and Taste Attitude Scale questionnaire was also administered to all participants to assess interest in healthy foods and diets, as well as attitudes toward food. The study showed that the score of the Food as Reward subscale of the HTAS had a significant effect on dropout from the intervention study, and that the use of the app among participants who remained resulted in a two-point increase in adherence to the Mediterranean diet, according to the MEDI-lite questionnaire. These results indicate the effectiveness of the EATMED tool and provide useful insights into how to understand and mitigate dropout in digital nutrition interventions. Full article

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17 pages, 299 KiB

Open AccessArticle

Dating Application Use and Its Relationship with Mental Health Outcomes Among Men Who Have Sex with Men in Urban Areas of Thailand: A Nationwide Online Cross-Sectional Survey

by Sarawut Nasahwan, Jadsada Kunno and Parichat Ong-Artborirak

Int. J. Environ. Res. Public Health 2025, 22(7), 1094; https://doi.org/10.3390/ijerph22071094 - 9 Jul 2025

Abstract

Dating applications (DAs) are widely used to establish social and sexual connections among men who have sex with men (MSM), particularly in urban areas. In this study, we aimed to examine the associations between DA use and mental health among Thai MSM. An [...] Read more.

Dating applications (DAs) are widely used to establish social and sexual connections among men who have sex with men (MSM), particularly in urban areas. In this study, we aimed to examine the associations between DA use and mental health among Thai MSM. An online cross-sectional survey was completed by 442 MSM residing in Bangkok and urban municipalities across all regions of Thailand. Psychological distress (PD) and probable depression were assessed using the General Health Questionnaire (GHQ-12) and the Patient Health Questionnaire (PHQ-9), respectively. Of the participants, 62.7% were current users, with 33.2% experiencing PD and 33.9% having depression. A logistic regression analysis showed that PD was significantly associated with late-night use (AOR = 2.02, 95% CI: 1.08–3.78), matching failure (AOR = 1.95, 95% CI: 1.12–3.38), rejection (AOR = 2.07, 95% CI: 1.18–3.62), and ghosting (AOR = 1.78, 95% CI: 1.02–3.11). Simultaneously, depression was significantly associated with using DAs with the motivation of hooking up (AOR = 2.27, 95% CI: 1.05–4.93), privacy violations (AOR = 2.76, 95% CI: 1.42–5.38), unsolicited sexual images (AOR = 2.04, 95% CI: 1.11–3.74), physical assault (AOR = 2.97, 95% CI: 1.57–5.61), harassment (AOR = 2.54, 95% CI: 1.37–4.70), scams (AOR = 2.59, 95% CI: 1.41–4.77), and extreme disappointment from DA use (AOR = 5.98, 95% CI: 1.84–19.41). These findings highlight how DA usage patterns and negative experiences may contribute to the poorer mental health among MSM in urban areas. Full article

(This article belongs to the Section Behavioral and Mental Health)

22 pages, 1180 KiB

Open AccessArticle

Guidelines and Preliminary Results of Group-Based Nutrition Interventions for Obesity Management Among Adults in Brazilian Primary Health Care

by Angélica Ribeiro e Silva, Maria Cecília Ramos de Carvalho, Nathália Luíza Ferreira, Natacha Toral, Camila Kümmel Duarte and Aline Cristine Souza Lopes

Int. J. Environ. Res. Public Health 2025, 22(7), 1093; https://doi.org/10.3390/ijerph22071093 - 9 Jul 2025

Abstract

This study presents the guideline and preliminary results of a randomized controlled community trial of group-based nutrition interventions for obesity management in Brazilian Primary Health Care (PHC), occurring between 2022 and 2023. Belo Horizonte PHC units were randomly sampled and allocated to the [...] Read more.

This study presents the guideline and preliminary results of a randomized controlled community trial of group-based nutrition interventions for obesity management in Brazilian Primary Health Care (PHC), occurring between 2022 and 2023. Belo Horizonte PHC units were randomly sampled and allocated to the control (CG) or intervention group (IG). Participants were those in preparation with high self-efficacy, action, or maintenance stages of change for weight reduction who were willing to participate in groups. CG participants received usual care, while IG participants were allocated into two therapeutic groups (TGs): non-severe (TG1) or severe obesity (TG2). We analyzed demographics data, stages of change and self-efficacy for weight reduction, and intervention adherence. The six-month theory-based interventions included face-to-face groups (TG1:7; TG2:9) and phone messages and postcards delivered (TG1:4; TG2:5). There were 1120 participants. Most were women, with a median age of 61.4 years; 45.4% were in the maintenance stage of change for weight reduction, and 76.1% had high self-efficacy. A total of 350 groups were held, 13,473 phone calls made, and 1973 postcards delivered. The median adherence was 52.4%. The reach and adherence to groups demonstrate their viability and scalable potential for the treatment of obesity in Brazilian PHC, contributing to the strengthening of chronic disease management actions. Full article

(This article belongs to the Special Issue The 20th Anniversary of IJERPH)

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10 pages, 235 KiB

Open AccessArticle

Developing a Maternal Health Education and Research Training Program for High School, Pharmacy, and Health Sciences Students

by Grace Olorunyomi, Cecilia Torres, Kennedi Norwood, Lashondra Taylor, Jazmyne Jones, Kimberly Pounds, Kehinde Idowu, Dominique Guinn, Denae King, Veronica Ajewole-Mwema, Ivy Poon and Esther Olaleye

Int. J. Environ. Res. Public Health 2025, 22(7), 1092; https://doi.org/10.3390/ijerph22071092 - 9 Jul 2025

Abstract

Maternal mortality and morbidity are critical health challenges in the U.S., and building the perinatal workforce is a key to providing high-quality maternal medical care and services. Texas Southern University (TSU), home to a Doctor of Pharmacy program, launched the first Maternal Health [...] Read more.

Maternal mortality and morbidity are critical health challenges in the U.S., and building the perinatal workforce is a key to providing high-quality maternal medical care and services. Texas Southern University (TSU), home to a Doctor of Pharmacy program, launched the first Maternal Health Education and Research Training (MHERT) program to educate a cohort of high school, pharmacy, and health sciences students. Aiming to raise awareness of maternal health issues, build research skills, and promote action-based solutions. MHERT integrated online self-paced interactive lessons with hands-on research or community projects. Topics included maternal health epidemiology, causes of morbidity and mortality, research methods, literature reviews, and the development of action plans addressing maternal health challenges. Assessment tools included quizzes, open-ended reflection responses, training surveys, and course evaluations. Running from 3 June to 26 July 2024, the program enrolled 22 students. All participants completed both course components. Course evaluations showed strong and consistent satisfaction with the program, with teaching effectiveness rated at 95% and 96% for mid-program and final evaluations, respectively. MHERT enhanced participants’ understanding of maternal health, improved research skills, and encouraged community engagement and interdisciplinary collaboration. It offers a scalable model to strengthen public health education among high school, pharmacy, and health sciences students. Full article

(This article belongs to the Special Issue Proceedings of the 2024 and 2025 Research Centers in Minority Institutions (RCMI) Consortium National Conferences)

20 pages, 1227 KiB

Open AccessReview

A Rapid Review of Ethical and Equity Dimensions in Telerehabilitation for Physiotherapy and Occupational Therapy

by Mirella Veras, Jennifer Sigouin, Louis-Pierre Auger, Claudine Auger, Sara Ahmed, Zachary Boychuck, Sabrina Cavallo, Martine Lévesque, Stacey Lovo, William C. Miller, Michelle Nelson, Nahid Norouzi-Gheidari, Jennifer O’Neil, Kadija Perreault, Reg Urbanowski, Lisa Sheehy, Hardeep Singh, Claude Vincent, Rosalie H. Wang, Diana Zidarov, Anne Hudon and Dahlia Kairy Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2025, 22(7), 1091; https://doi.org/10.3390/ijerph22071091 - 9 Jul 2025

Abstract

Introduction: The rapid adoption of telerehabilitation in physiotherapy and occupational therapy has transformed healthcare delivery, offering new opportunities for patient-centered care. However, its implementation raises critical ethical and equity-related questions that require proactive strategies to ensure fair and responsible practices. This review examines [...] Read more.

Introduction: The rapid adoption of telerehabilitation in physiotherapy and occupational therapy has transformed healthcare delivery, offering new opportunities for patient-centered care. However, its implementation raises critical ethical and equity-related questions that require proactive strategies to ensure fair and responsible practices. This review examines how ethical disparities and equity-related challenges are reflected in the existing literature on telerehabilitation. Objective: To investigate the presence of ethical-disparity and equity-related aspects in the provision of telerehabilitation in physiotherapy and occupational therapy as reflected in the literature. Data Sources: A rapid review methodology was employed to explore ethical and equity-related challenges in telerehabilitation. The search included articles published in English and French between 2010 and 2023 from the Medline and Embase databases. Study Selection: Articles were selected based on their relevance to ethical and equity considerations in telerehabilitation. A total of 1750 sources were initially identified, with 67 articles meeting the eligibility criteria for inclusion in this review. Data Extraction: Data were extracted based on variables such as age, gender, ethnicity, morbidity, cost, privacy, confidentiality, and autonomy. The data extraction and analysis were guided by the Progress Plus and Metaverse Equitable Rehabilitation Therapy frameworks. Data Synthesis: The findings were analyzed and discussed using a narrative synthesis approach. The results highlighted key ethical considerations, including adverse events, patient autonomy, and privacy issues. Equity-related aspects were examined, access to rehabilitation services and gender considerations. Disparities in technology access, socioeconomic status, and ethnicity were also identified. Conclusions: This rapid review highlights the growing relevance of ethical and equity considerations in the design and delivery of telerehabilitation within physiotherapy and occupational therapy. The findings show inconsistent reporting and limited depth in addressing key domains such as patient autonomy, privacy, and adverse events, alongside disparities related to age, gender, socioeconomic status, and geographic access. Although telerehabilitation holds promise for expanding access, particularly in underserved areas, this potential remains unevenly realized. The review underscores the critical need for structured, equity-driven, and ethically grounded frameworks such as the Metaverse Equitable Rehabilitation THerapy (MERTH) framework to guide future implementation, research, and policy. Full article

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30 pages, 998 KiB

Open AccessArticle

Barriers to Immunosuppressant Medication Adherence in Thoracic Transplant Recipients: Initial Findings

by Sparkle Springfield-Trice, Grishma Reddy, Cara Joyce, Benito M. Garcia, Palak Shah, Sean Agbor-Enoh and Hannah Valantine

Int. J. Environ. Res. Public Health 2025, 22(7), 1090; https://doi.org/10.3390/ijerph22071090 - 8 Jul 2025

Abstract

Although transplantation remains the gold-standard treatment for patients with end-organ failure, lifelong adherence to immunosuppressant medication is required to prevent rejection, graft failure, and mortality. Given the increase in thoracic organ transplantation, it is crucial to better understand the associated barriers to treatment. [...] Read more.

Although transplantation remains the gold-standard treatment for patients with end-organ failure, lifelong adherence to immunosuppressant medication is required to prevent rejection, graft failure, and mortality. Given the increase in thoracic organ transplantation, it is crucial to better understand the associated barriers to treatment. Examining sociodemographic, transplant, healthcare access, post-transplant treatment, and patient-related psychosocial factors may help to elucidate treatment barriers that have not been previously considered in the existing literature. This single-site cross-sectional study surveyed 65 thoracic (heart and lung) transplant recipients (mean age: 62 years; 76.2% male; 72.3% White, and 21.5% Black) via phone interviews. Immunosuppressant nonadherence was found in 49.2% of participants (46.9% heart, 51.5% lung). In a four-week period, 20% of participants missed at least one dose, 40% did not take their medications on time, and 1% stopped completely. Significant correlates of nonadherence included poorer diet quality, fewer comorbidities, and maladaptive coping responses to perceived discrimination. This preliminary study highlights the importance of considering the social determinants of health—particularly post-transplant treatment and psychosocial patient-related factors—to inform post-transplant care. Addressing such variables may improve medication adherence and, subsequently, overall health outcomes. Further research with larger samples is needed to better understand the associated correlates and inform effective interventions for enhanced medication adherence. Full article

(This article belongs to the Special Issue 3rd Edition: Social Determinants of Health)

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24 pages, 1152 KiB

Open AccessArticle

Analysis of the Correlation Between the Governance and Quality of Biomedical Waste Management in Public Health Facilities in Togo, 2024

by Sarakawa Abalo Niman, Edem Komi Koledzi and Nitale M’balikine Krou

Int. J. Environ. Res. Public Health 2025, 22(7), 1089; https://doi.org/10.3390/ijerph22071089 - 8 Jul 2025

Abstract

Increasing the use of healthcare facilities has resulted in the growing production of biomedical waste, which poses health risks to users, health professionals, and the environment. The aim of this research is to study the correlation between governance in Togo’s public health facilities [...] Read more.

Increasing the use of healthcare facilities has resulted in the growing production of biomedical waste, which poses health risks to users, health professionals, and the environment. The aim of this research is to study the correlation between governance in Togo’s public health facilities and the quality of biomedical waste management within these facilities. Methods: This was a cross-sectional, descriptive, and analytical study conducted from September to December 2024. It involved 264 public health facilities of all types in all health regions of Togo. Health facilities were selected using the simple random selection technique. Healthcare providers were selected using the reasoned choice technique. The statistical tests used were the chi-square test and logistic regression, which enabled proportions to be compared and confounding factors to be eliminated, respectively. Results: Multivariate analysis revealed a statistically significant association between the organization and training component of governance and the quality of biomedical waste management (BMWM) in health facilities (OR = 3.79; 95% CI [1.79–8.03]; p < 0.001). This relationship suggests that health facilities with functional infection prevention and control (ICP) or BMWM committees, trained staff at all levels (nursing, technical, and administrative), and dedicated waste management personnel are more likely to implement compliant waste management practices. Analyses of the data also revealed that, among the criteria for assessing the quality of biomedical waste management (BMWM), the most significant were sorting (OR = 1.482; 95% CI [1.286; 1.708]), quantification (OR = 2.026; 95% CI [1.491; 2.753]), transportation (OR = 1.403; 95% CI [1.187; 1.66]), and disposal infrastructure (OR = 1.604; 95% CI [1.298; 1.982]). The application of this grid shows that 17.8% of the health facilities surveyed had a score equal to or above 80% on all the criteria used to assess the quality of biomedical waste management, and they were therefore managing waste in an “acceptable” manner. The study highlights key findings in biomedical waste management practices, providing actionable insights for improving public health safety. Full article

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12 pages, 383 KiB

Open AccessArticle

Public Opinion Study on School Health Education Programs: Family Needs Assessment Study

by Hacer Efe and Ünsal Umdu Topsakal

Int. J. Environ. Res. Public Health 2025, 22(7), 1088; https://doi.org/10.3390/ijerph22071088 - 8 Jul 2025

Abstract

Health education programs are important interventions aimed at the acquisition of health knowledge and behaviors that are necessary throughout the lives of individuals of all ages. Considering the importance of health education in structuring the health of the society, it is very important [...] Read more.

Health education programs are important interventions aimed at the acquisition of health knowledge and behaviors that are necessary throughout the lives of individuals of all ages. Considering the importance of health education in structuring the health of the society, it is very important that health education responds to the needs of society and meets its expectations. At this point, public health is protected by providing access to families and communities through health education. In this context, a needs analysis study was conducted with families (students and parents) to establish a health education framework. The study group consisted of 289 volunteer primary and secondary school students and 60 parents who agreed to participate in the study. Semi-structured interviews were conducted with students and parents using a descriptive approach. The needs analysis form prepared by the researchers was used in the interviews and content analysis was applied to the obtained data. The qualitative data obtained from the analyses were interpreted. As a result of the study, it was found that families have expectations and needs in first aid and daily life behaviors (nutrition, hygiene, oral health and diseases) in school health education, and accordingly, school health education can be focused on these specified areas. The fact that families found health knowledge insufficient and considered health education important emphasizes the importance of the knowledge provided by health education and the results. The family health education views obtained in the study can be used in future studies to improve family health behaviors and community health. In addition, family-based school health education can be disseminated with contemporary interventions. Full article

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13 pages, 314 KiB

Open AccessArticle

Food Insecurity and Associated Factors Among Adolescents from Inland Northeast Brazil: A Cross-Sectional Study

by Maria Eliza Dantas Bezerra Romão, Maria Helena Rodrigues Galvão, Fábio Correia Sampaio, Jocianelle Maria Félix Fernandes Nunes and Franklin Delano Soares Forte

Int. J. Environ. Res. Public Health 2025, 22(7), 1087; https://doi.org/10.3390/ijerph22071087 - 8 Jul 2025

Abstract

This study aimed to investigate food insecurity (FI) and its association with sociodemographic characteristics and behavioral and dental alterations in adolescents from a county in the inland of northeastern Brazil. Data on 192 adolescents aged 11–14 years were analyzed in the public school [...] Read more.

This study aimed to investigate food insecurity (FI) and its association with sociodemographic characteristics and behavioral and dental alterations in adolescents from a county in the inland of northeastern Brazil. Data on 192 adolescents aged 11–14 years were analyzed in the public school system in Juripiranga, Paraíba, Northeast Brazil. The adolescents and their guardians responded to the Brazilian Food Insecurity Scale, the Strength and Difficulties Questionnaire for the caregiver, the Strength and Difficulties Questionnaire for children and adolescents, and a sociodemographic questionnaire. Academic performance was observed by calculating the median of the final assessments of basic school subjects. The prevalence of FI was 69.19, and FI was associated with a family income of up to one minimum wage per month (prevalence ratio [PR]: 1.90; 95% confidence interval [95% CI]: 1.20–3.01), no practice of religion by the guardian (PR: 1.34; 95% CI: 1.04–1.73), behavior considered inappropriate by the guardian (PR: 1.33; 95% CI: 1.02–1.73), and academic performance (PR: 1.35; 95% CI: 1.05–1.72). FI is considered a complex and multifactorial problem that requires appropriate intervention to deal with multiple social determinants. The results point to the need for integrated public policies between the health, education, social assistance, and food security sectors. Full article

(This article belongs to the Special Issue Oral Health Outcomes from Childhood to Adulthood)

10 pages, 259 KiB

Open AccessArticle

Vaping Education: A Two-Year Study Examining Health Literacy and Behaviors in a Southeastern State

by Adrienne M. Duke-Marks, James Benjamin Hinnant, Jessica R. Norton and Linda M. Gibson-Young

Int. J. Environ. Res. Public Health 2025, 22(7), 1086; https://doi.org/10.3390/ijerph22071086 - 8 Jul 2025

Abstract

Electronic nicotine delivery systems (vapes) are the most used nicotine products among U.S. adolescents, with usage increasing significantly from 2017 to 2019. School-based prevention programs are a critical strategy for curbing youth vaping. This study utilized a retrospective pre/post survey to evaluate the [...] Read more.

Electronic nicotine delivery systems (vapes) are the most used nicotine products among U.S. adolescents, with usage increasing significantly from 2017 to 2019. School-based prevention programs are a critical strategy for curbing youth vaping. This study utilized a retrospective pre/post survey to evaluate the effectiveness of a two-year school-based vaping prevention program utilizing a condensed version of the Stanford University Tobacco Prevention Toolkit. The program was implemented in-person and online across two years in a southeastern U.S. state. In year one, evalua-tion data were collected from 4252 youths from 20 rural counties who completed the in-person survey during the 2018–2019 program year. In year two, 1347 youths from 13 rural and urban counties completed the survey during the program year of 2019–2020. The key findings indicate significant increases in knowledge about vaping risks post-program. The findings from year one indicate that increases in knowledge about e-cigarettes were negatively related to the frequency of vaping, but this was not replicated in year two. Moreover, knowledge did not influence vaping frequency if youths had already started vaping, while pre-program knowledge did not predict the frequency of vaping in either year. These results suggest that vaping prevention education outcomes among youths are mixed. Full article

(This article belongs to the Special Issue Environmental Exposures and Epigenomics in Health and Disease)

13 pages, 273 KiB

Open AccessArticle

Barriers to Physical Activity Participation Among University Staff: A Cross-Sectional Study

by Sami Elmahgoub, Hassan Mohamed, Farah Abu Khadra, Aseel Aburub, Mohamed I. Mabrouk, Adel Eltaguri and Ákos Levente Tóth

Int. J. Environ. Res. Public Health 2025, 22(7), 1085; https://doi.org/10.3390/ijerph22071085 - 8 Jul 2025

Abstract

Regular physical activity (PA) is crucial for health, yet many individuals face barriers to engage in an active lifestyle. This study aimed to identify and analyze the barriers preventing university staff from participating in PA. A cross-sectional quantitative approach was utilized, distributing surveys [...] Read more.

Regular physical activity (PA) is crucial for health, yet many individuals face barriers to engage in an active lifestyle. This study aimed to identify and analyze the barriers preventing university staff from participating in PA. A cross-sectional quantitative approach was utilized, distributing surveys to a diverse sample of 238 university staff aged 19 to 77 years, with an average age of 40. The survey was designed to identify the barriers that individuals face in adhering to physical PA and collected data on various internal and external factors influencing PA participation. Younger participants reported significantly higher scores for lack of energy and motivation compared to older age groups. Additionally, female participants experienced greater internal and external barriers than their male counterparts. Furthermore, university employees experienced significantly higher internal barriers, namely a lack of energy and lack of motivation. The primary barrier to PA participation among university staff was a lack of time. This study highlights the need for supportive environments that address these obstacles to promote PA participation. The findings offer valuable insights for university administrations and policymakers, emphasizing the importance of targeted interventions and supportive policies to enhance the health and activity levels of university staff. Full article

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