International Journal of Environmental Research and Public Health

14 pages, 562 KiB

Open AccessArticle

Parental Knowledge, Attitudes, and Practices and Their Association with Dental Caries in Children Aged 5–9 Years: A Cross-Sectional Study in Rural Ecuador

by María Saquicela-Pulla, Mónica Dávila-Arcentales, Eleonor Vélez-León, Ana Armas-Vega and María Melo

Int. J. Environ. Res. Public Health 2025, 22(6), 953; https://doi.org/10.3390/ijerph22060953 (registering DOI) - 17 Jun 2025

Abstract

Childhood dental caries remains a critical public health issue in rural areas, where caregivers’ knowledge, attitudes, and practices (KAP) significantly influence oral health outcomes. This study assessed the association between parental KAP and the prevalence and severity of caries in children aged 5–9 [...] Read more.

Childhood dental caries remains a critical public health issue in rural areas, where caregivers’ knowledge, attitudes, and practices (KAP) significantly influence oral health outcomes. This study assessed the association between parental KAP and the prevalence and severity of caries in children aged 5–9 years in Cayambe, Ecuador. Methods: A cross-sectional study was conducted with 229 schoolchildren and their caregivers, using a validated questionnaire and clinical examinations (ICDAS criteria). Caries severity was categorized as “obvious decay” (ICDAS 4–6) or “no obvious decay” (ICDAS 0–3). Results: Advanced dental caries affected 73.4% of children (ICDAS 4–6). While parental knowledge and attitudes showed no significant association, brushing teeth ≥2 times/day significantly reduced caries severity (p < 0.05). Sociodemographic factors, such as parental education, were not significant predictors. Conclusion: Oral hygiene practices—particularly frequent toothbrushing—were the key protective factor against severe caries, highlighting the need for behavior-focused interventions promoting daily habits. Future research should evaluate long-term preventive strategies. Full article

(This article belongs to the Special Issue Dental Caries Diagnosis and Prevention in Children and Adolescents)

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16 pages, 563 KiB

Open AccessArticle

The Pandemic’s Impact on Mental Well-Being in Sweden. A Longitudinal Study on Life Dissatisfaction, Psychological Distress, and Worries

by Daniel Lindberg, Kent W. Nilsson, Jonas Stier and Birgitta Kerstis

Int. J. Environ. Res. Public Health 2025, 22(6), 952; https://doi.org/10.3390/ijerph22060952 (registering DOI) - 17 Jun 2025

Abstract

The COVID-19 pandemic has had a profound impact on society, including on physical and mental health. This study investigated changes in mental health parameters among a Swedish sample during and after the pandemic. Using a longitudinal study, we investigated the relationships among life [...] Read more.

The COVID-19 pandemic has had a profound impact on society, including on physical and mental health. This study investigated changes in mental health parameters among a Swedish sample during and after the pandemic. Using a longitudinal study, we investigated the relationships among life dissatisfaction, psychological distress, and worries, with factors such as age, sex, education, severe illness, and job loss due to the pandemic among 588 men (mean age 54.9 years), and 653 women (mean age 52.9 years). The results reveal sex differences in life dissatisfaction and psychological distress; in addition, younger individuals reported more life dissatisfaction, and psychological distress compared with older groups. Women were 4.5 times more likely than men to report worries in 2021 and 2.3 times more likely in 2022, even after adjusting for age, education, severe illness, and job loss. This study shows how societal expectations and sex roles may exacerbate these differences in mental well-being during a time of crisis. The conclusions emphasize the importance of considering factors such as sex, age, education, and employment status when developing interventions and support systems during a global crisis. The COVID-19 pandemic will continue to affect society for a long time, indicating a need for ongoing research into population-level consequences. Full article

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24 pages, 1654 KiB

Open AccessArticle

Local Landscapes, Evolving Minds: Mechanisms of Neighbourhood Influence on Dual-State Mental Health Trajectories in Adolescence

by Christopher Knowles, Emma Thornton, Kathryn Mills-Webb, Kimberly Petersen, Jose Marquez, Sanja Stojiljković and Neil Humphrey

Int. J. Environ. Res. Public Health 2025, 22(6), 951; https://doi.org/10.3390/ijerph22060951 (registering DOI) - 17 Jun 2025

Abstract

Neighbourhood variation in socioeconomic deprivation is recognised as a small but meaningful determinant of adolescent mental health, yet the mechanisms through which the effects operate remain poorly understood. This study used #BeeWell survey data collected from adolescents in Greater Manchester (England) in 2021–2023 [...] Read more.

Neighbourhood variation in socioeconomic deprivation is recognised as a small but meaningful determinant of adolescent mental health, yet the mechanisms through which the effects operate remain poorly understood. This study used #BeeWell survey data collected from adolescents in Greater Manchester (England) in 2021–2023 (life satisfaction: N = 27,009; emotional difficulties: N = 26,461). Through Latent Growth Mixture Modelling, we identified four non-linear trajectories of life satisfaction (Consistently High (71.0%), Improving (8.7%), Deteriorating (6.3%), and Consistently Low (13.9%); entropy = 0.66) and three non-linear trajectories of emotional difficulties (Low/Lessening (53.7%), Sub-Clinical (38.3%), and Elevated/Worsening (8.0%); entropy = 0.61). Using a multi-level mediation framework we assessed (1) whether neighbourhood deprivation predicted trajectory class membership and (2) the extent to which effects of deprivation operate through aspects of Community Wellbeing, as measured by the Co-op Community Wellbeing Index (CWI). Greater deprivation increased the odds of following Deteriorating (OR = 1.081, [1.023, 1.12]) and Consistently Low (OR = 1.084, [1.051, 1.119]) life satisfaction trajectories and reduced the odds of following a Sub-Clinical emotional difficulties trajectory (OR = 0.975, [0.954, 0.996]). Mediation analyses revealed that the effects of deprivation on Consistently Low life satisfaction partially operate through Equality (ab = 0.016, [0.002, 0.029]) and Housing, Space, and Environment (ab = −0.026, [−0.046, −0.006]). Further indirect effects were observed for Housing, Space, and Environment, which reduced likelihood of Sub-Clinical emotional difficulties for those living in deprived neighbourhoods (ab = −0.026, [−0.045, −0.008]). The findings highlight the distinct effects of neighbourhood deprivation on affective and evaluative domains of adolescent mental health and the protective effect of housing and related environmental factors in disadvantaged contexts, advancing our understanding of the mechanisms underpinning neighbourhood effects on dual-state adolescent mental health. Full article

17 pages, 639 KiB

Open AccessArticle

Feasibility Study for a Randomized Controlled Trial of Aromatherapy Footbath for Stimulating Onset of Labor in Term Pregnant Women

by Yuriko Tadokoro and Kaori Takahata

Int. J. Environ. Res. Public Health 2025, 22(6), 950; https://doi.org/10.3390/ijerph22060950 (registering DOI) - 17 Jun 2025

Abstract

We evaluated the feasibility of a new research methodology designed for conducting a future, large-scale randomized controlled trial (RCT). This future RCT is aimed at evaluating the effects of repeated aromatherapy footbaths on stimulating the onset of labor. Herein, we conducted a pilot [...] Read more.

We evaluated the feasibility of a new research methodology designed for conducting a future, large-scale randomized controlled trial (RCT). This future RCT is aimed at evaluating the effects of repeated aromatherapy footbaths on stimulating the onset of labor. Herein, we conducted a pilot RCT with two arms among low-risk pregnant women at or beyond 39 weeks of gestation before labor onset. These two arms consisted of a treatment group performing aromatherapy footbaths twice a day (n = 7) and a usual care group (n = 8). This study was prospectively registered in the Clinical Trials Registry of the University Hospital Medical Information Network in Japan (UMIN000037398). Feasibility was assessed across the domains of acceptability, demand, implementation, practicality, process, resources, and management using questionnaires, researcher records, and semi-structured interviews with the treatment group and midwives at the setting facility. The new research methodology was found to be feasible, although challenges were identified in the process and implementation. For process, the research participation rate was 55.5%. For implementation, the adherence rate among the multiparous participants in the treatment group ranged from 50% to 94%. An imbalance between both groups was found. Areas that need careful planning and methodological improvements include random allocation, treatment method, and participation criteria. Full article

(This article belongs to the Special Issue Improving the Quality of Maternity Care)

13 pages, 435 KiB

Open AccessArticle

Bone Mineral Density in Children and Adolescents of the Abay Region, Kazakhstan: Prevalence and Associated Risk Factors

by Madina Madiyeva, Gulnur Kanapiyanova, Gulzhan Bersimbekova, Mariya Prilutskaya, Alida Kaskabayeva, Tamara Rymbayeva and Altay Dyussupov

Int. J. Environ. Res. Public Health 2025, 22(6), 949; https://doi.org/10.3390/ijerph22060949 (registering DOI) - 17 Jun 2025

Abstract

Approximately 95% of skeletal size, bone, and muscle mass is achieved by the age of 18, with a rapid acceleration in bone mineral accumulation and muscle growth during the adolescent growth spurt. Bone mineral status in children and adolescents in Kazakhstan is a [...] Read more.

Approximately 95% of skeletal size, bone, and muscle mass is achieved by the age of 18, with a rapid acceleration in bone mineral accumulation and muscle growth during the adolescent growth spurt. Bone mineral status in children and adolescents in Kazakhstan is a relevant subject for both clinical and fundamental research. The aim of this study was to investigate the prevalence of low bone mineral density (BMD) and the factors associated with it in children and adolescents living in the Abay region of Kazakhstan. The target group consisted of children and adolescents aged 5 to 17 years (n = 509) who had been residing in the Abay region of Kazakhstan since birth. Based on physiological age, participants were divided into two groups: 5–10 years (preschool and early school age) and 11–17 years (adolescence). All participants completed a questionnaire and underwent bone mineral density assessment using dual-energy X-ray absorptiometry (DXA). Comparisons were made between two age groups (5–10 and 11–17 years) and based on the presence or absence of reduced bone mineralization. Regression analysis identified four factors independently associated with reduced bone mineralization: ionized calcium (AOR 2099.9; p = 0.007), age (AOR 1.21; p = 0.013), body weight (AOR 0.97; p = 0.047), and green vegetables (AOR 0.46; p = 0.017). Conclusions: Our study demonstrated that 50.5% of children aged 5–10 years and 57.4% of adolescents aged 11–17 years had BMD below the age-specific norm. The study identified several risk factors that are associated with a decrease in BMD. These include blood ionized calcium, age, inadequate consumption of fruits and vegetables and dairy products, low physical activity, and insufficient sun exposure. These findings highlight the importance of early prevention of osteopenic conditions beginning in childhood and adolescence. Full article

26 pages, 1387 KiB

Open AccessArticle

Academic Self-Pressure and Physiological Responses in Adolescents: A Pilot Experimental Study on the Moderating Role of an Escape Room-Based Physical Activity Intervention on Cognitive and Academic Outcomes

by Francesca Latino, Domenico Tafuri and Francesco Tafuri

Int. J. Environ. Res. Public Health 2025, 22(6), 948; https://doi.org/10.3390/ijerph22060948 (registering DOI) - 17 Jun 2025

Abstract

Academic self-pressure is a significant source of stress for students, with physiological and cognitive implications that can influence academic performance. This study investigated the impact of academic self-pressure on heart rate variability (HRV) and cognitive performance, exploring the moderating role of physical activity [...] Read more.

Academic self-pressure is a significant source of stress for students, with physiological and cognitive implications that can influence academic performance. This study investigated the impact of academic self-pressure on heart rate variability (HRV) and cognitive performance, exploring the moderating role of physical activity through an experimental intervention. A randomized controlled trial (RCT) was conducted on a sample of 50 secondary school students, divided into an experimental group and a control group. The intervention, lasting 16 weeks, integrated physical activity based on escape room challenges with the traditional school curriculum. The results show that the experimental group recorded a significant improvement in HRV, a reduction in perceived stress, and an increase in cognitive performance, working memory, and academic achievement. Correlational and regression analyses highlighted the key role of physiological stress regulation in academic success. The findings emphasize the potential of integrating movement-based learning activities, such as escape room interventions, into school curricula as an effective strategy to enhance students’ stress regulation, executive functioning, and academic performance. By improving physiological self-regulation and cognitive efficiency, this approach supports a more holistic educational model that addresses both academic outcomes and student well-being. These results suggest that incorporating physically active, cognitively engaging tasks into the classroom may foster resilience, motivation, and adaptive coping skills, offering practical value for educational policy and classroom practice. Full article

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19 pages, 797 KiB

Open AccessReview

Barriers and Facilitators to Smoking Cessation Among University Students: A Scoping Review

by Farhan Alanazi, Walid Jumaa Mohamed Mohamed, Stathis Th. Konstantinidis and Holly Blake

Int. J. Environ. Res. Public Health 2025, 22(6), 947; https://doi.org/10.3390/ijerph22060947 - 17 Jun 2025

Abstract

University students are a vulnerable population for smoking initiation and continuation, often facing unique challenges in accessing cessation support. This scoping review aimed to map the existing literature on the barriers and facilitators to smoking cessation among university students using the Theoretical Domains [...] Read more.

University students are a vulnerable population for smoking initiation and continuation, often facing unique challenges in accessing cessation support. This scoping review aimed to map the existing literature on the barriers and facilitators to smoking cessation among university students using the Theoretical Domains Framework (TDF). Following the JBI methodology, six studies conducted in the United States, Jordan, and Qatar were included, employing both qualitative and quantitative designs. A total of 22 barriers and 20 facilitators were identified and mapped across relevant TDF domains. Key barriers included time constraints, financial limitations, low self-efficacy, and social smoking norms. Facilitators included access to flexible, low-cost interventions, peer support, and previous quit attempts. Digital interventions were preferred by students. The findings suggest that smoking cessation strategies targeting university students should be flexible, affordable, and embedded within campus health systems. Interventions that combine behavioral support, peer involvement, and accessible technology show strong potential in addressing the multifaceted barriers faced by this population. This review provides a theory-informed foundation for the development of tailored smoking cessation interventions and identifies key directions for future research. Full article

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19 pages, 586 KiB

Open AccessArticle

Understanding the Parental Caregiving of Children with Cerebral Palsy in Saudi Arabia: Discovering the Untold Story

by Ashwaq Alqahtani, Ahmad Sahely, Heather M. Aldersey, Marcia Finlayson, Danielle Macdonald and Afolasade Fakolade

Int. J. Environ. Res. Public Health 2025, 22(6), 946; https://doi.org/10.3390/ijerph22060946 - 17 Jun 2025

Abstract

Parents provide most of the support needed for children with cerebral palsy (CP) to increase the child’s participation and independence. Understanding the experiences of parents caring for children with CP is essential for developing effective family programs and services. The current knowledge about [...] Read more.

Parents provide most of the support needed for children with cerebral palsy (CP) to increase the child’s participation and independence. Understanding the experiences of parents caring for children with CP is essential for developing effective family programs and services. The current knowledge about parents’ experiences in CP is based on studies in Western countries, with little known about this phenomenon in Arab countries like Saudi Arabia. This study aimed to understand the unique experiences and support needs of Saudi parents caring for children with CP from a social-ecological perspective. We conducted a qualitative, exploratory, descriptive study involving 12 semi-structured interviews with mothers and fathers of children with different types of CP. We analyzed the data using a reflexive thematic approach, following six distinct phases. Participants’ narratives revealed a complex caregiving journey marked by both challenges and rewards. Support from Saudi nuclear and extended family members was considered important; however, many parents expressed a need for additional physical and financial assistance from their families. Parents reported feeling stressed and experiencing challenges in accessing and navigating educational and healthcare services. Our findings highlight that Islamic values play a crucial role in the experiences of Saudi parents. These values foster a sense of collectivism, highlighting the importance of family support and community involvement, which can affect the Saudi caregiving environment. Parents remain an essential yet often invisible part of the Saudi caregiving system. Without adequate support, parents are at risk of experiencing social, financial, academic, physical, and mental health challenges, which may affect their overall family well-being. Future work may need to consider spiritual and gender roles when developing programs or services to support Saudi parents of children with CP. Full article

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12 pages, 253 KiB

Open AccessArticle

The Role of Mental Health, Recent Trauma, and Suicidal Behavior in Officer-Involved Shootings: A Public Health Perspective

by Liam O’Neill

Int. J. Environ. Res. Public Health 2025, 22(6), 945; https://doi.org/10.3390/ijerph22060945 - 17 Jun 2025

Abstract

This study uses a public health approach to identify the comorbid risk factors and protective factors that influence the likelihood of an officer-involved shooting (OIS). Methods: We analyzed 7.5 years of hospital inpatient data obtained from the state of Texas. The OIS subjects [...] Read more.

This study uses a public health approach to identify the comorbid risk factors and protective factors that influence the likelihood of an officer-involved shooting (OIS). Methods: We analyzed 7.5 years of hospital inpatient data obtained from the state of Texas. The OIS subjects (n = 177) were civilians who were shot during a legal intervention involving law enforcement. The control group (n = 33,539) included persons who were hospitalized due to injuries from a car accident. Logistic regression models were used to identify the predictors of an OIS incident. The data included information on chronic diseases, vulnerable population status, health insurance, mental health diagnoses, substance use disorders, and recent trauma. Results: About one-fourth (24.3%) of OIS subjects had a diagnosed mental illness, compared to 8.4% of control subjects (p < 0.001). Factors that greatly increased the risk for an OIS included the following: schizophrenia (AOR = 2.7; CI: 1.6, 4.6), methamphetamine use disorder (AOR = 3.5; CI: 2.2, 5.5), and recent family bereavement (AOR = 8.5; CI: 1.8, 39.6). Six subjects (3.4%) were persons experiencing homelessness (PEH). Protective factors that lowered the risk for an OIS included commercial health insurance (AOR = 0.27; CI: 0.17, 0.45) and Medicaid insurance (AOR = 0.61; CI: 0.11, 0.93). Conclusions: These findings underscore the preventable nature of many OIS incidents, especially those that involve untreated mental illness, homelessness, substance use disorders, and recent trauma. Addressing the root causes of these incidents will likely require interdisciplinary collaboration among law enforcement, public health agencies, and social services. Full article

17 pages, 473 KiB

Open AccessReview

Ultimate Context of the Termination of Parental Investment

by Josip Hrgović

Int. J. Environ. Res. Public Health 2025, 22(6), 944; https://doi.org/10.3390/ijerph22060944 - 16 Jun 2025

Abstract

This paper investigates the ultimate socioeconomic causes underlying the termination of parental investment in humans by analyzing the relationship between socioeconomic status and various forms of child mortality, including live births, stillbirths, infant deaths, and infanticide. Utilizing theoretical foundations from human behavioral ecology, [...] Read more.

This paper investigates the ultimate socioeconomic causes underlying the termination of parental investment in humans by analyzing the relationship between socioeconomic status and various forms of child mortality, including live births, stillbirths, infant deaths, and infanticide. Utilizing theoretical foundations from human behavioral ecology, the study illustrates how different forms of termination of parental investment can be viewed as points along a continuum of adaptive strategies aimed at optimizing reproductive fitness. The research emphasizes that technical and cognitive limitations lead to many instances of infanticide being concealed as natural child deaths, such as Sudden Infant Death Syndrome (SIDS), thus complicating the accurate detection of true causes of death. However, addressing common ultimate causes—specifically socioeconomic factors such as healthcare accessibility, nutritional quality, social support, and stress reduction—can simultaneously prevent or reduce all forms of investment termination. The paper further analyzes demographic data from Zagreb and surrounding municipalities. Ultimately, the study advocates a holistic approach to public health interventions and policies aimed at improving socioeconomic conditions as a crucial step toward reducing all forms of child mortality. Full article

(This article belongs to the Special Issue Human Behavioral Ecology and Health Outcomes)

25 pages, 3737 KiB

Open AccessArticle

Parents’ Perceptions Regarding Needs and Readiness for Tele-Practice Implementation Within a Public Health System for the Identification and Rehabilitation of Children with Hearing and Speech–Language Disorders in South India

by Neethi Jesudass, Vidya Ramkumar, Shuba Kumar and Lakshmi Venkatesh

Int. J. Environ. Res. Public Health 2025, 22(6), 943; https://doi.org/10.3390/ijerph22060943 - 16 Jun 2025

Abstract

Background: Tele-practice, as an evidence-based practice, has gained momentum over the last two decades. However, routine clinical adoption is not spontaneous. Implementation science facilitates stakeholder engagement and the assessment of needs and plans. The study aims to assess the needs related to audiology [...] Read more.

Background: Tele-practice, as an evidence-based practice, has gained momentum over the last two decades. However, routine clinical adoption is not spontaneous. Implementation science facilitates stakeholder engagement and the assessment of needs and plans. The study aims to assess the needs related to audiology and speech–language pathology services for children under six years of age and readiness for a tele-practice-based model of care for diagnostic and rehabilitation services among parents within the public sector in Tamil Nadu. Methods: A cross-sectional study design was used. The qualitative methods of focus group discussions and semi-structured interviews were conducted for parents of children with disabilities. A quantitative community survey was conducted on parents of children with no known disabilities. A deductive-inductive method of analysis was used. Results: Community survey responses were analyzed using percentage analysis. The results were classified based on the constructs of Bowen’s feasibility framework: demand/need for tele-practice, acceptability of tele-practice, and integration and practicality of tele-practice. Parents considered the existing services to be inadequate. Parents perceived tele-practice as beneficial, yet they felt a hybrid method would be more suitable, with sufficiently interspersed in-person visits. Parents believed that training and community awareness were necessary before implementing a technology-based model of services. Conclusions: The study’s findings guided the fine-tuning of the proposed comprehensive tele-practice model for hearing and speech–language services for children in this rural district. Full article

(This article belongs to the Special Issue Hearing Health in Vulnerable Groups)

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23 pages, 1106 KiB

Open AccessSystematic Review

Occupational Health Effects of Chlorine Spraying in Healthcare Workers: A Systematic Review and Meta-Analysis of Alternative Disinfectants and Application Methods

by Luca Fontana, Luca Stabile, Elisa Caracci, Antoine Chaillon, Kavita U. Kothari and Giorgio Buonanno

Int. J. Environ. Res. Public Health 2025, 22(6), 942; https://doi.org/10.3390/ijerph22060942 - 16 Jun 2025

Abstract

Chlorine spraying was widely used during filovirus outbreaks, but concerns about occupational health risks led to a shift toward wiping. This systematic review aimed to evaluate the health risks associated with exposure to disinfectants among healthcare workers (HCWs), with a specific focus on [...] Read more.

Chlorine spraying was widely used during filovirus outbreaks, but concerns about occupational health risks led to a shift toward wiping. This systematic review aimed to evaluate the health risks associated with exposure to disinfectants among healthcare workers (HCWs), with a specific focus on chlorine-based products and spraying compared to alternative disinfectants and general disinfection tasks (GDTs). PubMed, Embase, and Scopus were searched from inception to March 2025. Eligible studies included observational or experimental research on HCWs exposed to chemical disinfectants. Two reviewers independently screened studies, assessed the risk of bias using a validated occupational health tool, and evaluated evidence certainty with the GRADE approach. Meta-analyses used fixed- and random-effects models; heterogeneity was assessed with I² statistics. Out of 7154 records, 29 studies were included. Most studies were cross-sectional with a high bias risk. Odds ratios (ORs) were calculated using non-exposed groups as reference. Significant associations with respiratory conditions were found for chlorine-based products (OR 1.71), glutaraldehyde (OR 1.44), spraying (OR 2.25), and GDTs (OR 2.20). Exposure to chlorine-based products, glutaraldehyde, spraying, and GDTs likely increases respiratory risk in HCWs, as supported by moderate-certainty evidence. These findings support prioritizing safer disinfectants and strengthening protective measures over banning specific application methods. Full article

(This article belongs to the Section Environmental Health)

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17 pages, 2200 KiB

Open AccessArticle

Construction of Development Scores to Analyze Inequalities in Childhood Immunization Coverage: A Global Analysis from 2000 to 2021

by Andrea Maugeri, Martina Barchitta, Syed Muhammad Zaffar and Antonella Agodi

Int. J. Environ. Res. Public Health 2025, 22(6), 941; https://doi.org/10.3390/ijerph22060941 - 16 Jun 2025

Abstract

Immunization coverage is a key public health indicator reflecting healthcare accessibility and socio-economic conditions. This study employs Principal Component Analysis (PCA) to construct composite development scores and analyze their relationship with immunization coverage for measles and diphtheria-tetanus-pertussis (DTP) vaccines across 195 countries (2000–2021). [...] Read more.

Immunization coverage is a key public health indicator reflecting healthcare accessibility and socio-economic conditions. This study employs Principal Component Analysis (PCA) to construct composite development scores and analyze their relationship with immunization coverage for measles and diphtheria-tetanus-pertussis (DTP) vaccines across 195 countries (2000–2021). The analysis comprises a training period (2000–2015) for score development and a test period (2016–2021) for validation. Variables were selected based on correlation with immunization coverage and standardized before PCA extraction. PC1, the principal component explaining the largest variance, was identified as a key indicator of development disparities. Findings reveal that higher PC1 scores (lower socio-economic development) are associated with reduced immunization rates, while lower PC1 scores (higher socio-economic development) correspond to greater coverage, a trend consistent across both periods. Geospatial analysis highlights stark disparities, particularly in sub-Saharan Africa and South Asia, whereas North America, Europe, and East Asia maintain significantly higher coverage. These results provide policy-relevant insights, demonstrating the utility of PCA-derived scores for resource allocation and targeted interventions. Full article

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24 pages, 2398 KiB

Open AccessArticle

Risky Play Is Not a Dirty Word: A Tool to Measure Benefit–Risk in Outdoor Playgrounds and Educational Settings

by David Eager, Tonia Gray, Helen Little, Fiona Robbé and Lisa N. Sharwood

Int. J. Environ. Res. Public Health 2025, 22(6), 940; https://doi.org/10.3390/ijerph22060940 - 16 Jun 2025

Abstract

Challenge, adventure, and risky play have repeatedly been found to be learning environments that positively shape childhood well-being and development. Extant evidence-based research conveys the physical, cognitive, and socio-emotional growth associated with risky play provision. However, understanding the interplay of risky play, injury, [...] Read more.

Challenge, adventure, and risky play have repeatedly been found to be learning environments that positively shape childhood well-being and development. Extant evidence-based research conveys the physical, cognitive, and socio-emotional growth associated with risky play provision. However, understanding the interplay of risky play, injury, and safety is more nuanced and complex. The goal of this paper is to introduce a tool which allows educators, parents, health practitioners, urban planners, playground designers, certifiers, manufacturers, and inspectors to estimate both the benefit and risk of outdoor play and learning settings, such as playgrounds, adventure parks, or risk-taking activities. One of the key challenges associated with societal risk appetite or risk tolerance has been the inability to quantify the inherent benefits of risk taking in playgrounds and educational settings. Historically, the assessment of ‘benefit–risk’ has been dominated by a zero tolerance of incidents, whether in the workplace or road safety settings. Against this backdrop, if playgrounds and outdoor learning settings are boring, children will go elsewhere to seek thrills and adventure, which may often be manifested in antisocial behaviour. In 2023, ‘benefit–risk’ was formally recognised in the area of sport and recreation by the International Organisation for Standardisation, when it published the ISO 4980:2023 benefit–risk assessment for sport and recreational facilities, activities, and equipment. ISO 4980:2023 is a departure from the traditional view of risk management, in that it presents a perspective of risk which is not limited to framing risk as negative, but rather balances the calculation of positive benefits as well as the risks associated with the activity. Correspondingly, hazardous situations which have zero benefit should be eliminated or mitigated. The tool introduced in this paper offers playground inspectors and educators the ability to measure and assess both the benefit and risk of outdoor playgrounds and educational settings where children play, learn, and flourish. Full article

(This article belongs to the Section Global Health)

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22 pages, 3254 KiB

Open AccessArticle

A Data-Driven Analysis of Work-Related Accidents in the Brazilian Mining Sector (2019–2022)

by João Oliveira and Anna Luiza Marques Ayres da Silva

Int. J. Environ. Res. Public Health 2025, 22(6), 939; https://doi.org/10.3390/ijerph22060939 - 14 Jun 2025

Viewed by 37

Abstract

This study applied data analysis techniques to analyze work-related accidents in Brazil’s mining sector from 2019 onward, identifying key risks and patterns. Using public datasets from governmental sources, it categorized accidents by the type of injury, causal agents, and affected body parts. The [...] Read more.

This study applied data analysis techniques to analyze work-related accidents in Brazil’s mining sector from 2019 onward, identifying key risks and patterns. Using public datasets from governmental sources, it categorized accidents by the type of injury, causal agents, and affected body parts. The methodology employed included data cleaning, processing, and the development of interactive visualizations using advanced analytical tools, such as Python and Power BI, to facilitate data interpretation. Among the most significant events, the Brumadinho tailings dam collapse in 2019 emerged as a major outlier, substantially affecting multiple aspects of the analysis. This single incident accounted for 71.7% of all work-related fatalities recorded during the four-year period under study, highlighting its disproportionate impact on the dataset. This study also examined the main causes and consequences of mining accidents and facilitated the creation of victim profiles based on gender and age group, incorporating psychological theories regarding risk perception. It was concluded that, although the mining sector represents a small fraction of all work-related accidents in Brazil, the proportion of accidents relative to the number of workers in the sector is substantial, highlighting the need for stricter occupational safety management. The results can guide regulations and help companies and institutions to create safer, more sustainable mining policies. The methodology proved to be highly suitable, indicating its potential for application in safety analysis across other sectors. Full article

(This article belongs to the Special Issue Promoting Health and Safety in the Workplace)

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13 pages, 298 KiB

Open AccessPerspective

The Mental Health Impacts of Internet Scams

by Luke Balcombe

Int. J. Environ. Res. Public Health 2025, 22(6), 938; https://doi.org/10.3390/ijerph22060938 - 14 Jun 2025

Viewed by 67

Abstract

Internet scams have become more sophisticated and prevalent in countries such as Canada, the US, the UK, and Australia. Australia has made some progress in effective scam intervention strategies and seen possible growth in public awareness. However, there is a lack of insight [...] Read more.

Internet scams have become more sophisticated and prevalent in countries such as Canada, the US, the UK, and Australia. Australia has made some progress in effective scam intervention strategies and seen possible growth in public awareness. However, there is a lack of insight into factors associated with profound shame and embarrassment, emotional distress such as anxiety and depression, and trauma and suicide in scam victims. To fill this gap, this perspective paper aimed to provide insight into the factors associated with the negative mental health impacts of internet scams by integrating a narrative literature review with a victim case study detailing a group’s experience of an investment scam in Australia. It found that internet scams cause emotional and social issues like depression, anxiety, trauma, and isolation, mostly prolonged upon substantial loss. The author’s insight into the intensely negative mental health impacts of an investment scam allows for the presentation of a group who struggled to access adequate support and mental health care in their response to insidious organized crime. Better education, resilience-building, and support systems are needed. These shortcomings call for strategies for tailored digital mental health services such as emotionally attuned, trauma-informed digital companionship through human-like artificial intelligence (AI) applications. Full article

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

27 pages, 1390 KiB

Open AccessArticle

COVID-19 in Rural Ontario Communities: Exploring Women’s Mental Health During a Pandemic

by Amanda Norton, Laura Rosella, Matthew Adams and Leith Deacon

Int. J. Environ. Res. Public Health 2025, 22(6), 937; https://doi.org/10.3390/ijerph22060937 - 13 Jun 2025

Viewed by 93

Abstract

Purpose: Socio-demographic inequities in mental health were magnified by COVID-19, with women experiencing greater household burden with less support in Canada and globally. While some health patterns during COVID-19 have been observed globally, there is a research gap in rural mental health during [...] Read more.

Purpose: Socio-demographic inequities in mental health were magnified by COVID-19, with women experiencing greater household burden with less support in Canada and globally. While some health patterns during COVID-19 have been observed globally, there is a research gap in rural mental health during COVID-19 in Canada. We hypothesize there is a disparity in mental health decline during COVID-19 between men and women. Methods: In rural Ontario, mental health was measured through a survey of approximately 18,000 individuals living in seven counties. In 2021, survey respondents were asked to rate their mental health prior to and during COVID-19. Women reported poorer mental health during COVID-19 in comparison to men when tested via chi-squared tests, odds ratios, and percentage change. Responses to survey questions regarding social, financial, and mental health support were then evaluated. Findings: We found significant disparities in mental health ratings before and during COVID-19 between men and women. Women reported poorer mental health, increased substance use, and increased worry about social, financial, and community stressors. Respondents who self-identified as a woman were associated with poorer mental health outcomes. Conclusions: Interventions should be specific to geographic communities as well as individual needs (e.g., additional financial and childcare support). Rural communities need to be considered as independent geographies rather than as one geography (i.e., urban vs. rural). Full article

(This article belongs to the Special Issue Health Psychology and Behaviors during COVID-19)

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14 pages, 519 KiB

Open AccessArticle

Dietary Practices and Anthropometric Status of the Rural University Students in Limpopo Province, South Africa

by Lindelani F. Mushaphi, Khutso Mokoena, Anzani Mugware, Alphonce Bere and Selekane Ananias Motadi

Int. J. Environ. Res. Public Health 2025, 22(6), 936; https://doi.org/10.3390/ijerph22060936 - 13 Jun 2025

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Abstract

Obesity among adolescents has increased over the past decades in most parts of the world in low- and middle-income countries. This study aimed to investigate the dietary practices and anthropometric status of the rural university students in Limpopo Province. A cross-sectional study was [...] Read more.

Obesity among adolescents has increased over the past decades in most parts of the world in low- and middle-income countries. This study aimed to investigate the dietary practices and anthropometric status of the rural university students in Limpopo Province. A cross-sectional study was conducted among university students in Limpopo Province. A total of 363 students aged 18 to 42 years residing at the university residences were randomly selected. A structured self-administered questionnaire was used to collect data. Anthropometric measurements were conducted by a qualified biokinetist. Data were analysed using SPSS version 29. More than half (57.3%) of the students were females. About 42.1% reported that they consume fast food once per week. The prevalences of overweight and obesity were 21.8% and 7.5%, respectively. A chi-square analysis revealed a significant association between soft drinks, juice, and energised drink consumption frequency and BMI status (p = 0.006). Results revealed a significant association between the frequency of eating processed food per week and the WHR status (p = 0.013). Overweight and consuming fast food and sugary drinks are significant concerns amongst rural-based university students. The current study recommends that regular nutrition education campaigns be conducted at the university to encourage students to make healthier eating choices. Full article

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13 pages, 493 KiB

Open AccessArticle

Social Support as a Mediator in the Relationship Between Stigma and Mental Health in Adults Living with HIV

by Henry Santa-Cruz-Espinoza, Julio Domínguez-Vergara, Natalia Mavila Guzmán-Rodríguez, Janeth Molina-Alvarado, Jennifer Castañeda-Paredes and Gina Chávez-Ventura

Int. J. Environ. Res. Public Health 2025, 22(6), 935; https://doi.org/10.3390/ijerph22060935 - 13 Jun 2025

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Abstract

Exposure to HIV-related stigma and mental health problems have both been reported by HIV-positive individuals. We analyzed the role of social support as a mediator in the relationship between HIV-associated stigma and mental health among adults living with HIV. A total of 303 [...] Read more.

Exposure to HIV-related stigma and mental health problems have both been reported by HIV-positive individuals. We analyzed the role of social support as a mediator in the relationship between HIV-associated stigma and mental health among adults living with HIV. A total of 303 people aged 18 years and over (M = 40.5; SD = 11.2) with an HIV diagnosis who were selected using a non-probability convenience sampling method in Trujillo, Peru, participated in this study. The Macro PROCESS program for SPSS was used for data analysis. We found that stigma exerts an indirect effect on the mental health among adults living with HIV, mediated through social support (β = −0.05, SE = 0.02; 95% CI [−0.09; −0.02]). However, stigma does not exert a direct effect on mental health (β = −0.08; p = 0.21). It is concluded that social support negatively and fully mediates the relationship between HIV-linked stigma and mental health among adults living with HIV. A higher stigma was associated with lower social support, and lower social support negatively affects mental health. For this reason, strengthening social support networks in adults with HIV may have a positive impact on public health. Full article

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10 pages, 915 KiB

Open AccessArticle

Predicting Low Birth Weight in Big Cities in the United States Using a Machine Learning Approach

by Yulia Treister-Goltzman

Int. J. Environ. Res. Public Health 2025, 22(6), 934; https://doi.org/10.3390/ijerph22060934 - 13 Jun 2025

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Abstract

Objective: Low birth weight is a serious public health problem even in developed countries. The objective of this study was to assess the ability of machine learning to predict low birth weight rates in big cities in the USA on an ecological/population level. [...] Read more.

Objective: Low birth weight is a serious public health problem even in developed countries. The objective of this study was to assess the ability of machine learning to predict low birth weight rates in big cities in the USA on an ecological/population level. Study design: The study was based on publicly available data from the Big Cities Health Inventory Data Platform. The collected data related to the 35 largest, most urban cities in the United States from 2010 to 2022. The model-agnostic approach was used to assess and visualize the magnitude and direction of the most influential predictors. Results: The models showed excellent performance with R-squared values of 0.82, 0.81, 0.81, and 0.79, and residual root mean squared error values of 1.06, 0.87, 1.03, 0.99 for KNN, Best subset, Lasso, and XGBoost, respectively. It is noteworthy that the Best subset selection approach had a high RSq and the lowest residual root mean squared error, with only a four-predictor subset. Influential predictors that appeared in three/four models were rate of chlamydia infection, racial segregation, prenatal care, percentage of single-parent families, and poverty. Other important predictors were the rate of violent crimes, life expectancy, mental distress, income inequality, hazardous air quality, prevalence of hypertension, percent of foreign-born citizens, and smoking. This study was limited by the unavailability of data on gestational age. Conclusions: The machine learning algorithms showed excellent performance for the prediction of low birth weight rate in big cities. The identification of influential predictors can help local and state authorities and health policy decision makers to more effectively tackle this important health problem. Full article

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10 pages, 769 KiB

Open AccessArticle

Trends in Malignant and Benign Brain Tumor Incidence and Mobile Phone Use in the U.S. (2000–2021): A SEER-Based Study

by Li Zhang and Joshua E. Muscat

Int. J. Environ. Res. Public Health 2025, 22(6), 933; https://doi.org/10.3390/ijerph22060933 - 13 Jun 2025

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Abstract

(1) Background: There has been an ongoing concern for several decades that radiofrequencies emitted from mobile phones are related to brain cancer risk. We calculated temporal trends in brain cancer incidence rates in adults and children and compared them to mobile phone subscription [...] Read more.

(1) Background: There has been an ongoing concern for several decades that radiofrequencies emitted from mobile phones are related to brain cancer risk. We calculated temporal trends in brain cancer incidence rates in adults and children and compared them to mobile phone subscription data over the same time period. (2) Methods: We analyzed the Surveillance, Epidemiology and End Results (SEER 22) cancer database between 2000 and 2021. Age-standardized incidence rates (ASR) per 100,000 people were calculated and the annual percentage change (APC) for malignant and benign brain cancer and vestibular schwannomas (acoustic neuromas of the 8th cranial nerve) was established. The total number of mobile phone subscriptions in the United States was plotted for the period 1985–2024. (3) Results: The APC for adolescents and adults was −0.6 (p = 0.0004) for malignant tumors, −0.06 (p = 0.551) for temporal lobe tumors, and 1.9 (p = 0.00003) for benign tumors. The APC for benign acoustic neuroma was 0.09 (p = 0.8237), suggesting that mobile phone use is unlikely to be associated with this tumor type. There was a 1200-fold increase in the number of cell phone subscriptions during this period. (4) Conclusions: These findings suggest that mobile phone use does not appear to be associated with an increased risk of brain cancer, either malignant or benign. Full article

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13 pages, 363 KiB

Open AccessArticle

Internalizing and Externalizing Behaviors: A Cross-Cultural Study in Colombian and Mexican Adolescents with Eating Disorders

by Jaime Humberto Moreno Méndez, María Margarita Rozo Sánchez, Natalia Maldonado Avendaño, Andrés Mauricio Santacoloma Suárez, Julieta Vélez Belmonte, Jesús Adrián Figueroa Hernández, Stephanie Tanus Minutti and Rodrigo César León Hernández

Int. J. Environ. Res. Public Health 2025, 22(6), 932; https://doi.org/10.3390/ijerph22060932 - 13 Jun 2025

Viewed by 147

Abstract

In Colombia and Mexico, an increase in emotional, behavioral, and eating problems in adolescents has been documented after the pandemic. The objective was to characterize the relationship between internalizing and externalizing behaviors in adolescents with eating disorders in Colombia and Mexico according to [...] Read more.

In Colombia and Mexico, an increase in emotional, behavioral, and eating problems in adolescents has been documented after the pandemic. The objective was to characterize the relationship between internalizing and externalizing behaviors in adolescents with eating disorders in Colombia and Mexico according to the adolescents’ self-report and the parents’ report. In Colombia, 17 adolescents between 12 and 18 years old (M = 15.4; SD = 1.8) and one of their parents (n = 17); in Mexico, 8 adolescents between 12 and 17 years old (M = 14.6; SD = 1.6) and one of their parents (n = 8) were evaluated. The parents completed the Child Behavior Checklist (CBCL), and the adolescents completed the self-report (YSR) and the EAT-26. The analyses showed a statistically significant correlation between eating problems and anxiety/depression of the YSR (r = 0.39; p = 0.031). Statistically significant differences (p < 0.05) were found in the CBCL scores for externalizing problems, somatic complaints, and rule-breaking behavior; all scores were higher in the Colombian sample. The findings provided partial support for differences between adolescents with eating disorders and parental reports. A higher percentage of clinical levels was reported by adolescents compared to their parents, except for the anxious/depressive and aggressive behavior subscales. Full article

(This article belongs to the Special Issue Mental Health and Health Promotion in Young People)

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13 pages, 1157 KiB

Open AccessArticle

Effects of Different Bedside Physiotherapy Frequencies in Hospitalized COVID-19 Patients, Focusing on Mild to Moderate Cases

by Netchanok Jianramas, Thanaporn Semphuet, Veeranoot Nissapatorn, Chaisith Sivakorn, Maria de Lourdes Pereira, Anuttra (Chaovavanich) Ratnarathon, Chenpak Salesingh, Eittipad Jaiyen, Salinee Chaiyakul, Nitita Piya-Amornphan, Thanrada Thiangtham, Kornchanok Boontam and Khomkrip Longlalerng

Int. J. Environ. Res. Public Health 2025, 22(6), 931; https://doi.org/10.3390/ijerph22060931 - 12 Jun 2025

Viewed by 218

Abstract

Currently, knowledge of the effects of different frequencies of administration of bedside physiotherapy programs (PTPs) on hospitalized COVID-19 patients is limited. Therefore, this study aimed to compare the effects of administering PTPs once or twice during hospitalization versus daily PTPs until discharge. Fifty-two [...] Read more.

Currently, knowledge of the effects of different frequencies of administration of bedside physiotherapy programs (PTPs) on hospitalized COVID-19 patients is limited. Therefore, this study aimed to compare the effects of administering PTPs once or twice during hospitalization versus daily PTPs until discharge. Fifty-two COVID-19 patients were equally assigned to two groups, matched by gender and age (1:1 ratio). Experimental Group 1 (Ex-G1) received PTPs one to two times during hospitalization, while Experimental Group 2 (Ex-G2) received daily PTPs until discharge. The outcomes assessed included the survival rate, length of hospitalization (LoH), intensive care unit (ICU) referrals, and in-hospital complications. Most participants were classified as having mild to moderate COVID-19, with a mean age of 45 years. No significant differences were observed between the groups in all primary outcomes, including the survival rate (p = 1.000), LoH (p = 0.117), ICU referrals (p = 0.313), and complications (p = 0.555). The overall survival rate was 98%. One Ex-G2 participant was referred to the ICU, while complications occurred in two Ex-G1 and four Ex-G2 participants. In summary, for patients with mild to moderate COVID-19, one to two bedside physiotherapy sessions produced comparable results to daily physiotherapy in terms of the survival rate, LoH, ICU referrals, and in-hospital complications. Full article

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32 pages, 602 KiB

Open AccessArticle

Investigating Drug Treatment Costs and Patient Characteristics of Female Breast, Cervical, Colorectal, and Prostate Cancers in Antigua and Barbuda: A Retrospective Data Study (2017–2021)

by Andre A. N. Bovell, Jabulani Ncayiyana and Themba G. Ginindza

Int. J. Environ. Res. Public Health 2025, 22(6), 930; https://doi.org/10.3390/ijerph22060930 - 12 Jun 2025

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Abstract

Cancers are problematic for health systems globally, including in Antigua and Barbuda, where understanding the changing extent of common cancers is key to implementing effective prevention and control strategies. This study aimed to assess the relationship between treatment rates and drug treatment costs [...] Read more.

Cancers are problematic for health systems globally, including in Antigua and Barbuda, where understanding the changing extent of common cancers is key to implementing effective prevention and control strategies. This study aimed to assess the relationship between treatment rates and drug treatment costs along with characteristics affecting these costs for patients with female breast, cervical, colorectal and prostate cancers in Antigua and Barbuda from 2017 to 2021. A retrospective observational study design was used. Estimates of age-standardized treatment rates and drug treatment costs were determined using direct standardization and a micro-costing approach, respectively. Linear regression was used to evaluate the relationship between age-standardized treatment rates and drug treatment costs. Model independent variables were assessed for multicollinearity and residuals examined for variance and normality. With a sum of 242 cases identified for this study, each cancer type showed evidence of strong positive correlations and significant associations between treatment costs and age-standardized treatment rates. The mean cost (USD) of drug treatment was highest for female breast (USD 25,009.63) and colorectal (USD 13,317.16) cancers and lowest for prostate (USD 12,528.10) and cervical (USD 5121.41) cancers, with several variables showing significance in the respective final models. An association existed between age-standardized treatment rates and drug treatment costs for the cancers studied. These results offer a basis for encouraging strategies in obtaining affordably priced cancer medicines in Antigua and Barbuda. Full article

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12 pages, 474 KiB

Open AccessArticle

A Quantitative Study on Determinants of COVID-19 Vaccine Uptake in a Mandatory Vaccination Workplace Setting in South Africa

by Dhirisha Naidoo and Bernard Hope Taderera

Int. J. Environ. Res. Public Health 2025, 22(6), 929; https://doi.org/10.3390/ijerph22060929 - 12 Jun 2025

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Abstract

Coronavirus disease 2019 (COVID-19) resulted in significant morbidity and mortality globally. Despite the efficacy of COVID-19 vaccines in reducing morbidity and mortality, uptake in South Africa was sub-optimal due to a number of factors which remain not fully understood, particularly in mandatory vaccination [...] Read more.

Coronavirus disease 2019 (COVID-19) resulted in significant morbidity and mortality globally. Despite the efficacy of COVID-19 vaccines in reducing morbidity and mortality, uptake in South Africa was sub-optimal due to a number of factors which remain not fully understood, particularly in mandatory vaccination workplace settings. This quantitative, cross-sectional study aimed to understand determinants of COVID-19 vaccination uptake among clinical and non-clinical workers, aged 18 years and older, employed at a large organisation with a mandatory workplace COVID-19 vaccination policy in South Africa. Workers completed a one-off, self-administered, online questionnaire that explored determinants of COVID-19 vaccination, barriers and enablers to accessing vaccines, and perspectives regarding the mandatory workplace vaccine policy. Among the 88 workers enrolled in the study, the frequent reasons for COVID-19 vaccination included preventing the spread of COVID-19 (71%, n = 62), fear of contracting COVID-19 (64%, n = 56), protecting colleagues and patients (63%, n = 55), and the mandatory workplace policy (65%, n = 57). Just under two-thirds of workers (63%, n = 55) were supportive/very supportive of the mandatory COVID-19 vaccine policy. Reasons for support included the fact that vaccination would create a safer work environment, protecting oneself/others from acquiring COVID-19, and receiving support from their employer. Only 15% (n = 13) of workers were not supportive/against the policy. The findings of this study could inform occupational health policy and counselling and support in workplaces in future pandemics. Full article

(This article belongs to the Section Global Health)

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13 pages, 264 KiB

Open AccessArticle

Behavioral Consequences Among Survivors of Cerebral Malaria and Acceptability to Different Disciplinary Methods

by Gudlaug Maria Sveinbjornsdottir, Sam Kabota, Sveinbjorn Gizurarson and Urdur Njardvik

Int. J. Environ. Res. Public Health 2025, 22(6), 928; https://doi.org/10.3390/ijerph22060928 - 12 Jun 2025

Viewed by 332

Abstract

Cerebral malaria (CM) is a life-threatening disease that affects mainly children in sub-Saharan Africa. Studies have shown that children who survive CM are often left with neurological disabilities after recovery, such as behavioral changes similar to attention deficit hyperactivity disorder (ADHD) and oppositional [...] Read more.

Cerebral malaria (CM) is a life-threatening disease that affects mainly children in sub-Saharan Africa. Studies have shown that children who survive CM are often left with neurological disabilities after recovery, such as behavioral changes similar to attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). However, diagnosis and treatments for ADHD are limited in many places in Africa. The purpose of this study was to assess behavioral changes following CM infection in Children in Malawi and parents’ acceptability of behavioral treatments. Twenty-one parents of children who had survived CM were compared to forty parents from the general population. Assessment instruments included the Disruptive Behavior Rating Scale (DBRS), Treatment Evaluation Inventory-Short Form (TEI-SF), and ADHD symptom checklist. The results showed that the most acceptable treatments among parents in Malawi were interrupt/redirect, discussion, and medication. Parents of CM-surviving children were significantly more accepting of medication (F(1,59) = 7.92, p < 0.007). The majority of the children who survived CM were rated above the clinical cut-off for ADHD and ODD symptoms. Full article

19 pages, 542 KiB

Open AccessArticle

Compensation for Patients with Work-Related Lung Cancers: Value of Specialised Occupational Disease Consultations to Reduce Under-Recognition

by Clémence Roux, Mélanie Fafin-Lefevre, Rémy Morello, Laurent Boullard and Bénédicte Clin

Int. J. Environ. Res. Public Health 2025, 22(6), 927; https://doi.org/10.3390/ijerph22060927 - 12 Jun 2025

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Abstract

Purpose: The aim of this retrospective study was to analyse the compensation procedures concerning patients presenting with work-related lung cancer (LC), hospitalised in a French university hospital, and to assess the benefit of systematic specialised occupational disease (OD) consultations in improving procedures for [...] Read more.

Purpose: The aim of this retrospective study was to analyse the compensation procedures concerning patients presenting with work-related lung cancer (LC), hospitalised in a French university hospital, and to assess the benefit of systematic specialised occupational disease (OD) consultations in improving procedures for reporting and recognising OD. Methods: Patient exposure to occupational lung carcinogens was assessed via an analysis of a standardised questionnaire, completed between 1 January 2009 and 24 April 2023. Among the 2024 patients who completed the questionnaire, 621 patients with probable exposure to occupational lung carcinogens were included. Among these patients, two groups were compiled: group 1, consisting of the 392 subjects who did not benefit from specialised OD consultations, and group 2, consisting of the 229 subjects who benefited from such consultations since 2014 and to whom a medical certificate to claim for compensation was issued by a physician. During the second phase of our study, we determined the outcome of the compensation procedure for OD. Uni- and multivariate logistic regressions were performed according to descending logistic regression methods. Results: Multivariate analyses, including smoking status, sex, age and claim for compensation, confirm the significant relationship between specialised OD consultation and claim for compensation (OR 18.13, 95% CI [11.47–28.64]). Furthermore, the rate of occupational disease recognition has multiplied by 1.5 since 2014. Conclusion: This study confirms the importance of specialised OD consultations in helping patients with LC to obtain compensation and to reduce under-recognition. Full article

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44 pages, 998 KiB

Open AccessSystematic Review

Evaluating the Cost-Effectiveness of Air Pollution Mitigation Strategies: A Systematic Review

by Bo Vandenbulcke, Nick Verhaeghe, Lisa Cruycke, Max Lelie, Steven Simoens and Koen Putman

Int. J. Environ. Res. Public Health 2025, 22(6), 926; https://doi.org/10.3390/ijerph22060926 - 11 Jun 2025

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Abstract

Air pollution is the world’s greatest environmental health risk. Pollutants that pose large health concerns are particulate matter (PM_2.5 and PM₁₀), ozone (O₃), carbon monoxide (CO), nitrogen dioxide (NO₂), and sulphur dioxide (SO₂). These [...] Read more.

Air pollution is the world’s greatest environmental health risk. Pollutants that pose large health concerns are particulate matter (PM_2.5 and PM₁₀), ozone (O₃), carbon monoxide (CO), nitrogen dioxide (NO₂), and sulphur dioxide (SO₂). These compounds (especially PM_2.5 and PM₁₀) contribute to the onset of diseases, such as respiratory diseases (e.g., asthma, chronic obstructive pulmonary disease (COPD), or lung cancer) and cardiovascular diseases. Abatement interventions are implemented to reduce air pollution and thereby the risk of these diseases. This systematic review examined the published scientific evidence on the cost-effectiveness of strategies aimed at reducing or controlling air pollution and assessed the reporting quality of included studies. It employed rigorous data extraction and quality scoring procedures to ensure the reliability and validity of our findings. Overall, there is substantial evidence supporting the cost-effectiveness of interventions aimed at reducing air pollution. Seventy-four studies and four policy reports were included in this review. Predominantly, cost–benefit analyses have been reported (n = 40), reflecting the multisectoral impacts and associated costs of air pollution. Only four cost–utility analyses were found, indicating the need for more research within this domain. Additionally, eight articles reported one or more non-economic results. Thirty-nine studies focused on particulate matter (PM), and eleven focused on nitrogen oxides (NOx). The quality assessment yielded moderate results. The heterogeneity of studies and moderate quality of reporting make it difficult to compare results and draw definitive conclusions. Full article

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14 pages, 290 KiB

Open AccessArticle

Adherence to Personalised Nutrition Education Based on Glycemic and Food Insulin Index Principles and Their Association with Blood Glucose Control in Individuals with Type 2 Diabetes Mellitus

by Hildegard Strydom, Jane Muchiri, Elizabeth Delport and Zelda White

Int. J. Environ. Res. Public Health 2025, 22(6), 925; https://doi.org/10.3390/ijerph22060925 - 11 Jun 2025

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Abstract

Personalised nutrition education (PNE) can enhance blood glucose control (BGC). We determined whether patients with type 2 diabetes (T2DM) adhered to PNE based on glycemic index (GI), glycemic load (GL), and food insulin index (FII) principles and whether adherence was associated with improved [...] Read more.

Personalised nutrition education (PNE) can enhance blood glucose control (BGC). We determined whether patients with type 2 diabetes (T2DM) adhered to PNE based on glycemic index (GI), glycemic load (GL), and food insulin index (FII) principles and whether adherence was associated with improved BGC. This retrospective cohort included 67 files for patients who received PNE. The patients completed 3-day food and blood glucose records at three points over 90 days. HbA1c values were compared between time points. An adherence score sheet (ASS) was used to determine their adherence to PNE and the main meal adherence classification (MMAC). A one-way repeated measures ANOVA was used to assess the changes over time. A chi-square test determined the association between the MMAC and blood glucose levels falling within the targeted ranges. Correlations between dietary adherence and BGC indicators were examined using Pearson’s product–moment correlation. Adherence ranged from 88 to 95%. MMAC score was significantly associated with blood glucose being within the targeted ranges (p = 0.028). Mean blood glucose decreased over time, but the correlations with adherence were only significant at time point 1 (p = 0.029). HbA1c levels decreased significantly over time (p = 0.003), but their correlation with adherence was not significant (p > 0.05). In patients with T2DM, high adherence to PNE based on GI, GL, and FII principles was associated with improved BGC. Full article

(This article belongs to the Special Issue Nutrition and Diabetes: Advances in Prevention and Management)

12 pages, 562 KiB

Open AccessArticle

Acute Physical Exercise Reduces Mental Stress-Induced Responses in Teachers

by Laura Cristina Nonato, Alexandre Konig Garcia Prado, Daniela Lopes dos Santos, Karen Dennise Lozada Tobar, Jaqueline Alves Araújo, Jacielle Carolina Ferreira and Lucieli Teresa Cambri

Int. J. Environ. Res. Public Health 2025, 22(6), 924; https://doi.org/10.3390/ijerph22060924 - 11 Jun 2025

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Abstract

This study assessed the correlation between obesity markers and mental stress reactivity. Mainly, it evaluated whether physical exercise (PE) influences cardiovascular reactivity to the Stroop color word test (SCWT) in teachers. Thirty-one school teachers were evaluated. The SCWT was carried out under (1) [...] Read more.

This study assessed the correlation between obesity markers and mental stress reactivity. Mainly, it evaluated whether physical exercise (PE) influences cardiovascular reactivity to the Stroop color word test (SCWT) in teachers. Thirty-one school teachers were evaluated. The SCWT was carried out under (1) baseline and (2) 30 min after aerobic PE conditions. Teachers performed 30 min of PE. The reactivity to mental stress (Δ) during the SCWT for blood pressure (BP) was determined, with Δ being the highest value observed [Δ2 or Δ4: with pre-test values (0 min)]. Of the teachers, 64.52% were considered overweight/obese and 19.35% had a high clinical BP. However, 67.74% of teachers were considered physically active. Systolic BP (SBP) reactivity to SCWT correlated negatively with obesity markers (Rho = −0.36 to −0.60; p < 0.05). The SBP and diastolic BP (DBP) were higher at 2 and 4 min compared to 0 during the SCWT under both conditions (p < 0.01). Moreover, SBP was always lower after PE (p < 0.01) and DBP was lower at 2 and 4 min after PE (p < 0.01). In summary, SBP reactivity to mental stress correlated negatively with obesity markers. Moderate-intensity acute PE reduced BP reactivity to mental stress in teachers. Full article

(This article belongs to the Topic The Effect of Physical Activity on the Population's Health)

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Int. J. Environ. Res. Public Health, Volume 22, Issue 6 (June 2025) – 140 articles

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