International Journal of Environmental Research and Public Health

13 pages, 327 KiB

Open AccessArticle

Association Between Movement Behaviors and Health-Related Quality of Life in Adolescents: A Cross-Sectional Study

by Pedro Henrique Garcia Dias, Maria Carolina Juvêncio Franscisquini, Thais Maria de Souza Silva, Géssika Castilho dos Santos, Rodrigo de Oliveira Barbosa, Jadson Márcio da Silva and Antonio Stabelini Neto

Int. J. Environ. Res. Public Health 2025, 22(6), 969; https://doi.org/10.3390/ijerph22060969 - 19 Jun 2025

Viewed by 377

Abstract

Health-related quality of life (HRQoL) is a multidimensional construct that encompasses physical, emotional, psychological, and social domains, according to an individual’s perception. Studies have indicated that lifestyle-related factors, such as engaging in physical activity (PA), reducing screen time (ST), and maintaining adequate sleep [...] Read more.

Health-related quality of life (HRQoL) is a multidimensional construct that encompasses physical, emotional, psychological, and social domains, according to an individual’s perception. Studies have indicated that lifestyle-related factors, such as engaging in physical activity (PA), reducing screen time (ST), and maintaining adequate sleep duration, may contribute to improved HRQoL in adolescents. The present study aimed to examine the associations of the 24 h movement behaviors (PA, ST, and sleep duration) with physical and psychological well-being, and HRQoL in adolescents. This study included 746 adolescents of both sexes, aged 11 to 15 years, enrolled in public schools. Sleep duration was assessed through a specific question related to habitual bedtime and wake-up time. ST was evaluated using a question regarding the daily time spent using recreational electronic devices. PA was measured using accelerometers (ActiGraph GT3X-BT). The KIDSCREEN questionnaire was used to assess physical and psychological well-being and HRQoL. Generalized linear models were used for statistical analysis. Significant associations were observed between meeting sleep duration recommendations and higher HRQoL scores (β = 1.05, 95% CI: 1.01–1.08), as well as psychological well-being (β = 1.07, 95% CI: 1.03–1.11). Additionally, adherence to ST recommendations was significantly associated with higher physical well-being scores (β = 1.07, 95% CI: 1.01–1.14). Concerning the combination of adherence to guidelines, meeting both sleep duration and ST recommendations was significantly associated with higher HRQoL scores (β = 1.08, 95% CI: 1.02–1.15), physical well-being (β = 1.11, 95% CI: 1.03–1.21), and psychological well-being (β = 1.09, 95% CI: 1.01–1.18). The findings of this study highlight the importance of adhering to the 24 h movement guidelines, which may contribute to improved adolescent well-being. Full article

15 pages, 783 KiB

Open AccessArticle

Family Members’ Help-Seeking Behaviour for Their Relative Who Uses Substances: A Cross-Sectional National Study in Brazil

by Cassandra Borges Bortolon, Martha Canfield, Maria de Fatima Rato Padin, Jim Orford and Ronaldo Laranjeira

Int. J. Environ. Res. Public Health 2025, 22(6), 968; https://doi.org/10.3390/ijerph22060968 - 19 Jun 2025

Viewed by 619

Abstract

The affected family members (AFM) of relatives with substance use problems (RSU) play an important role in supporting their relatives to enter substance use treatment. This study investigated the help-seeking behaviours for their relatives by AFM in Brazil, including the characteristics of those [...] Read more.

The affected family members (AFM) of relatives with substance use problems (RSU) play an important role in supporting their relatives to enter substance use treatment. This study investigated the help-seeking behaviours for their relatives by AFM in Brazil, including the characteristics of those who sought help and the risk factors for delaying it. A secondary analysis from a national cross-sectional study of 3030 AFM was performed. Participants were recruited from a range of services focused on AFM across each of the five Brazilian regions (North, Northeast, Central-West, Southeast, South). While 92.7% sought help, 66.0% delayed for an average of 37.2 (SD 70.71) months. Help seeking was associated with higher socioeconomic status and being from the Southeastern region. Barriers included the relative refusing help (31.5%) and the belief that help was not needed (20.6%). Longer delays were associated with female AFM, residents in the Central-West region, non-parents, older RSU, alcohol use, and withdrawal coping strategies. The findings show disparities in help-seeking behaviour across socioeconomic groups, regions, and substance types, highlighting the need for better healthcare workforce distribution and targeted interventions to educate AFMs on the importance of engagement with healthcare services. Full article

(This article belongs to the Section Health Care Sciences)

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18 pages, 525 KiB

Open AccessArticle

Users’ Perceptions of Access to and Quality of Public Health Services in Brazil: A Cross-Sectional Study in Metropolitan Rio de Janeiro, Including Pharmaceutical Services

by Mariana Crespo Raimundo, Edna Afonso Reis, Igor Fradique Leandro Ferraz, Carlos Podalirio Borges de Almeida, Brian Godman, Stephen M. Campbell, Johanna C. Meyer and Isabella Piassi Dias Godói

Int. J. Environ. Res. Public Health 2025, 22(6), 967; https://doi.org/10.3390/ijerph22060967 - 19 Jun 2025

Viewed by 492

Abstract

Background: This study evaluates one of the five regions of the state of Rio de Janeiro, Brazil, as part of a broader research project examining users’ perceptions of the Unified Health System (SUS), which has already generated publications in previous phases. The aim [...] Read more.

Background: This study evaluates one of the five regions of the state of Rio de Janeiro, Brazil, as part of a broader research project examining users’ perceptions of the Unified Health System (SUS), which has already generated publications in previous phases. The aim was to assess users’ perceptions of the SUS regarding access to and the quality of public health services, including pharmaceutical services, in the Metropolitan Region of Rio de Janeiro State. Method: A cross-sectional study was conducted between January and August 2024 with 200 participants, using a 66-item survey addressing access to and the quality of SUS services, appointment scheduling, medication acquisition, and the pharmacist’s role. Associations between variables were investigated using the Pearson Chi-Square Test in R software. Results: Frequent SUS users rated access as very good/good (p = 0.002) and overall quality as very good/good (p = 0.045). Reported challenges included the need for improved infrastructure (48.5%), better professional qualifications (30.6%), and easier access to medicines (16.8%). Higher ratings were given by those who used the SUS more frequently, and, in general, there was a tendency for participants with lower socioeconomic conditions to provide more favorable assessments of access to public health services (p = 0.024). Conclusions: A universal health system should cover diverse regions with unique needs. However, 49.4% of participants stated they never received information on how to store their medicines, and 42.3% reported never encountering a pharmacist in public pharmacies. Further ongoing studies assessing user perceptions are essential to ensure users play a central role in health decision-making, contributing to the system’s strengthening and improvement. Full article

(This article belongs to the Special Issue Social Medicine and Healthcare Management)

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12 pages, 1028 KiB

Open AccessArticle

Physiotherapy Intervention Improves Clinical Outcomes and Quality of Life in Elderly Patients with Osteoarthritis: A Prospective Cohort Study

by Jeel Moya-Salazar, Jordy R. Olortegui-Panaifo, Hans Contreras-Pulache, Eliane A. Goicochea-Palomino and Marx E. Morales-Martinez

Int. J. Environ. Res. Public Health 2025, 22(6), 966; https://doi.org/10.3390/ijerph22060966 - 19 Jun 2025

Viewed by 925

Abstract

Osteoarthritis is the most common disease among the elderly population and is expected to be one of the leading causes of physical disability worldwide. Our objective was to compare the effects of physiotherapeutic interventions versus pharmacological treatment on outcomes and quality of life [...] Read more.

Osteoarthritis is the most common disease among the elderly population and is expected to be one of the leading causes of physical disability worldwide. Our objective was to compare the effects of physiotherapeutic interventions versus pharmacological treatment on outcomes and quality of life in elderly patients with osteoarthritis. This cohort study was conducted on 119 elderly individuals aged 60 to 95 years (58.8% women) from the YUYAQ nursing home. Two groups were divided: the intervention group (58 individuals–48.7%) received a two-month physiotherapy program, and the control group (61–51.5%) received exclusive use of anti-inflammatories. Between the intervention and control groups, we observed significant improvements (all p < 0.001) regarding pain (93.1% vs. 60.75%), stiffness (94.8% vs. 62.3%), and functional capacity (96.6% vs. 68.9%). Additionally, the intervention group showed better quality of life than the control group (13.81 vs. 41.38, p < 0.001). Quality of life improvement and clinical outcomes in the treatment group significantly improved in all areas of osteoarthritis, primarily in hip, spine, and knee osteoarthritis (p < 0.001). In conclusion, the physiotherapy intervention improved pain, stiffness, functional capacity, and quality of life in elderly patients with osteoarthritis after two months of treatment. Transitioning from pharmacological treatment to physiotherapeutic treatment in patients with osteoarthritis may substantially improve quality of life and disease symptomatology, but long-term studies are needed. Full article

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14 pages, 254 KiB

Open AccessArticle

Barriers and Facilitators to Accessing Mental and Physical Health Care Among Sexual Minority Women: A Qualitative Exploration

by Charlotte A. Dawson, Alicia Moulder and Kristin E. Heron

Int. J. Environ. Res. Public Health 2025, 22(6), 965; https://doi.org/10.3390/ijerph22060965 - 19 Jun 2025

Viewed by 461

Abstract

Cisgender sexual minority women (SMW, e.g., lesbian, queer) are at greater risk for poor mental and physical health compared to heterosexual women and face challenges when accessing health care. Previous research has largely focused on general sexual and gender minority barriers to health [...] Read more.

Cisgender sexual minority women (SMW, e.g., lesbian, queer) are at greater risk for poor mental and physical health compared to heterosexual women and face challenges when accessing health care. Previous research has largely focused on general sexual and gender minority barriers to health care, but more research is needed on the experiences of specific subgroups, including cisgender SMW. The current study qualitatively explored barriers and facilitators for cisgender SMW seeking health care. Twenty cisgender SMW aged 18–40 recruited using Meta advertisements and past participant lists completed 45 min semi-structured interviews and a brief survey. Thematic analysis conducted by two coders revealed a barrier theme with six subthemes, and a facilitator theme with seven subthemes. The barrier subthemes included discrimination, dominant culture centric, unsupportive socio-political environment, lack of patient-centered care, avoidance/concealment of sexual identity, and socio-economic challenges. The facilitator subthemes included supportive socio-political environment, advance identification of LGBTQ-affirming HCPs, patient-centered care, HCP identity similar to patient, social support, re-engagement with care after bad experiences, and socio-economic advantages. This study provides insight into the lived experiences of cisgender SMW that can help improve knowledge about health care disparities and inform health care interventions for this population. Full article

(This article belongs to the Special Issue Mental Health Challenges Affecting LGBTQ+ Individuals and Communities)

9 pages, 253 KiB

Open AccessBrief Report

Urban–Rural Disparities in Non-Adherence to Iron Supplementation Among Pregnant Women Aged 15 to 49 in Sub-Saharan Africa

by Yibeltal Bekele, Bircan Erbas and Mehak Batra

Int. J. Environ. Res. Public Health 2025, 22(6), 964; https://doi.org/10.3390/ijerph22060964 - 19 Jun 2025

Viewed by 501

Abstract

Background: Adherence to iron supplementation is influenced by systemic barriers, including poor healthcare infrastructure, shortage of healthcare providers, and limited access to antenatal care (ANC) services. These challenges are more pronounced in rural areas. However, evidence on urban–rural disparities in non-adherence to iron [...] Read more.

Background: Adherence to iron supplementation is influenced by systemic barriers, including poor healthcare infrastructure, shortage of healthcare providers, and limited access to antenatal care (ANC) services. These challenges are more pronounced in rural areas. However, evidence on urban–rural disparities in non-adherence to iron supplementation remains limited, particularly in sub-Saharan Africa. This study examined these regional differences, stratified by income levels and national contexts. Method: This analysis utilised Demographic Health Survey (DHS) data conducted between 2015 and 2023 from 26 sub-Saharan African countries, including 287,642 women from urban (n = 91,566) and rural areas (n = 196,076). The outcome of this study was non-adherence to iron supplementation, defined as taking iron supplementation for less than 90 days during pregnancy. This study examines urban–rural differences in non-adherence stratified by country income levels based on World Bank 2022 income classifications and national context. A chi-square test was used to assess urban–rural differences, with a p-value of <0.05 considered statistically significant. Results: Non-adherence was significantly higher in rural areas (68.42%) than in urban areas (51.32%) (p < 0.001), with the disparity more pronounced in low-income countries (LICs). Ethiopia, Madagascar, Uganda, and Burundi were among the countries with the highest rural non-adherence, reflecting severe poverty and limited access to ANC. In contrast, Zimbabwe showed an inverse trend, where rural adherence was higher than urban. Conclusions: Rural sub-Saharan Africa has significantly higher non-adherence to iron supplementation, particularly in LICs, likely driven by systemic barriers such as poor infrastructure and limited access to healthcare. This non-adherence in rural areas undermines efforts to improve pregnancy and birth outcomes across the region. Targeted interventions, like those in Zimbabwe, can help address these inequities and improve maternal health outcomes. Full article

16 pages, 295 KiB

Open AccessArticle

Occupational Health and Safety Among Brazilian Immigrant Women in the United States: A Cross-Sectional Survey

by Ashley Scott, Salima F. Taylor and Jennifer D. Allen

Int. J. Environ. Res. Public Health 2025, 22(6), 963; https://doi.org/10.3390/ijerph22060963 - 19 Jun 2025

Viewed by 414

Abstract

The Brazilian population in the United States is growing, and many Brazilian workers are employed in settings that may lack occupational health and safety (OHS) protections. In this study, we examined two domains of OHS (measured by the Occupational Health and Safety Vulnerability [...] Read more.

The Brazilian population in the United States is growing, and many Brazilian workers are employed in settings that may lack occupational health and safety (OHS) protections. In this study, we examined two domains of OHS (measured by the Occupational Health and Safety Vulnerability Survey), namely, Workplace Hazards (potential dangers that may result in injury or illness) and Workplace Vulnerability (inadequate occupational health and safety resources), and described health and demographic characteristics associated with these conditions. Eligible participants were women aged 18 and over, born in Brazil, currently residing in the United States, and employed. A cross-sectional online survey was conducted between July and August 2020. Recruitment occurred through community partnerships and social media. Multivariable models among n = 191 women revealed that greater exposure to Workplace Hazards was associated with employment in private household settings, including childcare and housecleaning (p < 0.001). The association between Workplace Vulnerability and jobs in private household services approached statistical significance (p = 0.07). Both Workplace Hazards and Workplace Vulnerability were associated with lower incomes and educational attainment, as well as having public insurance. Our findings suggest the need for stronger OHS protections and policies, particularly among those working in private household services, to ensure safer working conditions for Brazilian immigrant women. Full article

(This article belongs to the Section Global Health)

15 pages, 3866 KiB

Open AccessArticle

Prevalence and Factors Associated with Anaemia and Undernutrition Among Children Aged 6–24 Months in Rural Tanzania

by Naelijwa Mshanga, Sally Moore, Neema Kassim, Carolyn I. Auma, Yun Yun Gong and Haikael D. Martin

Int. J. Environ. Res. Public Health 2025, 22(6), 962; https://doi.org/10.3390/ijerph22060962 - 19 Jun 2025

Cited by 1 | Viewed by 565

Abstract

Background: Anaemia and undernutrition remain a significant public health problem in low and middle-income countries (LMICs), particularly affecting under-five children. In Tanzania, the prevalence of anaemia and undernutrition in under-five children is still high; however, less is known about the prevalence and predictors [...] Read more.

Background: Anaemia and undernutrition remain a significant public health problem in low and middle-income countries (LMICs), particularly affecting under-five children. In Tanzania, the prevalence of anaemia and undernutrition in under-five children is still high; however, less is known about the prevalence and predictors of these conditions in rural areas. Therefore, the current cross-sectional study presents the prevalence and determinants of anaemia and undernutrition among 457 children aged 6–24 months in the Babati and Hanang districts of Tanzania. Method: Haemoglobin concentration was assessed through capillary blood samples. Anaemia was classified according to WHO 2011 guidelines using a cut-off of <11.0 g/dL for children under five, while the WHO 2006 growth indicators were used to classify the nutritional status (i.e., stunting, wasting and underweight). Results: The results from this study show that 32%, 32%, 20% and 4% of children aged 6–24 months were anaemic, stunted, underweight and wasted, respectively, while only 33% had an adequate minimum dietary diversity (MDD). In addition, the child’s age (13–24 months) was significantly associated with anaemia (AOR: 2.1 95% CI 1.4, 3.1), stunting (AOR:17.4 95% CI 10.3, 29.4) and underweight (AOR: 15.9 95% CI 7.9, 32.0). Moreover, male children were three times more likely to be wasted (AOR: 3.5 95% CI 1.1, 10.9) than their female counterparts. Anaemia and stunting were the most prevalent nutritional disorders among 6–24-month-old children in the Hanang and Babati districts. Moreover, age (13–24 months) was found to be the common predictor for anaemia, stunting and underweight. Conclusion: The observed association between age and anaemia, as well as undernutrition, suggest that age may be an essential factor when designing nutrition-related programs in similar rural settings. Full article

(This article belongs to the Special Issue Early Childhood Nutrition and Associated Food Preferences, Dietary Patterns, and Health Outcomes)

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1 pages, 180 KiB

Open AccessCorrection

Correction: Słoniewski et al. A Comparative Analysis of Quality of Life in Women Diagnosed with Breast and Ovarian Cancer. Int. J. Environ. Res. Public Health 2022, 19, 6705

by Robert Słoniewski, Marta Dąbrowska-Bender, Urszula Religioni, Adam Fronczak, Anna Staniszewska, Aneta Duda-Zalewska, Magdalena Milewska, Magdalena Kędzierska, Rafał Adam Matkowski, Grażyna Dykowska, Anna Słoniewska and Anna Kupiecka

Int. J. Environ. Res. Public Health 2025, 22(6), 961; https://doi.org/10.3390/ijerph22060961 - 19 Jun 2025

Viewed by 355

Abstract

Marta Dąbrowska-Bender was not listed as co-corresponding author and co-first author in the original publication [...] Full article

18 pages, 640 KiB

Open AccessArticle

Nicotine Dependence in a Banned Market: Biomarker Evidence from E-Cigarette Users in São Paulo, Brazil

by Jaqueline Ribeiro Scholz, Elaine Cristine D’Amico, Juliana Takitane, Daniele Mayumi Sinagawa, João Mauricio Castaldelli-Maia, Marcelo Filonzi dos Santos, Rodrigo Alves de Oliveira, Guilherme Vinicius Marques, Eric Nagamine Lima, Diana Fernanda Lasso Rodriguez, Sara Ziotti, Vilma Leyton and Maria Cristina Megid

Int. J. Environ. Res. Public Health 2025, 22(6), 960; https://doi.org/10.3390/ijerph22060960 - 19 Jun 2025

Viewed by 637

Abstract

Although electronic cigarettes have been banned in Brazil since 2009, their use is increasing, particularly among youth. We conducted a biomarker-based study to profile exclusive e-cigarette users in São Paulo and to examine the associations of e-cigarette use with salivary nicotine and cotinine [...] Read more.

Although electronic cigarettes have been banned in Brazil since 2009, their use is increasing, particularly among youth. We conducted a biomarker-based study to profile exclusive e-cigarette users in São Paulo and to examine the associations of e-cigarette use with salivary nicotine and cotinine levels. A population-based, cross-sectional study was conducted between April and September 2024 in six municipalities in São Paulo, Brazil. Randomly selected participants who reported exclusive use of electronic cigarettes completed a questionnaire and provided oral fluid samples for the determination of their nicotine and cotinine concentrations using LC-MS/MS. The cohort consisted of N = 417 participants. Significant associations were found between nicotine and cotinine concentrations and variables such as knowledge of nicotine content and product type. Addiction status significantly influenced the nicotine and cotinine concentrations, as well as smoking history, last consumption, recharge/purchase frequency, and consumption duration (all p < 0.001). Participants who perceived themselves to have a moderate or severe addiction exhibited higher nicotine and cotinine concentrations compared with those who did not perceive that they had an addiction (p < 0.001). Most participants were young, predominantly White, and highly educated and earned higher incomes. The findings reveal a correlation between perceived nicotine dependence and salivary nicotine and cotinine concentrations, underscoring the physiological and behavioral markers of electronic cigarette addiction. High salivary concentrations of nicotine appear to be independent of duration of e-cigarette use, smoking history, and age. These findings underscore the urgent need for surveillance and public health interventions, even in jurisdictions where these products remain illegal. The study limitations include its cross-sectional design and potential selection bias due to convenience sampling. Full article

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1 pages, 163 KiB

Open AccessCorrection

Correction: Si et al. Research on the Influence of Non-Cognitive Ability and Social Support Perception on College Students’ Entrepreneurial Intention. Int. J. Environ. Res. Public Health 2022, 19, 11981

by Wentao Si, Jiayi Tian, Qi Yan, Wenshu Wang and Maocong Zhang

Int. J. Environ. Res. Public Health 2025, 22(6), 959; https://doi.org/10.3390/ijerph22060959 - 19 Jun 2025

Viewed by 281

Abstract

In the original publication [1], Jiayi Tian was not included as an author in the original publication [...] Full article

27 pages, 1246 KiB

Open AccessArticle

Nourishing Beginnings: A Community-Based Participatory Research Approach to Food Security and Healthy Diets for the “Forgotten” Pre-School Children in South Africa

by Gamuchirai Chakona

Int. J. Environ. Res. Public Health 2025, 22(6), 958; https://doi.org/10.3390/ijerph22060958 - 18 Jun 2025

Viewed by 594

Abstract

Adequate and diverse diets are essential for children’s physical and cognitive development, yet food insecurity and malnutrition continue to threaten this fundamental right, which remains a pressing concern in many resource-poor settings. This study investigated food and nutrition security in Early Childhood Development [...] Read more.

Adequate and diverse diets are essential for children’s physical and cognitive development, yet food insecurity and malnutrition continue to threaten this fundamental right, which remains a pressing concern in many resource-poor settings. This study investigated food and nutrition security in Early Childhood Development (ECD) centres in Makhanda, South Africa, through a community-based participatory research approach. Using a mixed-methods approach combining questionnaire interviews, focus group discussions, direct observations, and community asset mapping across eight ECD centres enrolling 307 children aged 0–5 years, the study engaged ECD facilitators and analysed dietary practices across these centres. Results indicated that financial constraints severely affect the quality and diversity of food provided at the centres, thus undermining the ability to provide nutritionally adequate meals. The average amount spent on food per child per month at the centres was R90 ± R25 (South African Rand). Although three meals were generally offered daily, cost-driven dietary substitutions with cheaper, less diverse alternatives, often at the expense of nutritional value, were common. Despite guidance from Department of Health dieticians, financial limitations contributed to suboptimal feeding practices, with diets dominated by grains and starchy foods, with limited access to and rare consumption of protein-rich foods, dairy, and vitamin A-rich fruits and vegetables. ECD facilitators noted insufficient parental contributions and low engagement in supporting centre operations and child nutrition provision, indicating a gap in awareness and limited nutrition knowledge regarding optimal infant and young child feeding (IYCF) practices. The findings emphasise the need for sustainable, multi-level and community-led interventions, including food gardening, creating ECD centre food banks, parental nutrition education programmes, and enhanced financial literacy among ECD facilitators. Strengthening local food systems and establishing collaborative partnerships with communities and policymakers are essential to improve the nutritional environment in ECD settings. Similarly, enhanced government support mechanisms and policy-level reforms are critical to ensure that children in resource-poor areas receive adequate nutrition. Future research should focus on scalable, locally anchored models for sustainable child nutrition interventions that are contextually grounded, community-driven, and should strengthen the resilience of ECD centres in South Africa. Full article

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13 pages, 861 KiB

Open AccessReview

The Role of Rehabilitation Nurses in Empowering Mastectomised Women for Self-Care: A Scoping Review

by Madalena Rodrigues, Inês Deus, Pedro Bengalinha, Raquel Duro, David Carpinteiro, Rogério Ferreira, Celso Silva and César Fonseca

Int. J. Environ. Res. Public Health 2025, 22(6), 957; https://doi.org/10.3390/ijerph22060957 - 18 Jun 2025

Viewed by 478

Abstract

Background: Breast cancer is one of the most prevalent neoplasms among women, often requiring mastectomy, a procedure with a significant impact on functionality, self-esteem, and quality of life. Objective: This study aimed to map the main interventions performed by the Rehabilitation Nursing Specialist [...] Read more.

Background: Breast cancer is one of the most prevalent neoplasms among women, often requiring mastectomy, a procedure with a significant impact on functionality, self-esteem, and quality of life. Objective: This study aimed to map the main interventions performed by the Rehabilitation Nursing Specialist in the follow-up care of mastectomised women. Methods: A review was conducted according to the Joanna Briggs Institute methodology. The search included 11 articles published between 2019 and 2024 in Portuguese, English, and Spanish, available on the EBSCO platform (MEDLINE with Full TEXT, CINAHL). The descriptors used were (Mastectomy OR Breast Removal) AND (Rehabilitation Nursing OR Nursing Intervention). Results: The Rehabilitation Nursing Specialist interventions focused on education regarding upper limb mobilisation, medication administration, lymphedema prevention, strategies for performing Daily Life Activities with less effort and pain, implementation of rehabilitation plans with physical exercises, and emotional support in accepting body image changes. Hospital discharge planning and caregiver education also emerged as key elements to ensure continuity of care. Most studies (six) identify performing exercises to strengthen muscles and prevent lymphoedema as a very important intervention for nurses, followed by education on care for upper limb mobilisation and lymphoedema prevention (five) and emotional and social support (four), among other interventions. Conclusions: The Rehabilitation Nursing Specialist interventions are fundamental for promoting functionality, emotional well-being, and quality of life in mastectomised women, reinforcing the importance of a multidisciplinary, person-centred approach supported by scientific evidence. Full article

(This article belongs to the Section Infectious Diseases, Chronic Diseases, and Disease Prevention)

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29 pages, 1463 KiB

Open AccessSystematic Review

Pharmacological and Non-Pharmacological Interventions to Improve Sleep in People with Cognitive Impairment: A Systematic Review and Meta-Analysis

by Patrick Crowley, Mark R. O’Donovan, Peter Leahy, Evelyn Flanagan and Rónán O’Caoimh

Int. J. Environ. Res. Public Health 2025, 22(6), 956; https://doi.org/10.3390/ijerph22060956 - 18 Jun 2025

Viewed by 970

Abstract

Sleep disturbance is common among people with cognitive impairment and, when present, is an important target for intervention because it potentially leads to negative outcomes and cognitive decline. Given this association, sleep represents a potential public health target, although evidence for efficacy is [...] Read more.

Sleep disturbance is common among people with cognitive impairment and, when present, is an important target for intervention because it potentially leads to negative outcomes and cognitive decline. Given this association, sleep represents a potential public health target, although evidence for efficacy is lacking. For this study, a systematic review and meta-analysis was undertaken of controlled clinical trials of pharmacological and non-pharmacological interventions to improve sleep in mild cognitive impairment and dementia. A total of 144 trials involving 13,471 participants (median 50 per trial) were included. To measure sleep, 68 trials used subjective measures exclusively, and 41 used only objective measures, while 35 used a combination. In all, 287 discrete sleep outcome measures were reported. Bright light therapy was the most frequently examined non-pharmacological intervention, but results were equivocal. Other non-pharmacological interventions (such as physical activity, cognitive behavioural therapy for insomnia, music, and continuous positive airway pressure) showed promise but require further evidence. Results for melatonin, the most frequently examined pharmacological intervention, were inconclusive, but lower doses may be more effective. Other pharmacological interventions (such as trazadone and orexin-receptor antagonists) demonstrated effectiveness in a small number of trials but require further evidence. Overall, there is insufficient evidence upon which to base clinical decisions regarding the treatment of sleep disturbance in this population. Existing research is marked by wide heterogeneity, which limits opportunities for data synthesis. A core outcome set is urgently required to ensure that future research provides more coherent and reliable evidence to improve outcomes for people with cognitive impairment and sleep disturbance. Full article

(This article belongs to the Special Issue Sleep Disorders and Cognitive Impairment)

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21 pages, 522 KiB

Open AccessArticle

Perpetrating–Suffering Intimate Violence: Self-Harm–Suicide Thoughts and Behaviors, Mental Health, and Alcohol Use Among Mexican Youth During COVID-19

by Silvia Morales-Chainé, Gonzalo Bacigalupe, Rebeca Robles-García, Alma Luisa López-Fuentes and Violeta Félix-Romero

Int. J. Environ. Res. Public Health 2025, 22(6), 955; https://doi.org/10.3390/ijerph22060955 - 18 Jun 2025

Viewed by 550

Abstract

Background The COVID-19 epidemic had a deleterious impact on mental health and substance abuse and led to an increase in several forms of violence, including self-harm and interpersonal violence among youth from low- and middle-income countries. Nevertheless, the relationship between the variables and [...] Read more.

Background The COVID-19 epidemic had a deleterious impact on mental health and substance abuse and led to an increase in several forms of violence, including self-harm and interpersonal violence among youth from low- and middle-income countries. Nevertheless, the relationship between the variables and their directionality has not been recognized. This study describes the relationship directionality between these variables among 18- to 20-year-old Mexican youths during the COVID-19 pandemic. Methods The longitudinal cohort study comprises an evolving group of young Mexican adults: 1390 participants aged 18 in 2021, 654 aged 19 in 2022, and 442 aged 20 in 2023. Proportions by sex—50% were matched in every cohort, and the evolution–age sample accomplishment accounted for 47% in 2022 and 32% in 2023. Results According to a structural equation model, which fit the data from 195 iterations with 246 parameters (X²[2722] = 8327.33, p < 0.001), yielding a CFI of 0.946, a TLI of 0.943, and an RMSEA of 0.029 [0.028–0.029]), perpetrating intimate violence, preceded by suffering intimate violence, combined with suffering anxiety symptoms, was associated with self-harm–suicide thoughts and behaviors (ShSTB), marked distress, dysfunction, and somatization symptoms. The relationship was stronger in women and 20-year-old Mexicans. In men, this pathway was exclusively associated with ShSTB. Suffering from intimate violence has been associated with depression, anxiety, and PTSD symptoms, as well as harmful alcohol use. Conclusions During an epidemic, prevention programs should be designed to warn about self-harm–suicide thoughts and behaviors, not only to ensure the safety of the victims of intimate personal-violence but also to prevent the suicidal behavior of perpetrators. Full article

(This article belongs to the Special Issue Alcohol Use in Disadvantaged Populations: Health Equalities and Appropriate Intervention)

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18 pages, 419 KiB

Open AccessArticle

Coproduction Within Intersectoral Collaboration in the Context of a Neighborhood with Low Socioeconomic Scores in The Netherlands

by Roos van Lammeren, Jelmer Schalk, Suzan van der Pas and Jet Bussemaker

Int. J. Environ. Res. Public Health 2025, 22(6), 954; https://doi.org/10.3390/ijerph22060954 - 18 Jun 2025

Viewed by 457

Abstract

Intersectoral collaboration between health care, social care and other sectors has been widely advocated to improve population health outcomes. Similarly, the active role of citizens as coproducers is increasingly described in the literature as an important element for improving people’s health and well-being. [...] Read more.

Intersectoral collaboration between health care, social care and other sectors has been widely advocated to improve population health outcomes. Similarly, the active role of citizens as coproducers is increasingly described in the literature as an important element for improving people’s health and well-being. Yet, there is little understanding of the role of coproduction in intersectoral collaboration, particularly in neighborhoods with low socioeconomic scores (SESs). In this empirical study, we analyze two aspects of coproduction that potentially drive positive health outcomes in intersectoral collaboration: How do coproducers in neighborhoods with low socioeconomic scores actively contribute to intersectoral collaboration, and what role does the relationship between professionals and citizens play in shaping these contributions? The study was conducted in a low-SES neighborhood in The Hague, the Netherlands. In this study, we explored the team ‘the Connectors’, an intersectoral collaboration of professionals and citizens with various (professional) backgrounds, focusing on accessible support for mental health services. The cause of mental health problems in low-SES neighborhoods varies; therefore, intersectoral collaboration is required in the approach to addressing these mental health problems. Using an action research approach, we demonstrated the importance of a reciprocal relationship between coproducers and professionals. We also found that ‘boundary spanners’ can help to improve this relationship, regardless of whether they are professionals or coproducers. We conclude that citizens in a low-SES neighborhood can not only benefit from coproduction, but can also contribute to it, because they have a high incentive to improve their neighborhood together with professionals in the intersectoral collaboration. Full article

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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 - 17 Jun 2025

Viewed by 707

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 - 17 Jun 2025

Viewed by 557

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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23 pages, 2154 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 - 17 Jun 2025

Viewed by 459

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

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17 pages, 1542 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 - 17 Jun 2025

Viewed by 386

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)

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13 pages, 641 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 - 17 Jun 2025

Viewed by 335

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

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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 - 17 Jun 2025

Viewed by 503

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

Viewed by 641

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

Viewed by 548

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

Viewed by 403

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, 667 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

Viewed by 300

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)

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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

Viewed by 499

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

Viewed by 523

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

Viewed by 449

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

Viewed by 739

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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Int. J. Environ. Res. Public Health, Volume 22, Issue 6 (June 2025) – 156 articles

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