International Journal of Environmental Research and Public Health

16 pages, 1401 KiB

Open AccessArticle

Empowering Women, Enhancing Health: The Role of Education in Water, Sanitation, and Hygiene (WaSH) and Child Health Outcomes

by Aminata Kilungo, Mark Bayer, Zoe Baccam, Hamisi Malebo and Halima Alaofe

Int. J. Environ. Res. Public Health 2025, 22(5), 706; https://doi.org/10.3390/ijerph22050706 (registering DOI) - 29 Apr 2025

Abstract

Background: Adequate water, sanitation, and hygiene (WaSH) are critical to maintaining good health and hygiene. However, health is a function of many health determinants, and WASH services alone may not be sufficient to improve health outcomes. Objective: To identify whether the presence of [...] Read more.

Background: Adequate water, sanitation, and hygiene (WaSH) are critical to maintaining good health and hygiene. However, health is a function of many health determinants, and WASH services alone may not be sufficient to improve health outcomes. Objective: To identify whether the presence of WaSH services is associated with fewer children under five years of age experiencing symptoms of diarrhea in Katoma, Geita, Tanzania. Method: A cross-sectional study was conducted to collect health data, demographics, and other variables, such as WASH, food insecurity, education of the mother, vaccination data, and household income data, for 452 households with children under five. Surveys were completed in-person through interviews. Health outcome data included being sick with diarrhea or symptoms. Data analysis was performed using SAS OnDemand for Academics. Multivariate logistic regression and mixed-effects logistic regression models were employed to determine the association between the covariates and sickness of inclusion children and all the children involved in the study, respectively. Results: The findings suggest that WASH services alone do not have a significant impact on diarrhea, but other determinants of health, including the education of the mother, showed a significant impact on health outcomes among children with at least one WASH service. These demographic variables were also associated with lower food insecurity and poverty. The findings highlight the need to (1) include other covariates when analyzing WASH data to understand health outcomes; and (2) improve education attainment for women to maximize health benefits for their children. Full article

(This article belongs to the Section Global Health)

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25 pages, 504 KiB

Open AccessReview

Evaluating User Safety Aspects of AI-Based Systems in Industrial Occupational Safety: A Critical Review of Research Literature

by Jaroslava Huber, Bernhard Anzengruber-Tanase, Martin Schobesberger, Michael Haslgrübler, Robert Fischer-Schwarz and Alois Ferscha

Int. J. Environ. Res. Public Health 2025, 22(5), 705; https://doi.org/10.3390/ijerph22050705 (registering DOI) - 29 Apr 2025

Abstract

AI technologies are becoming increasingly prevalent in industrial workplaces, extending their applications beyond productivity to critical areas such as occupational safety. From our perspective, it is important to consider the safety of these AI systems for users already at the research and development [...] Read more.

AI technologies are becoming increasingly prevalent in industrial workplaces, extending their applications beyond productivity to critical areas such as occupational safety. From our perspective, it is important to consider the safety of these AI systems for users already at the research and development stage, rather than only after deployment. Therefore, in this review, we synthesize publications that propose such AI-based safety systems to assess how potential risks are addressed early in their design and prototype stages. Consequently, we explore current advancements in AI-driven, sensor-based, and human-centered applications designed to enhance occupational safety by monitoring compliance, detecting hazards in real time, or assisting users. These systems leverage wearables and environmental sensing to proactively identify risks, support decision-making, and contribute to creating safer work environments. In this paper, we categorize the technologies according to the sensors used and highlight which features are preventive, reactive, or post-incident. Furthermore, we address potential risks posed by these AI applications, as they may introduce new hazards for workers. Through a critical review of current research and existing regulations, we identify gaps and propose key considerations for the safe and ethical deployment of trustworthy AI systems. Our findings suggest that in AI- and sensor-based research applications for occupational safety, some features and risks are considered notably less than others, from which we deduce that, while AI is being increasingly utilized to improve occupational safety, there is a significant need to address regulatory and ethical challenges for its widespread and safe adoption in industrial domains. Full article

(This article belongs to the Special Issue Navigating the AI-Driven Workplace: Emerging Challenges and Innovative Solutions in Occupational Health and Safety)

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19 pages, 9566 KiB

Open AccessArticle

Associations Between 10-Year Physical Performance and Activities of Daily Living Trajectories and Physical Behaviors in Older Adults

by Mikael Anne Greenwood-Hickman, Weiwei Zhu, Abisola Idu, Laura B. Harrington, Susan M. McCurry, Andrea Z. LaCroix, Pamela A. Shaw and Dori E. Rosenberg

Int. J. Environ. Res. Public Health 2025, 22(5), 704; https://doi.org/10.3390/ijerph22050704 (registering DOI) - 29 Apr 2025

Abstract

Physical function is likely bidirectionally associated with physical activity (PA), sedentary behavior (SB), and sleep. We examined trajectories of physical function as predictors of these behaviors in community-dwelling adults aged ≥65 y without dementia from the Adult Changes in Thought cohort. Exposures were [...] Read more.

Physical function is likely bidirectionally associated with physical activity (PA), sedentary behavior (SB), and sleep. We examined trajectories of physical function as predictors of these behaviors in community-dwelling adults aged ≥65 y without dementia from the Adult Changes in Thought cohort. Exposures were trajectories of physical performance (short Performance-Based Physical Function [sPPF]) and self-reported activities of daily living (ADL) impairment. Outcomes were device-measured PA and SB and self-reported sleep. We fit linear mixed-effects models to define trajectory slopes and intercepts for each functional measure over the prior 10 years. We used multivariable linear regression to investigate the relationship between trajectory features and outcomes, using bootstrap confidence intervals. Participants (N = 905) were 77.6 (SD = 6.9) years old, 55% female, 91% white, and had a median sPPF score of 9 (IQR = [8, 11]) and median impairment of 1 ADL (IQR = [0, 2]) at the time of activity measurement (baseline). Steeper decreases in sPPF (0.3-unit, 25% of the range) were associated with fewer steps (−1180, 95% CI = [−2853, −185]) and less moderate-to-vigorous PA (−15.7 min/day [−35.6, −2.3]). Steeper increases in ADL impairment were associated with 35.0 min/day (4.3, 65.0) additional sitting time, longer mean sitting bout duration (3.5 min/bout [0.8, 6.2]), fewer steps (−1372 [−2223, −638]), less moderate-to-vigorous PA (−13 min/day [−22.6, −5.0]), and more time-in-bed (25.5 min/day [6.5, 43.5]). No associations were observed with light PA or sleep quality. Worsening physical function is associated with lower PA and higher SB, but not with light-intensity movement or sleep quality, supporting the bidirectional nature of the relationship between physical function and physical behaviors. Full article

(This article belongs to the Special Issue Aging Strong: Promoting Exercise and Nutrition to Combat Frailty in Older Adults)

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11 pages, 884 KiB

Open AccessReview

Health Disparities at the Intersection of Racism, Social Determinants of Health, and Downstream Biological Pathways

by Roland J. Thorpe, Jr., Marino A. Bruce, Tanganyika Wilder, Harlan P. Jones, Courtney Thomas Tobin and Keith C. Norris

Int. J. Environ. Res. Public Health 2025, 22(5), 703; https://doi.org/10.3390/ijerph22050703 (registering DOI) - 29 Apr 2025

Abstract

Despite overall improvements in the accessibility, quality, and outcomes of care in the U.S. health care system over the last 30 years, a large proportion of marginalized racial and ethnic minority (minoritized) groups continue to suffer from worse outcomes across most domains. Many [...] Read more.

Despite overall improvements in the accessibility, quality, and outcomes of care in the U.S. health care system over the last 30 years, a large proportion of marginalized racial and ethnic minority (minoritized) groups continue to suffer from worse outcomes across most domains. Many of these health disparities are driven by inequities in access to and the scope of society’s health-affirming structural resources and opportunities commonly referred to as structural drivers or social determinants of health—SDoH. Persistently health-undermining factors in the social environment and the downstream effects of these inequities on neurocognitive and biological pathways exacerbate these disparities. The consequences of these circumstances manifest as behavioral, neurohormonal, immune, and inflammatory and oxidative stress responses, as well as epigenetic changes. We propose a theoretical model of the interdependent characteristics of inequities in the SDoH driven by race-based discriminatory laws, policies, and practices that eventually culminate in poor health outcomes. This model provides a framework for developing and validating multi-level interventions designed to target root causes, thereby lessening health disparities and accelerating improved health outcomes for minoritized groups. Full article

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

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19 pages, 902 KiB

Open AccessArticle

The Positive Influence of Individual-Level Disaster Preparedness on the Odds of Individual-Level Pandemic Preparedness—Insights from FEMA’s 2021–2023 National Household Survey

by Dionne Mitcham and Crystal R. Watson

Int. J. Environ. Res. Public Health 2025, 22(5), 702; https://doi.org/10.3390/ijerph22050702 (registering DOI) - 29 Apr 2025

Abstract

Objective: To explore the possible association and trends between individual-level disaster preparedness status (for natural, technological, and human-caused hazards) and the level of pandemic preparedness during the COVID-19 pandemic among adults in the U.S. from 2021 through 2023. Methods: Multivariate logistic regression was [...] Read more.

Objective: To explore the possible association and trends between individual-level disaster preparedness status (for natural, technological, and human-caused hazards) and the level of pandemic preparedness during the COVID-19 pandemic among adults in the U.S. from 2021 through 2023. Methods: Multivariate logistic regression was conducted using data from the U.S. Federal Emergency Management Agency’s (FEMA) annual National Household Survey (NHS) from 2021 to 2023 to identify statistically significant variables associated with personal pandemic preparedness behavior among participants of the nationally representative survey during the COVID-19 pandemic. Results: Overall, the results showed that the proportion of respondents that were considered prepared for a pandemic peaked in 2021 (54.0%) and steadily decreased in the following years (2022: 43.3%; 2023: 41.3%) highlighting the need for pandemic preparedness resources and educational campaigns to be available prior to a pandemic occurring. The final multivariate logistic regression models featuring consistent significant covariates demonstrated a highly statistically significant relationship between individual-level disaster preparedness and pandemic preparedness across all three study years (2021: odds ratio (OR): 21.35, standard error (SE): 2.59, p < 0.001; 2022: OR: 9.26, SE: 0.87, p < 0.001; 2023: OR: 6.75, SE: 0.59, p < 0.001). Conclusions: The significant results suggest individuals who are prepared for a disaster have higher odds of being prepared for a pandemic. These findings support the continued increase in collaboration between emergency management and public health entities to jointly support the development of evidence-based resources to increase personal preparedness for both disasters and pandemics. Full article

(This article belongs to the Special Issue Health Emergencies and Disasters Preparedness)

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11 pages, 801 KiB

Open AccessArticle

Cardiovascular, Hemodynamic, and Anthropometric Adaptations Induced by Walking Training at FATmax in Obese Males and Females over 45 Years Old

by Laurence Mille-Hamard, Iman Momken, Jean-Pierre Koralsztein and Véronique Louise Billat

Int. J. Environ. Res. Public Health 2025, 22(5), 701; https://doi.org/10.3390/ijerph22050701 (registering DOI) - 29 Apr 2025

Abstract

Aims and Objectives: The present study aimed to examine the effects of 6 months of unsupervised training, walking at maximal fat oxidation (FATmax), on body composition and cardiovascular function at rest and exercise, in middle aged obese subjects. Methods and results: A single [...] Read more.

Aims and Objectives: The present study aimed to examine the effects of 6 months of unsupervised training, walking at maximal fat oxidation (FATmax), on body composition and cardiovascular function at rest and exercise, in middle aged obese subjects. Methods and results: A single group with pre-test/post-test study design was conducted. Eighteen obese subjects (11 males and 7 females) over 45 were engaged in a non-supervised walking training for 6 months, 40 min, 3 times per week, at the targeted HR corresponding to FATmax (5.5 ± 0.6 km·h⁻¹). This training modality led to a reduction in obesity-related indicators among participants, including weight (−3.7 ± 3.4 kg), BMI (−1.4 ± 1.3 kg/m²), waist circumference (−5.6 ± 4.7 cm), and body fat percentage (−2.1 ± 2.7%). However, we observed a great variability in this response to training according to individuals. Furthermore, heart rate and rate of pressure product (RPP) at rest significantly decreased (6% and 11% respectively) as well as the cardiac load during exercise (RPP −11% and cardiac cost −8%) after training. In conclusion, walking at FATmax is an efficient non-supervised training modality, allowing improvement in both body parameters and cardiovascular markers at rest and during exercise in middle age obese subjects. Even if body parameter changes were modest, the cardiac load decrease is an important factor for reducing the risk of cardiovascular diseases in this population. Full article

(This article belongs to the Special Issue Long-Distance Running for Sport and Public Health: Advances in Methods, Technologies, and Applications)

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1 pages, 180 KiB

Open AccessRetraction

RETRACTED: Wee et al. Triaging Medical Referrals Based on Clinical Prioritisation Criteria Using Machine Learning Techniques. Int. J. Environ. Res. Public Health 2022, 19, 7384

by Chee Keong Wee, Xujuan Zhou, Ruiliang Sun, Raj Gururajan, Xiaohui Tao, Yuefeng Li and Nathan Wee

Int. J. Environ. Res. Public Health 2025, 22(5), 700; https://doi.org/10.3390/ijerph22050700 (registering DOI) - 29 Apr 2025

Abstract

The journal retracts and remove the article Triaging Medical Referrals Based on Clinical Prioritisation Criteria Using Machine Learning Techniques [...] Full article

22 pages, 1199 KiB

Open AccessArticle

Post-Traumatic Growth in Volunteers Following the 2023 Kahramanmaraş Earthquakes

by Kader Demiröz, Mehtap Kılıç and Sevda Demiröz Yıldırım

Int. J. Environ. Res. Public Health 2025, 22(5), 699; https://doi.org/10.3390/ijerph22050699 (registering DOI) - 28 Apr 2025

Viewed by 14

Abstract

The 6 February 2023 Kahramanmaraş earthquakes were devastating events that caused widespread destruction. This mixed-methods study examined post-traumatic growth (PTG) in volunteers who participated in the relief efforts. A total of 169 volunteers participated in the quantitative phase, completing a standardized PTG measure. [...] Read more.

The 6 February 2023 Kahramanmaraş earthquakes were devastating events that caused widespread destruction. This mixed-methods study examined post-traumatic growth (PTG) in volunteers who participated in the relief efforts. A total of 169 volunteers participated in the quantitative phase, completing a standardized PTG measure. In-depth interviews were conducted with 14 volunteers during the qualitative phase. The study found that gender had a significant effect on total PTG scores. Additionally, gender, earthquake experience, and volunteer organization were significant factors in the “change in self-concept” sub-dimension. Gender was the only significant factor in the “change in philosophy of life” sub-dimension. Qualitative analysis revealed that participants experienced trauma symptoms after the earthquake but also reported positive changes in self-concept and life philosophy. This study suggests that disasters can lead to PTG, despite the presence of trauma symptoms. Further research is needed to explore PTG in different disaster response groups. Full article

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14 pages, 1397 KiB

Open AccessArticle

The Ability of the Hopkins Symptom Checklist-5 to Identify Generalized Anxiety Disorder and Major Depressive Disorder in the General Population

by Benedicte Kirkøen, Ragnhild Elise Ørstavik, Anne Reneflot, Jens Christoffer Skogen, Børge Sivertsen and Ann Kristin Skrindo Knudsen

Int. J. Environ. Res. Public Health 2025, 22(5), 698; https://doi.org/10.3390/ijerph22050698 (registering DOI) - 28 Apr 2025

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Abstract

Background: The Hopkins Symptom Checklist (HSCL) is a widely used measure of anxiety and depression symptoms. The short form HSCL-5 is especially suitable for large population-based studies, but its ability to detect mental disorders in the general population remains unknown. The aim [...] Read more.

Background: The Hopkins Symptom Checklist (HSCL) is a widely used measure of anxiety and depression symptoms. The short form HSCL-5 is especially suitable for large population-based studies, but its ability to detect mental disorders in the general population remains unknown. The aim of the study was to assess how well the HSCL-5 identified cases of generalized anxiety disorder (GAD) and major depressive disorder (MDD) measured by the Composite International Diagnostic Interview (CIDI) 5.0 and to find the optimal sex-specific cut-off levels of the HSCL-5. Methods: Participants from the population-based Trøndelag Health Study (HUNT) in Norway were recruited for the current study. Between April and September 2020, 1343 participants (64% women) aged 20–65 years completed the CIDI, followed by the HSCL-5. The overall agreement between the HSCL-5 and GAD or MDD measured by CIDI was examined with Receiver Operator Characteristics (ROC) analysis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) for different cut-off levels were assessed. Results: The area under the curve for GAD or MDD was 0.90 (CI 95% = 0.85–0.95) for women and 0.85 (CI 95% = 0.68–1.00) for men. For women, a cut-off level of ≥1.80 had the best balance between sensitivity (85%) and specificity (84%), while the corresponding numbers were ≥2.00, 73%, and 93% for men. The global PPV was 21%, while the NPV was 99%. Conclusions: The HSCL-5 has high sensitivity and specificity for identifying cases of GAD or MDD. In the current study, the positive predictive value of HSCL-5 was low. Full article

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

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14 pages, 298 KiB

Open AccessArticle

Factors Associated with the Enjoyment of Physical Education Class for Children with Special Educational Needs

by Julie Dalgaard Guldager, Laura Mørk Emtoft, Line Nørgaard Remmen and Anette Lisbeth Bentholm

Int. J. Environ. Res. Public Health 2025, 22(5), 697; https://doi.org/10.3390/ijerph22050697 (registering DOI) - 28 Apr 2025

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Abstract

Enjoying physical education class (PE) is important for children with special educational needs (SEN) due to its impact on their physical and mental health. However, there is a research gap concerning children with SEN and their enjoyment of PE. This exploratory study investigated [...] Read more.

Enjoying physical education class (PE) is important for children with special educational needs (SEN) due to its impact on their physical and mental health. However, there is a research gap concerning children with SEN and their enjoyment of PE. This exploratory study investigated how school children with and without SEN report enjoyment of physical education class and explored associated factors. A cross-sectional survey was conducted among school children with and without SEN. Both groups reported very high enjoyment of PE, but children without SEN had higher enjoyment. Among children with SEN, boys, those attending schools in East Denmark, and those engaged in leisure physical activity reported higher enjoyment levels, while children from larger schools consistently reported lower enjoyment levels. Understanding the differences in PE enjoyment between children with and without SEN is crucial for educators and policymakers to develop inclusive practices that ensure equitable experiences for all children, fostering a positive and supportive environment in school PE programs. Our findings highlight nuanced differences in PE enjoyment perceptions between children with and without SEN, emphasizing the need to consider diverse student characteristics when designing PE programs to enhance overall enjoyment. Full article

(This article belongs to the Special Issue Child Physical Activity and Health)

18 pages, 892 KiB

Open AccessReview

What Is the Impact of Unemployment as an Adverse Experience? Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder: A Meta-Analysis

by Marcelo Nvo-Fernandez, Valentina Miño-Reyes, Carlos Serrano, Hedy Acosta-Antognoni, Fabiola Salas, Claudio Vásquez Wiedeman, Francisco Ahumada-Méndez and Marcelo Leiva-Bianchi

Int. J. Environ. Res. Public Health 2025, 22(5), 696; https://doi.org/10.3390/ijerph22050696 (registering DOI) - 28 Apr 2025

Viewed by 99

Abstract

This meta-analysis examined how unemployment, a psychosocial stressor, influences post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). It specifically explores unemployment as a risk factor for trauma, with emphasis on CPTSD, and investigates economic variables, including the GINI coefficient, as potential moderators. A [...] Read more.

This meta-analysis examined how unemployment, a psychosocial stressor, influences post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). It specifically explores unemployment as a risk factor for trauma, with emphasis on CPTSD, and investigates economic variables, including the GINI coefficient, as potential moderators. A systematic search in Web of Science, Scopus, and PubMed yielded 33 studies comprising more than 57,000 participants. Odds ratios (OR) were computed, and a random-effects model was used to synthesize the findings. Meta-regression analyses were conducted to evaluate the effects of economic inequality (GINI) and nominal gross domestic product (NGDP), but neither moderator reached statistical significance; this is addressed in detail in the Discussion. The results revealed that unemployment significantly elevated the risk for PTSD (OR = 1.500; logOR = 0.3826; PI: 0.457–4.702) and CPTSD (OR = 2.180; logOR = 0.7430; PI: 0.501–8.808), with a stronger impact on CPTSD. These findings emphasize unemployment as a pivotal predictor of trauma, especially CPTSD, broadening the traditional focus on interpersonal factors. They also highlight the importance of integrating psychosocial and economic variables into clinical assessments and public health policies. Addressing both unemployment and economic inequality could be critical for effective interventions and prevention efforts, underscoring the need for further multidisciplinary research. Full article

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

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13 pages, 420 KiB

Open AccessSystematic Review

Learning from COVID-19: A Systematic Review of the IHR-SPAR Framework’s Role in the Pandemic Response

by Ida Santalucia, Michele Sorrentino, Claudio Fiorilla, Sabrina Tranquilli, Giordana Strazza, Paolo Montuori, Raffaele Palladino, Maria Fiore, Margherita Ferrante and Maria Triassi

Int. J. Environ. Res. Public Health 2025, 22(5), 695; https://doi.org/10.3390/ijerph22050695 (registering DOI) - 27 Apr 2025

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Abstract

The International Health Regulations (IHR) provide a global framework for health security, requiring annual reporting on 35 indicators across 15 core capacities via the State Parties Annual Reporting (SPAR) tool. The COVID-19 pandemic exposed gaps in the IHR framework and monitoring systems, prompting [...] Read more.

The International Health Regulations (IHR) provide a global framework for health security, requiring annual reporting on 35 indicators across 15 core capacities via the State Parties Annual Reporting (SPAR) tool. The COVID-19 pandemic exposed gaps in the IHR framework and monitoring systems, prompting calls for reform. This systematic review analyzed the correlations between IHR-SPAR scores and pandemic outcomes across nine studies (2020–2024), selected using the PRISMA guidelines. The study quality was assessed using the Joanna Briggs Institute’s tool for cross-sectional studies. Of 1019 screened studies, nine met the inclusion criteria. Higher SPAR scores generally correlated with lower COVID-19 incidence and mortality, although some high-scoring countries experienced severe outbreaks. Middle-income countries showed the greatest improvement, particularly in risk communication and emergency response, while zoonotic disease capacities saw little progress. While the SPAR tool aids monitoring, it requires revisions to better reflect real-world pandemic responses. High SPAR scores do not always indicate effective crisis management. This study recommends integrating more dynamic, operational, and context-sensitive indicators to enhance the global preparedness for future health emergencies. Full article

(This article belongs to the Special Issue Pandemic Preparedness: Lessons from COVID-19, Arboviral Outbreaks, and Other Emerging Infectious Diseases)

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19 pages, 651 KiB

Open AccessArticle

Depressive Symptoms Among South African Construction Workers: Associations with Demographic, Social and Work-Related Factors, and Substance Use

by Rita Peihua Zhang, Paul Bowen and Peter Edwards

Int. J. Environ. Res. Public Health 2025, 22(5), 694; https://doi.org/10.3390/ijerph22050694 (registering DOI) - 27 Apr 2025

Viewed by 58

Abstract

The construction industry exhibits higher rates of depression in its workforce compared to other industries. This study investigates the association between the prevalence of depressive symptoms and various demographic (e.g., age, ethnicity, education), social, and work-related factors (e.g., relationship status, living environment, work [...] Read more.

The construction industry exhibits higher rates of depression in its workforce compared to other industries. This study investigates the association between the prevalence of depressive symptoms and various demographic (e.g., age, ethnicity, education), social, and work-related factors (e.g., relationship status, living environment, work situation) and behavioural factors (e.g., alcohol and drug use). Survey data collected from 496 male construction workers working in the Western Cape were analysed using binomial logistic regression to determine the associations. The results showed that ‘Black African’ construction workers exhibited lower levels of depressive symptoms than ‘Other’ ethnic groups, and workers with at least secondary education had the highest levels of depressive symptoms compared to workers with other levels of education. Workers who were single or living with other adults without children had a significantly higher risk of depression compared to those in other forms of family relationships. Substance use was found to be associated with lower levels of depressive symptoms, suggesting that construction workers use alcohol and drugs as a coping strategy for short-term depressive symptom reduction. Construction organisations should develop strategies to protect the mental health of construction workers, particularly those who are prone to depression. Full article

(This article belongs to the Special Issue Substance Use Disorder and Other Mental Health Comorbidities: Evidence-Based Approaches to Prevention and Treatment)

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13 pages, 281 KiB

Open AccessArticle

The Quality of Life and Associated Factors Among Older Adults in Central Nepal: A Cross-Sectional Study Using the WHOQOL-OLD Tool

by Rubisha Adhikari, Rajani Shah, Kamal Ghimire, Birat Khanal, Sunil Baral, Anisha Adhikari, Dinesh Kumar Malla and Vishnu Khanal

Int. J. Environ. Res. Public Health 2025, 22(5), 693; https://doi.org/10.3390/ijerph22050693 (registering DOI) - 27 Apr 2025

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Abstract

Ensuring people’s quality of life (QOL) has become increasingly challenging due to population aging. This study aimed to investigate the QOL among older people and factors associated with it in an urban setting of Central Nepal using the World Health Organization Quality of [...] Read more.

Ensuring people’s quality of life (QOL) has become increasingly challenging due to population aging. This study aimed to investigate the QOL among older people and factors associated with it in an urban setting of Central Nepal using the World Health Organization Quality of Life (WHOQOL-OLD) tool. A cross-sectional study was conducted in Central Nepal. The association between QOL and independent variables was first examined using a univariate analysis of variance followed by multiple linear regressions. The mean age of the 366 participants was 70 years (standard deviation [SD]: 8.2 years). The mean of the overall QOL scores was 74.37 (SD: 7.82). Older people who were literate (regression coefficient (β): 1.909; 95% confidence interval (CI): 3.771 (1.986, 5.556)), who had an annual household income of NPR 40,000 (Nepalese Rupees) or more (β: 1.909: 95% CI: 0.337, 3.480), who reported health services as accessible (β: 4.019; 95% CI: 0.666, 7.371) and affordable (β: 3.176; 95% CI: 1.327, 5.025), and who reported partaking in physical activity (β: 2.107; 95% CI: 0.607, 3.606) had higher QOL scores compared to their respective counterparts. A holistic model of service using the social determinants of health framework is essential to improve the well-being of older people in Nepal. Full article

(This article belongs to the Section Global Health)

33 pages, 68063 KiB

Open AccessArticle

The Socio-Environmental Impact in the Adjacent Settlements of a Former Foundry

by Griselda Vázquez-Quintero, Daniel Lira-Hernández, César Damián Pérez-Olmos, María Cecilia Valles-Aragón, Leonor Cortes-Palacios, César Guillermo García-González, Ireyli Zuluamy Iracheta-Lara, Myrna Concepción Nevárez-Rodríguez and Gilberto Sandino Aquino-de los Ríos

Int. J. Environ. Res. Public Health 2025, 22(5), 692; https://doi.org/10.3390/ijerph22050692 (registering DOI) - 27 Apr 2025

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Abstract

Mining has caused major pollution, especially in poorly regulated areas. The former Ávalos Foundry in Chihuahua, Mexico left toxic contamination after its closure in 1997, affecting the nearby settlements. This study examines the socio-environmental impact on residents adjacent to the site. A total [...] Read more.

Mining has caused major pollution, especially in poorly regulated areas. The former Ávalos Foundry in Chihuahua, Mexico left toxic contamination after its closure in 1997, affecting the nearby settlements. This study examines the socio-environmental impact on residents adjacent to the site. A total of 5773 dwellings were considered, with 4634 inhabited by 14,187 persons. A survey to 465 residents assessed sociodemographic aspects, environmental perceptions, and disposition to community participation. Tap water samples from 70 homes were analyzed for metals and compared to Mexican, American and European regulatory standards. Water pollutant dispersion was modeled using ArcGIS interpolation. Residents face economic, social, environmental, and health issues from ongoing contamination. Several suffer respiratory and skin diseases linked to excessive dust from the proximity to mining waste and unpaved streets. While the majority consider their lives comfortable or very comfortable, many would not have moved there if aware of the risks before moving. Despite concerns, most residents are reluctant to engage in community efforts to address the pollution. Tap water tests revealed levels above the regulatory standards of arsenic, copper, chromium, iron, manganese, and nickel, posing serious health risks. This study calls for immediate action, including awareness and health campaigns, environmental remediation, and intersectoral collaboration to secure funding for long-term solutions. Full article

(This article belongs to the Collection Environmental Risk Assessment)

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18 pages, 281 KiB

Open AccessArticle

My Pillow Is Filled with Tears… Syrian Refugees’ Journey to Australia: Narratives of Human Courage and Resilience

by Rosemary Qummouh, Sheridan Linnell, Shameran Slewa-Younan and Sera Harris

Int. J. Environ. Res. Public Health 2025, 22(5), 691; https://doi.org/10.3390/ijerph22050691 (registering DOI) - 27 Apr 2025

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Abstract

This article showcases Syrian refugees’ narratives of trauma and survival, through a phenomenological approach to in-depth research, with refugees who have resettled in Australia. It explores their journey towards resettlement, highlighting the nexus between displacement in the home–transit–host countries and the biopsychosocial determinants [...] Read more.

This article showcases Syrian refugees’ narratives of trauma and survival, through a phenomenological approach to in-depth research, with refugees who have resettled in Australia. It explores their journey towards resettlement, highlighting the nexus between displacement in the home–transit–host countries and the biopsychosocial determinants of mental health. Since the 2011 uprising, over 12 million Syrians have been displaced, both internally and worldwide. A refugee’s journey to safety often involves multiple displacements and exposure to dangerous, life-threatening, and dehumanising experiences. We have therefore adopted a qualitative approach that counters this dehumanisation by honouring the unique humanity in the voice of each of our research participants. This article aims to portray the nuanced interdependence between the individual, social, and political contexts of seven Syrian refugees’ lived experiences through an in-depth consideration of what they have told us, how they narrate their stories, and the meanings they ascribe to what they have experienced. The findings of this small yet eloquent study reinforce the insight that the journey to resettlement is far from linear and that resettlement itself is a process marked by recurrent and persistent complexities. The article suggests that the resilience of these refugees is best understood as an ethical and altruistic commitment to collective well-being, transcending notions of individual fortitude. Full article

(This article belongs to the Special Issue Refugee Health and Well-Being: Psychological, Behavioral and Biochemical Insights)

28 pages, 3945 KiB

Open AccessSystematic Review

Green Environments for Sustainable Brains: Parameters Shaping Adaptive Neuroplasticity and Lifespan Neurosustainability—A Systematic Review and Future Directions

by Mohamed Hesham Khalil

Int. J. Environ. Res. Public Health 2025, 22(5), 690; https://doi.org/10.3390/ijerph22050690 (registering DOI) - 26 Apr 2025

Viewed by 174

Abstract

As global urbanisation is rising and public health challenges intensify, this systematic review is conducted at a critical time to explore and explain the associations between the parameters of green environments and nuanced adaptive neuroplasticity in the human brain to advance the development [...] Read more.

As global urbanisation is rising and public health challenges intensify, this systematic review is conducted at a critical time to explore and explain the associations between the parameters of green environments and nuanced adaptive neuroplasticity in the human brain to advance the development of health-focused sustainable cities and buildings in line with the concept of neurosustainability. This review includes studies involving participants of all ages and genders, with no restrictions on health conditions, exposed to green environments regardless of built environment comparisons. A systematic search of Scopus, PubMed, and Web of Science identified relevant studies published up to November 2024. The risk of bias was assessed using the PEDro scale and ROBINS-I domains, and data were analysed narratively due to heterogeneity. Twenty-three studies were included, conducted across the USA, UK, Germany, Spain, Bulgaria, the Netherlands, Japan, and South Korea. Findings reveal that green environments are associated with positive, region-specific brain changes across the lifespan, surprisingly from before birth to late adulthood. While forests showed more significant effects than blue spaces or urban green spaces, residential greenness emerged as a consistently effective exposure, especially within a 300–500 m buffer around home addresses, provided that sky visibility is present. Notably, no studies have examined green architecture or biophilic interiors, although they are more proximal, are associated with greater exposure time, have antagonistic effects, and may potentially limit sky visibility, highlighting a key gap for future research. Limitations include heterogeneity in exposure definitions, methodologies, and targeted brain regions. Still, this review offers a novel synthesis, providing insight into how greening the built environment may sustain not only the planet but also the plasticity of the brain. This review is registered with INPLASY (INPLASY2024110103) and forms part of a doctoral research project funded by the Cambridge Trust in partnership with the Jameel Education Foundation. Full article

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14 pages, 1284 KiB

Open AccessArticle

Dietary Fluoride Exposure During Early Childhood and Its Association with Dental Fluorosis in a Sample of Mexican Adolescents

by Gina A. Castiblanco-Rubio, Emily C. Hector, Jose Urena-Cirett, Alejandra Cantoral, Howard Hu, Karen E. Peterson, Martha M. Tellez-Rojo and E. Angeles Martinez-Mier

Int. J. Environ. Res. Public Health 2025, 22(5), 689; https://doi.org/10.3390/ijerph22050689 (registering DOI) - 26 Apr 2025

Viewed by 148

Abstract

Dental fluorosis indicates past fluoride intake. People living in Mexico City are exposed to fluoridated salt, which contributes significantly to fluoride intake. This study aimed to (1) estimate fluoride intake during early childhood and fluorosis prevalence in permanent teeth in adolescence and (2) [...] Read more.

Dental fluorosis indicates past fluoride intake. People living in Mexico City are exposed to fluoridated salt, which contributes significantly to fluoride intake. This study aimed to (1) estimate fluoride intake during early childhood and fluorosis prevalence in permanent teeth in adolescence and (2) identify intake windows associated with higher fluorosis scores in upper central incisors (UCIs). We included 432 participants from the ELEMENT project (Early-Life Exposures in Mexico to Environmental Toxicants), with data on fluoride intake at ages 1–5 and fluorosis (TFI) at adolescence. Median intakes ranged from 0.56 at age 1 to 1.14 mg/day at age 5, exceeding recommendations. All adolescents had some level of fluorosis, predominantly mild (62% with TFI 2). For every 0.1 mg of daily fluoride intake at age 1, the odds of higher TFI in UCIs were 1.08 [95% CI: 1.00–1.17]. At age 2, the odds were marginally significant [OR: 1.07; 95% CI: 1.00–1.16]. In conclusion, for participants of ELEMENT: (1) fluoride intake during early childhood exceeded recommendations and the prevalence of mild fluorosis in adolescence was high, and (2) fluorosis in UCIs was associated with dietary exposure during the first two years of life and may be used in future ELEMENT studies as exposure biomarkers. Full article

(This article belongs to the Special Issue Influence of Population Exposure to Fluoride on Oral Health)

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10 pages, 536 KiB

Open AccessArticle

What Guides Organizations’ Current Dementia-Related Practices Across Four Canadian Provinces?

by Maria Baranowski, Nancy Jokinen, Leslie Udell, Sandy Stemp, Tracey Berman and Shahin Shooshtari

Int. J. Environ. Res. Public Health 2025, 22(5), 688; https://doi.org/10.3390/ijerph22050688 (registering DOI) - 26 Apr 2025

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Abstract

We conducted a survey to learn what guides current dementia-related practice to support community-dwelling adults with intellectual and developmental disabilities who may be experiencing dementia in Canada. We invited organizations working in health, disability, or senior sectors in 4 Canadian provinces to complete [...] Read more.

We conducted a survey to learn what guides current dementia-related practice to support community-dwelling adults with intellectual and developmental disabilities who may be experiencing dementia in Canada. We invited organizations working in health, disability, or senior sectors in 4 Canadian provinces to complete an online cross-sectional survey between April and July 2023. A total of 173 people completed the survey, representing 125 unique organizations, and nearly half resided in Ontario. The most common support and services provided to adults with intellectual and developmental disabilities and their families were related to residential care, day programming, and group home living. Half of our survey respondents reported that they followed dementia-related practice guidelines. The most common guideline followed and early detection tool used were from the National Task Group on Intellectual Disabilities and Dementia Practices and the National Task Group-Early Detection and Screen for Dementia, respectively. Lack of awareness about guidelines and detection tools, challenges to implement the same, and organizational needs for future training and service provision were identified. Commitment to resources to monitor adults with IDD who may be experiencing dementia is recommended to provide meaningful support and service to them and their families. Full article

(This article belongs to the Special Issue Promoting Mentation: Assessment and Support for Dementia, Depression and Delirium)

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16 pages, 1623 KiB

Open AccessArticle

Where Muscle Matters: How Regional Differences, Pain, and Gender Define Gamer Health

by Joanne DiFrancisco-Donoghue, Min-Kyung Jung, Matteo J. Balentine and Hallie Zwibel

Int. J. Environ. Res. Public Health 2025, 22(5), 687; https://doi.org/10.3390/ijerph22050687 (registering DOI) - 26 Apr 2025

Viewed by 116

Abstract

Competitive gaming presents unique musculoskeletal challenges due to prolonged sitting and repetitive hand and arm movements. This study explores gender-specific regional lean body mass (LBM) differences and their associations with musculoskeletal discomfort in competitive gamers. Sixty participants (30 gamers and 30 matched controls; [...] Read more.

Competitive gaming presents unique musculoskeletal challenges due to prolonged sitting and repetitive hand and arm movements. This study explores gender-specific regional lean body mass (LBM) differences and their associations with musculoskeletal discomfort in competitive gamers. Sixty participants (30 gamers and 30 matched controls; 15 males and 15 females in each group) underwent DXA scans to assess total and regional LBM, handgrip strength tests, and self-reported musculoskeletal pain surveys. Controls were matched for age and BMI and reported comparable academic and screen time but were not engaged in competitive gaming. Male gamers exhibited significantly reduced forearm (p < 0.05) and upper body LBM (p < 0.001), alongside lower grip strength (p < 0.001), compared to controls. Female gamers demonstrated lower upper body LBM (p = 0.01) but showed no significant differences in forearm lean mass or grip strength. In male gamers, negative correlations were observed between forearm LBM and lower back pain (r = −0.59, p < 0.01), highlighting the protective role of regional LBM against discomfort. Extended gaming duration was associated with increased musculoskeletal pain in both sexes (p < 0.05). These findings emphasize the need for targeted ergonomic interventions and physical conditioning programs to address muscle imbalances and reduce injury risk in esports athletes. Future research should focus on longitudinal and interventional designs to optimize musculoskeletal health and performance in this growing population. Full article

(This article belongs to the Special Issue Physical Fitness and Injury Prevention in Athletes)

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11 pages, 406 KiB

Open AccessArticle

Exploring How Rheumatic Fever Is Portrayed on TikTok: A Descriptive Content Analysis

by Siobhan Tu’akoi, Malakai Ofanoa, Samuela Ofanoa, Maryann Heather, Hinamaha Lutui and Felicity Goodyear-Smith

Int. J. Environ. Res. Public Health 2025, 22(5), 686; https://doi.org/10.3390/ijerph22050686 (registering DOI) - 26 Apr 2025

Viewed by 163

Abstract

TikTok is a popular social media platform offering educational opportunities for health issues such as rheumatic fever, which primarily affects 4–19-year-olds globally. This content analysis aimed to explore the type of rheumatic fever content available and popular on TikTok and the role that [...] Read more.

TikTok is a popular social media platform offering educational opportunities for health issues such as rheumatic fever, which primarily affects 4–19-year-olds globally. This content analysis aimed to explore the type of rheumatic fever content available and popular on TikTok and the role that rheumatic fever representation may play in shaping public understanding and attitudes. The top 100 TikTok video posts under the hashtag #rheumaticfever were examined. Descriptive statistics were used to summarize video metrics and deductive thematic analysis enabled the coding of video content. The majority of TikTok users creating rheumatic fever content were patients or family members of people suffering from rheumatic fever (42%), followed by health professionals (30%). Forty-three percent of videos had negative connotations and personal stories were the most commonly coded type of video (42%). In terms of rheumatic fever content, symptoms (n = 59), medications/treatment (n = 37) and disease pathogenesis (n = 36) were the most common themes. Misinformation was identified in 3% of videos. This study provides a unique insight into who is making rheumatic fever-related content on TikTok and the primarily negative framing of narratives people are exposed to. There are opportunities for future health promotion strategies to focus on the gaps identified in this study, including information on where to seek health services, primordial prevention and stories of recovery. Full article

(This article belongs to the Section Global Health)

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16 pages, 732 KiB

Open AccessArticle

Illegal Dumping Sites in Bloemfontein, South Africa: Respiratory Symptoms, Risk Factors, and Community Perspectives

by Botle Maluleka, Phoka C. Rathebe and Busisiwe Shezi

Int. J. Environ. Res. Public Health 2025, 22(5), 685; https://doi.org/10.3390/ijerph22050685 (registering DOI) - 25 Apr 2025

Viewed by 89

Abstract

Illegal waste dumping is a significant global issue, particularly in low- and middle-income countries such as South Africa. This study aimed to investigate the risk factors for acute respiratory symptoms among residents living near illegal domestic waste dumping sites. The study also explored [...] Read more.

Illegal waste dumping is a significant global issue, particularly in low- and middle-income countries such as South Africa. This study aimed to investigate the risk factors for acute respiratory symptoms among residents living near illegal domestic waste dumping sites. The study also explored community perceptions regarding illegal dumping and its health effects. This cross-sectional study was conducted in Rocklands, Free State, South Africa, with 200 participants: 117 living within 0–5 km of a dumping site and 83 residing ≥5–10 km away. Data were collected using a structured questionnaire. Generalized linear models were employed to explore the relationship between proximity to illegal dumping sites and respiratory symptoms, adjusting progressively for confounders in successive models. Respiratory symptoms were more prevalent among those within 5 km of illegal dumping sites: cough (48.0% vs. 27.0%), shortness of breath (23.0% vs. 18.0%), wheezing (20.0% vs. 7.0%), and chest tightness (20.0% vs. 7.0%). Proximity was significantly associated with wheezing (PR: 2.77; 95% CI: 1.10–6.98) and chest tightness (PR: 2.86; 95% CI: 1.19–6.84). Community-driven initiatives, such as awareness campaigns and recycling, were strongly supported as solutions. These findings highlight the need for education on waste management. Collaborative efforts are essential to reduce illegal dumping and improve waste management. Full article

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14 pages, 1329 KiB

Open AccessArticle

The Perinatal Multisite Psychiatry Databank: A Cohort Update

by Mariane Aumais, Francois Freddy Ateba, Rahel Wolde-Giorghis, Kathelijne Keeren, Barbara Hayton, Sawsan Kalache, Isabelle Collin, Hannah Schwartz, Kirsten Gust, Marie-Josée Poulin, Andréanne Wassef, Katherine Tardif, Martin St-André, Irena Stikarovska, Phyllis Zelkowitz, Catherine M. Herba and Eszter Szekely

Int. J. Environ. Res. Public Health 2025, 22(5), 684; https://doi.org/10.3390/ijerph22050684 (registering DOI) - 25 Apr 2025

Viewed by 81

Abstract

The Perinatal Multisite Databank (PMD) aims at facilitating research on perinatal mental health by collecting clinical information of patients referred for evaluations at perinatal mental health clinics across the province of Quebec, Canada with the potential to improve patient care and support evidence-based [...] Read more.

The Perinatal Multisite Databank (PMD) aims at facilitating research on perinatal mental health by collecting clinical information of patients referred for evaluations at perinatal mental health clinics across the province of Quebec, Canada with the potential to improve patient care and support evidence-based practice. This study provides a detailed description of the first 693 participants concerning psychosocial risk characteristics, the prevalence of psychiatric disorders and comorbidity during the perinatal period, the evolution of perinatal depression and anxiety symptoms over time, and the treatments received. Data were collected using clinical reports and well-validated questionnaires at multiple timepoints (from pregnancy to 6 months postpartum). Results are discussed within the context of improving patient care and disease prevention strategies in the perinatal period. Full article

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

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13 pages, 1555 KiB

Open AccessSystematic Review

The Impact of Domiciliary Dental Care and Oral Health Promotion in Nursing Homes of Older Adults: A Systematic Review

by Cibelle Cristina Oliveira dos Santos, Izabelle Muller Lessa Miranda, Katherine Thuller, Karoline Reis Silva, Leonardo Santos Antunes, Fernanda Signorelli Calazans and Bruna Lavinas Sayed Picciani

Int. J. Environ. Res. Public Health 2025, 22(5), 683; https://doi.org/10.3390/ijerph22050683 - 25 Apr 2025

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Abstract

Background: The global increase in the population older than 80 years has led to a paradigm shift centered in the hospital environment, with the inclusion of domiciliary oral health actions improving quality of life. This review evaluates the effects of domiciliary dental care [...] Read more.

Background: The global increase in the population older than 80 years has led to a paradigm shift centered in the hospital environment, with the inclusion of domiciliary oral health actions improving quality of life. This review evaluates the effects of domiciliary dental care and oral health promotion in nursing homes of older adults. Methods: Seven databases were searched without date restrictions from 15 September to 21 November 2024. A manual search was also performed in the reference lists of the included articles. This research included studies evaluating older adults aged ≥80 years, regardless of sex, who received domiciliary dental care associated or not with oral health promotion, evaluating periodontal condition, dental caries, and the dental and denture plaque index. Regarding data collection and analysis, a risk of bias assessment was performed using RoB 2.0 and RoB 1.0, according to the study design. The level of evidence was assessed using the GRADE tool. Results: Of the 2415 studies found, 5 met the eligibility criteria. After quality assessment, one randomized clinical trial presented a moderate risk of bias, and one presented a low risk. Also, two non-randomized studies presented a high risk and one a low risk. The certainty of evidence was classified as low for all outcomes assessed. One study demonstrated a reduction in the caries level of participants. Regarding periodontal and gingival conditions, although the occurrence of deep pockets (greater than 3.5 mm) decreased over time, there was no significant difference between the control and intervention groups. The level of dental and denture plaque showed a slight reduction. Conclusion: There is limited evidence that domiciliary dental care in nursing homes for older adults can lead to a reduction in caries levels and that oral health programs can reduce dental and denture plaque in evaluations conducted over periods of up to two years. Although the results show a limited magnitude, this does not diminish the importance of promoting domiciliary oral health care. Full article

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

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17 pages, 536 KiB

Open AccessArticle

Double Burden of Distress: Exploring the Joint Associations of Loneliness and Financial Strain with Suicidal Ideation During the COVID-19 Pandemic in Canada

by Fahima Hassan, Lihui Liu and Cindy Feng

Int. J. Environ. Res. Public Health 2025, 22(5), 682; https://doi.org/10.3390/ijerph22050682 (registering DOI) - 25 Apr 2025

Viewed by 85

Abstract

Background: The COVID-19 pandemic, coupled with social distancing measures and economic disruptions, has been associated with increased experiences of loneliness and financial strain. While prior research has examined their separate associations with suicidal ideation, limited attention has been given to their joint relationship. [...] Read more.

Background: The COVID-19 pandemic, coupled with social distancing measures and economic disruptions, has been associated with increased experiences of loneliness and financial strain. While prior research has examined their separate associations with suicidal ideation, limited attention has been given to their joint relationship. Methods: We used data from the 2022 Mental Health and Access to Care Survey (MHACS) (n = 9861; ages 15+ in Canada) to assess whether financial strain modifies the association between loneliness or emotional distress and suicidal ideation. Multivariable survey-weighted logistic regression was conducted, adjusting for sociodemographic, economic, psychosocial, and health-related characteristics, including mental health and substance use conditions. Results: Among the 9743 respondents who answered the question on suicidal ideation, 355 (3.65%) reported suicidal ideation. Compared to individuals with neither stressor, those who experienced loneliness or emotional distress alone had 1.54 times higher odds of suicidal ideation (aOR = 1.54, 95% CI: 1.29–1.84, p < 0.001), while those who reported financial strain alone had 0.58 times the odds (aOR = 0.58, 95% CI: 0.43–0.80, p = 0.001). The highest odds were observed among individuals who experienced both loneliness/emotional distress and financial strain, with an adjusted odds ratio of 2.05 (95% CI: 1.71–2.45, p < 0.001), indicating an interaction between these stressors. Conclusion: The co-occurrence of loneliness or emotional distress and financial strain was associated with higher odds of suicidal ideation during the COVID-19 pandemic, compared to individuals experiencing neither stressor. These findings highlight the importance of considering both social and economic stressors when assessing mental health risks. Given the cross-sectional nature of this study, further longitudinal research is needed to explore the temporal relationships and potential causal pathways linking these experiences to suicidal ideation. Full article

(This article belongs to the Special Issue Depression and Suicide: Current Perspectives)

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9 pages, 568 KiB

Open AccessSystematic Review

Private Sector Engagement for Tuberculosis Services in Latin America: A Systematic Review

by Carlos Podalirio Borges de Almeida, Leonid Lecca and Courtney M. Yuen

Int. J. Environ. Res. Public Health 2025, 22(5), 681; https://doi.org/10.3390/ijerph22050681 - 25 Apr 2025

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Abstract

Objectives: Private sector engagement has been shown to improve tuberculosis diagnosis and treatment outcomes in Asia and Africa, but systematic reviews in 2015 and 2017 identified only two reports from Latin America. We conducted a systematic review to identify descriptions of private sector [...] Read more.

Objectives: Private sector engagement has been shown to improve tuberculosis diagnosis and treatment outcomes in Asia and Africa, but systematic reviews in 2015 and 2017 identified only two reports from Latin America. We conducted a systematic review to identify descriptions of private sector engagement interventions for tuberculosis in Latin America. Methods: We systematically searched for reports on private sector engagement for tuberculosis services in Spanish- and Portuguese-speaking countries of the Western Hemisphere. On 1 November 2024, we searched PubMed, Embase, LILACS, and SciELO, with terms related to tuberculosis, the private sector, and eligible countries. We double-reviewed abstracts and full-text articles and classified private sector engagement mechanisms according to an established framework. Results: We identified seven documents describing five distinct interventions for private sector engagement in 10 countries. The most common engagement mechanism was technical support to increase awareness, knowledge, or capacity in the private sector. Intervention goals included promoting collaboration, ensuring adherence to national guidelines, increasing referrals to the public sector, and reducing tuberculosis drug sales in private pharmacies. Three impact evaluations found evidence of improved referral to the public sector. Conclusions: We found few reports of private sector engagement interventions for tuberculosis in Latin America, suggesting missed opportunities for collaborations to expand and improve tuberculosis service delivery. A lack of impact assessments suggests a dearth of evidence on the best models for private sector engagement to advance tuberculosis elimination in the Latin American region. Full article

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16 pages, 1034 KiB

Open AccessArticle

Access to Vaccines in Floodplains and Hard-to-Reach Areas of the Brazilian Amazon: The Contribution of Street-Level Bureaucrats and the Use of Social Technologies

by Jair Araújo de Lima, Anízia Aguiar Neta, Suze Mary Camurça Assis, Bruno de Oliveira Rodrigues and Helena Ribeiro

Int. J. Environ. Res. Public Health 2025, 22(5), 680; https://doi.org/10.3390/ijerph22050680 - 25 Apr 2025

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Abstract

Introduction: Access to vaccines provided by the Brazilian National Immunization Program (NIP) to populations living in floodplains and hard-to-reach areas of the Amazon is complex and conditioned by the geographic characteristics of the region. The success of vaccination campaigns requires different strategies, technologies, [...] Read more.

Introduction: Access to vaccines provided by the Brazilian National Immunization Program (NIP) to populations living in floodplains and hard-to-reach areas of the Amazon is complex and conditioned by the geographic characteristics of the region. The success of vaccination campaigns requires different strategies, technologies, and the involvement of professionals whose work goes beyond standard procedures and vaccination protocols. Objectives: To investigate the specificities of the immunization process of populations inhabiting floodplains and areas of difficult access in the municipality of Careiro da Várzea, in the state of Amazonas, Brazil. To analyze the theoretical and practical aspects of the National Immunization Program in the region. Methods: The case study included qualitative-descriptive techniques that combined data analysis, document analysis, and participant observation to reveal different socio-sanitary aspects of the immunization process of the Amazonian populations studied. The concepts of Street Level Bureaucracy and Social Technologies guided the analysis and description of the immunization process in the area studied. Results: The study described the geographic conditions, the social technologies used, and the individuals involved in the immunization process of the populations of communities and villages in flooded areas of the Amazon in Brazil. The high temperatures in the region create the need for thermal control in the storage of vaccines during their transfer to the communities and villages. The local coordination of the Imuniza SUS Program acts as a strategic mediator between the different bodies, ensuring the population’s access to vaccines, which means that the actions of government agents (Street Level Bureaucracy) are crucial to the functioning of the immunization program. Conclusions: The success of the immunization campaigns in the hard-to-reach flooded areas of the municipality is due to the existence of a virtuous cycle arising from the synergy between the different stakeholders that make up the immunization service; there is a clear relationship between the vaccination coverage rates achieved and the municipal administration’s commitment to public health. The immunization rates achieved in the municipality studied were compatible with the average established by the Brazilian Ministry of Health. This case study might enhance knowledge about health practices in this important world region. Full article

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9 pages, 1027 KiB

Open AccessArticle

Impact of Different Occupational Noises on Static and Dynamic Postural Stability in Healthy Young Adults

by Kristy Gourley, Harish Chander, Asher Street Beam and Adam C. Knight

Int. J. Environ. Res. Public Health 2025, 22(5), 679; https://doi.org/10.3390/ijerph22050679 - 25 Apr 2025

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Abstract

Background: Sounds that cause disturbances and perturbations to the vestibular (inner ear organ responses) and visual (acute oculomotor responses) systems can impact postural stability. The purpose of this study was to assess the impact of different types of sounds and noises on both [...] Read more.

Background: Sounds that cause disturbances and perturbations to the vestibular (inner ear organ responses) and visual (acute oculomotor responses) systems can impact postural stability. The purpose of this study was to assess the impact of different types of sounds and noises on both static and dynamic PS. Methods: A total of 20 participants (12 females and 8 males; age: 21.35 ± 1.79 years; height: 170.7 ± 9.3 cm; mass: 66.725 ± 14.1 kg) were tested using the limits of stability (LOS) test on the BTrackS™ balance plate and a Timed Up and Go (TUG) test, when exposed to four different sounds and occupational noises [construction noise (CN), white noise (WN), sirens (SRs), and nature sounds (NAs)] in a randomized order with a no sounds (NSs) control performed initially (intensity range of 70–80 dB). The center of pressure (COP) total sway area (cm²) from the LOS and the time to completion of the TUG (seconds) were analyzed using a one-way repeated measures of analysis of variance at an alpha level of 0.05. Results: The observations demonstrated significant differences between the sounds and noises for the TUG (p < 0.001) but not for the LOS test (p = 0.406). Pairwise comparisons for the significant main effect for the TUG revealed that NSs demonstrated significantly slower time to completion compared to CN, WN, and SRs but not NAs. Conclusions: The findings suggest that the different sounds and noises did not impact static PS during the LOS test, which involved the voluntary excursion of the COP while maintaining the same base of support (BOS). However, during dynamic PS with a changing BOS while walking in the TUG, exposure to CN, SRs, and WN demonstrated a faster completion time than NSs or NAs. This finding may be attributed to the anxiety induced by the noise immersion and perception of sounds, compared to calm NAs and no sounds. The findings can aid in better understanding the impact of different occupational noises on PS and emphasize the need for better noise protection and reduction in loud work environments. Full article

(This article belongs to the Special Issue Work Environment Effects on Health and Safety of Employees)

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17 pages, 543 KiB

Open AccessArticle

Lessons Learned in Transgender Peer Navigation: A Year of Reflective Journaling

by Gwen Rose, Ken Mullock, Elijah Gatin, T. Fayant-McLeod, Michelle C. E. McCarron, Megan Clark and Stéphanie J. Madill

Int. J. Environ. Res. Public Health 2025, 22(5), 678; https://doi.org/10.3390/ijerph22050678 - 25 Apr 2025

Viewed by 82

Abstract

People who are trans and gender-diverse are underserved by the healthcare system; one way to improve healthcare access is with peer healthcare navigators. We piloted two trans peer health navigators from April 2021 to March 2022 in a small Canadian province. The purpose [...] Read more.

People who are trans and gender-diverse are underserved by the healthcare system; one way to improve healthcare access is with peer healthcare navigators. We piloted two trans peer health navigators from April 2021 to March 2022 in a small Canadian province. The purpose of this study was to explore how trans peer navigators experienced their work and work environment through reflective journalling. The navigators journalled roughly weekly. They were encouraged to interrogate their own biases and to think about what was omitted from conversations with others. Each journal was treated as a qualitative case study, anonymized and analyzed thematically using Interpretive Phenomenological Analysis. Six themes emerged: expected work, unexpected work, teamwork, lived experience, challenges, and systemic factors. These themes were complexly interwoven with a network of subthemes that frequently fell under multiple main themes and were highly emotionally charged, many both positively and negatively. The importance of navigators being transgender themselves was highlighted. The rewards came from being able to provide meaningful help to people in their community and the challenges came from not being respected by other healthcare providers and systemic barriers that prevented them from helping clients. The navigators successfully adapted their services to bridge some systemic barriers. This research has implications for improving both navigators’ and clients’ experiences. Full article

(This article belongs to the Special Issue Sexuality, Health, and Gender)

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10 pages, 239 KiB

Open AccessArticle

Enhancing Nutrition Communication in Early Childhood Education Settings: Overcoming Challenges and Promoting Collaboration with Caregivers

by Elder G. Varela, Ciana Bonfiglio, Jamie Zeldman, Alexandra Chavez and Amy R. Mobley

Int. J. Environ. Res. Public Health 2025, 22(5), 677; https://doi.org/10.3390/ijerph22050677 - 25 Apr 2025

Viewed by 157

Abstract

Early childhood plays a critical role in shaping food preferences and eating habits, emphasizing the importance of effective communication between families and Early Childhood Education (ECE) settings to promote healthy eating behaviors. This qualitative study examines ECE providers’ perspectives on barriers and facilitators [...] Read more.

Early childhood plays a critical role in shaping food preferences and eating habits, emphasizing the importance of effective communication between families and Early Childhood Education (ECE) settings to promote healthy eating behaviors. This qualitative study examines ECE providers’ perspectives on barriers and facilitators to nutrition communication with caregivers, comparing Early Head Start/Head Start (EHS/HS) and non-EHS/HS centers. Semi-structured interviews were conducted via Zoom with ECE providers (n = 20) serving children aged 0–3 in Florida. Using inductive thematic analysis, two researchers independently coded the data, identified themes, and compared similarities and differences between EHS/HS and non-EHS/HS providers through an iterative review process. Participants were predominantly white (74%) females (95%) with an average of 7.6 years of work experience. Both EHS and non-EHS providers reported common barriers, including limited time, caregiver resistance to change, and language challenges. However, EHS providers identified additional issues like economic constraints, limited nutrition knowledge among both caregivers and providers, and restricted access to technology. In contrast, non-EHS providers emphasized trust issues and caregiver non-compliance with center policies. To improve communication, EHS providers suggested trust-building and documenting dietary intake for personalized interactions, while non-EHS providers recommended regular meetings and mobile messaging. Addressing these barriers is crucial for fostering collaboration between providers and caregivers and promoting healthy food habits in young children. Full article

(This article belongs to the Special Issue Healthy Diet and Nutrition during Childhood and Adolescence)

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Int. J. Environ. Res. Public Health, Volume 22, Issue 5 (May 2025) – 52 articles

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