International Journal of Environmental Research and Public Health

22 pages, 658 KiB

Open AccessArticle

Unveiling Key Factors in Child Development: From Breastfeeding to Teachers’ Care in Brazilian Early Childcare Centers

by Alessandra Bombarda Müller, Helena Cristina V. S. Vieira, Carolina Panceri, Glauber Carvalho Nobre and Nadia Cristina Valentini

Int. J. Environ. Res. Public Health 2025, 22(7), 1158; https://doi.org/10.3390/ijerph22071158 - 21 Jul 2025

Viewed by 669

Abstract

This study aimed to compare cognitive, language, and motor development outcomes among children attending public and private Early Childcare Centers (ECCs), considering birth factors and family and daycare environments. Additionally, it examined the proximal and distal factors influencing children’s development. Cognitive, language, and [...] Read more.

This study aimed to compare cognitive, language, and motor development outcomes among children attending public and private Early Childcare Centers (ECCs), considering birth factors and family and daycare environments. Additionally, it examined the proximal and distal factors influencing children’s development. Cognitive, language, and motor skills were assessed in the children, along with evaluations of ECC quality, teacher practices, and knowledge of child development. Results indicated that children enrolled in public ECCs achieved higher scores in cognitive and language development, despite coming from families with lower socioeconomic status and having lower birth weights. They also benefited from longer periods of breastfeeding. Teachers in public ECCs demonstrated greater daily practices, providing enhanced movement opportunities for children. Private ECCs offered more suitable outdoor spaces, whereas public ECCs had better indoor spaces. Regression analysis revealed that daily practice, teachers’ experience, and the availability of gross motor toys explained 41% of the variance in motor development. The duration of breastfeeding explained 24% of the variance in cognitive development. Teachers’ knowledge about children’s development and attendance at public ECCs explained 31% of the variance in language development. These findings underscore the importance of prioritizing teacher education in both public and private ECCs to optimize children’s overall development. Full article

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16 pages, 851 KiB

Open AccessArticle

Impact of Combined Hypertension and Diabetes on the Prevalence of Disability in Brazilian Older People—Evidence from Population Studies in 2013 and 2019

by Rafaela Gonçalves Ribeiro-Lucas, Barbara Niegia Garcia de Goulart and Patricia Klarmann Ziegelmann

Int. J. Environ. Res. Public Health 2025, 22(7), 1157; https://doi.org/10.3390/ijerph22071157 - 21 Jul 2025

Viewed by 674

Abstract

Disability in basic and instrumental activities of daily living (BADL and IADL) reflects functional decline in older adults and can be associated with chronic conditions like type 2 diabetes (T2DM) and hypertension (SAH). This cross-sectional study utilized data from the 2013 and 2019 [...] Read more.

Disability in basic and instrumental activities of daily living (BADL and IADL) reflects functional decline in older adults and can be associated with chronic conditions like type 2 diabetes (T2DM) and hypertension (SAH). This cross-sectional study utilized data from the 2013 and 2019 Brazilian National Health Surveys to investigate the associations between T2DM, SAH, and disability levels. Exposures were self-reported diagnoses and outcomes were classified as independent, moderate, or severe. Multivariable Poisson regression models, with robust variance estimates, estimated adjusted prevalence ratios (PRa), accounting for sociodemographic variables and the survey design. In 2013, the absence of diabetes and hypertension was associated with a lower prevalence (PRa = 0.70; 95% CI: 0.58–0.85) of moderate disability in BADL when compared with the presence of only one of the conditions. On the other hand, the coexistence of T2DM and SAH was associated with a higher prevalence (PRa = 1.39; 95% CI: 1.01–1.91). A similar result was found in 2019 with the addition that coexistence was also associated with a higher prevalence of severe disability in BADLs (PRa = 1.82; 95% CI: 1.59–2.07). For IADL, the absence of T2DM and SAH was associated with a lower prevalence of severe disability in 2013 and 2019 and a lower prevalence of moderate disability only in 2019. However, coexistence showed a higher prevalence in both degrees of disability and both years of the survey. These findings highlight the impact of T2DM and SAH on disability in older people. Therefore, it is crucial to develop targeted strategies for vulnerable subgroups to enhance functional independence in aging populations. Full article

(This article belongs to the Special Issue Access to Public Health Services and Challenges to Healthcare Management)

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16 pages, 420 KiB

Open AccessArticle

Supervision, Moral Distress and Moral Injury Within Palliative Care—A Qualitative Study

by Pia Geuenich, Lena Schlömer, Sonja Owusu-Boakye and Henrikje Stanze

Int. J. Environ. Res. Public Health 2025, 22(7), 1156; https://doi.org/10.3390/ijerph22071156 - 21 Jul 2025

Viewed by 731

Abstract

The number of people requiring palliative care is increasing. This can result in moral and ethical conflicts that may lead to psychological distress and moral injury. (MI). Solutions are needed to counteract career abandonment—supervision (SV) could be one solution. This study examines the [...] Read more.

The number of people requiring palliative care is increasing. This can result in moral and ethical conflicts that may lead to psychological distress and moral injury. (MI). Solutions are needed to counteract career abandonment—supervision (SV) could be one solution. This study examines the extent to which palliative care nurses link MI to their everyday experiences and whether SV can contribute to the identification and prevention of moral distress and MI. In addition, factors that influence the implementation of, participation in, and perception of SV are analyzed. A qualitative study design was chosen for the investigation, consisting of guided interviews, narrative-generating questions with seven participants working in palliative care, and participant observation with audio recording during two supervisions of two palliative care teams with 16 participants in total. The data was analyzed using qualitative content analysis according to Mayring. The results show differences in workload between acute and palliative care wards. Time pressure and hierarchical structures promote distress and MI and are particularly evident on acute wards. The interviewees described specific experiences of MI. In addition, factors were identified that influence participation in SV. The analysis of SV showed that workload is a key cause of moral distress and can have an impact on health. SV can be used for sensitization and exchange. Implementation and acceptance of SV depend on individual and structural factors. In palliative care, signs of moral distress are present and are specifically addressed in SV, which means that SV can be a tool for dealing with stressful situations. Full article

(This article belongs to the Special Issue End-of-Life Care and Nursing)

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11 pages, 578 KiB

Open AccessProtocol

Climate Change and Its Health Impact in South Africa: A Scoping Review Protocol

by Olubunmi Margaret Ogbodu, Ayodeji Oluwabunmi Oriola and Busisiwe Mrara

Int. J. Environ. Res. Public Health 2025, 22(7), 1155; https://doi.org/10.3390/ijerph22071155 - 21 Jul 2025

Viewed by 480

Abstract

Climate change is profoundly impacting human health in South Africa, aggravating existing health challenges and creating new threats, particularly in vulnerable populations. This scoping review aims to comprehensively map existing evidence of climate change and diverse human health impacts to assist in the [...] Read more.

Climate change is profoundly impacting human health in South Africa, aggravating existing health challenges and creating new threats, particularly in vulnerable populations. This scoping review aims to comprehensively map existing evidence of climate change and diverse human health impacts to assist in the equipping of health systems to address evolving challenges of climate change. The scoping review will inform the development of evidence-based policy, improve public health preparedness, and ensure that adaptation strategies are effectively tailored to South Africa’s socio-economic and environmental conditions. This scoping review protocol will be conducted using the Joanna Briggs Institute (JBI) methodology, following five steps: (1) defining the research question, (2) search strategy, (3) setting inclusion criteria, (4) extracting data, (5) assessing, summarizing, and presenting findings. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) tool will be used. A comprehensive peer-reviewed literature search, including PubMed, Scopus, ScienceDirect, and Google Scholar, will be conducted by two independent reviewers. The review will be conducted over eight weeks, focusing on English studies published between 2015 and 2025, and conducted within South Africa. A two-stage screening process will determine article eligibility. Disagreements will be resolved through consensus and consultation of a third reviewer. The results of this review will be presented as tables, including a narrative synthesis of the findings. Full article

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10 pages, 468 KiB

Open AccessArticle

Sociodemographic and Clinical Predictors of Tuberculosis and Unsuccessful Treatment Outcomes in Davao City, Philippines: A Retrospective Cohort Study

by Alfredo A. Hinay, Jr., Marielle A. Mamalintaw, Joulei Mei L. Damasin, Bai Jana Shamera A. Dilangalen, Brent Adrian S. Montinola, Cristine Joy S. Napinas, Lester Evan Rey L. Valiente, Nathasia Lyn C. Insular, April Joy D. Parilla, Nelyn Mae T. Cadotdot, Nikka Mae R. Elipio, Jennifer Ashley H. Reyes and Avee Joy B. Dayaganon

Int. J. Environ. Res. Public Health 2025, 22(7), 1154; https://doi.org/10.3390/ijerph22071154 - 21 Jul 2025

Viewed by 479

Abstract

Background/Objectives: Tuberculosis (TB) remains a major public health challenge in Davao City, Philippines, with persistent issues in both disease burden and treatment outcomes. Understanding the risk factors for TB and its unsuccessful treatment is essential for guiding effective interventions. This study aimed to [...] Read more.

Background/Objectives: Tuberculosis (TB) remains a major public health challenge in Davao City, Philippines, with persistent issues in both disease burden and treatment outcomes. Understanding the risk factors for TB and its unsuccessful treatment is essential for guiding effective interventions. This study aimed to evaluate the association of sociodemographic and clinical factors with TB occurrence and to identify predictors of unsuccessful TB treatment outcomes among patients in Davao City. Methods: A retrospective cohort study was conducted using data from 521 patients diagnosed with drug-susceptible TB at Davao Chest Center between January 2021 and May 2024. The sociodemographic and clinical profiles of the patients were described using descriptive statistics. Chi-square tests were used to assess the associations between sociodemographic and clinical variables with TB risk and treatment outcomes. Results: The patient cohort was predominantly aged 31–50 years (n = 201, 38.58%), male (n = 284, 54.51%), and married (n = 285, 54.70%), with most residing in Districts I and II (n = 98, 38% each), and had no previous TB treatment (n = 344, 66.03%). Among the 456 patients assessed for comorbidities, 56.14% (n = 256) had at least one comorbidity. Evaluation of the risk factors for TB occurrence among the study population revealed that comorbidity status was not significantly associated with an increased risk of TB diagnosis (p = 0.682). However, among patients diagnosed with TB, the presence of comorbidities was significantly associated with unsuccessful treatment outcomes (p = 0.003). Conclusions: Although sociodemographic factors did not significantly influence TB risk or treatment outcomes, the presence of comorbidities was a significant predictor of unsuccessful TB treatment. These findings highlight the importance of integrating comorbidity management with TB care to improve treatment success in high-burden urban settings. Full article

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17 pages, 321 KiB

Open AccessArticle

Black Men and Health Literacy: Strategies for Improvement in a Digital Age Through the Adaptation of a Chronic Disease Self-Management Program

by Evelina Weidman Sterling, Laura Stevens, Vanessa Robinson-Dooley and Tyler Collette

Int. J. Environ. Res. Public Health 2025, 22(7), 1153; https://doi.org/10.3390/ijerph22071153 - 21 Jul 2025

Viewed by 427

Abstract

Health literacy is a critical determinant of health outcomes, yet it is often overlooked, particularly among marginalized groups. This paper explores the significance of health literacy, with a particular focus on low-income African American and Black (AA/B) men, a population that faces unique [...] Read more.

Health literacy is a critical determinant of health outcomes, yet it is often overlooked, particularly among marginalized groups. This paper explores the significance of health literacy, with a particular focus on low-income African American and Black (AA/B) men, a population that faces unique challenges due to intersecting factors such as race, gender, socioeconomic status, and educational disparities. We examine how these factors contribute to health literacy gaps, highlighting adverse effects on health outcomes for AA/B men compared to the general population. Additionally, we stress the growing importance of digital literacy in an increasingly technology-driven world. Not actively addressing digital health literacy, especially within chronic disease self-management programs (CDSMPs), further exacerbates health disparities within this group. Recommendations are provided for improving health literacy, with specific strategies to also enhance general literacy and digital literacy, among low-income AA/B men. The paper also advocates for a systematic review of the existing literature on health literacy among this group, emphasizing the need for tailored interventions that account for the unique challenges faced by low-income AA/B men. In conclusion, the paper underscores the critical need for targeted research and practical approaches to improve health literacy and ultimately health outcomes for AA/B men in the digital age, particularly through CDSMPs. Full article

(This article belongs to the Special Issue Men’s Health Care and Health Literacy)

27 pages, 3707 KiB

Open AccessSystematic Review

Mobile and Web Apps for Weight Management in Overweight and Obese Adults: An Updated Umbrella Review and Meta-Analysis

by Felipe da Fonseca Silva Couto and Carlos Podalirio Borges de Almeida

Int. J. Environ. Res. Public Health 2025, 22(7), 1152; https://doi.org/10.3390/ijerph22071152 - 21 Jul 2025

Viewed by 722

Abstract

Obesity is a global epidemic with substantial health and economic impacts, making scalable weight management strategies essential. A comprehensive synthesis of eHealth interventions for weight management is needed to guide clinical practice. This umbrella review evaluated mobile and web-based interventions for weight loss [...] Read more.

Obesity is a global epidemic with substantial health and economic impacts, making scalable weight management strategies essential. A comprehensive synthesis of eHealth interventions for weight management is needed to guide clinical practice. This umbrella review evaluated mobile and web-based interventions for weight loss in adults with overweight or obesity, compared to conventional or non-intervention controls. Systematic reviews were identified across five electronic databases from inception to February 2025. Two reviewers independently selected studies and assessed methodological quality using AMSTAR 2. Pooled estimates were calculated using random-effects models. Eleven systematic reviews (261 primary studies, 62,407 participants) were included. Mobile app interventions yielded a significant reduction in body weight (MD = −1.32 kg; I² = 82%), as did long-term eHealth interventions (MD = −1.13 kg; I² = 76%). Most meta-analyses showed high heterogeneity. Web-based interventions showed no significant effect. In conclusion, mobile apps and long-term eHealth interventions resulted in modest but statistically significant reductions in body weight, body mass index, and waist circumference. The evidence for web-based approaches remains inconclusive. Further research should focus on low-resource settings, primary care, and the integration of emerging technologies such as artificial intelligence. (PROSPERO CRD42025644218). Full article

(This article belongs to the Section Global Health)

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13 pages, 369 KiB

Open AccessPerspective

Early Warning Signs for Monitoring Airborne Respiratory Virus Transmission

by Qingyang Liu

Int. J. Environ. Res. Public Health 2025, 22(7), 1151; https://doi.org/10.3390/ijerph22071151 - 20 Jul 2025

Viewed by 570

Abstract

Airborne respiratory viruses (e.g., influenza, respiratory syncytial virus (RSV), and SARS-CoV-2) continue to pose a serious threat to global public health due to their ability to spread through multiple transmission pathways. Among these, aerosol transmission stands out as a key route, particularly in [...] Read more.

Airborne respiratory viruses (e.g., influenza, respiratory syncytial virus (RSV), and SARS-CoV-2) continue to pose a serious threat to global public health due to their ability to spread through multiple transmission pathways. Among these, aerosol transmission stands out as a key route, particularly in enclosed environments. However, current monitoring systems have major limitations in sensitivity, standardization, and high time resolution. This study provides a summary of the latest information on the monitoring technologies for respiratory virus aerosols. It discusses the technical and ethical challenges in real-world applications. In addition, this study proposes practical solutions and future development pathways. The aim of this study is to provide theoretical support for building a dynamic, precise, and effective early warning system for monitoring variants of airborne respiratory viruses Full article

(This article belongs to the Section Environmental Health)

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27 pages, 1004 KiB

Open AccessArticle

A Conceptual Model for Strengthening Family Capabilities Through a Process of Care

by James Reid, Chanté Johannes, Shenaaz Wareley, Collen M. Ngadhi, Avukonke Nginase and Nicolette V. Roman

Int. J. Environ. Res. Public Health 2025, 22(7), 1150; https://doi.org/10.3390/ijerph22071150 - 20 Jul 2025

Viewed by 506

Abstract

Family capabilities shape the well-being of individuals and families, particularly in diverse sociocultural contexts. However, existing frameworks often fail to capture the complexities of family dynamics, particularly in South Africa. This limitation is addressed in this study by developing a new conceptual model, [...] Read more.

Family capabilities shape the well-being of individuals and families, particularly in diverse sociocultural contexts. However, existing frameworks often fail to capture the complexities of family dynamics, particularly in South Africa. This limitation is addressed in this study by developing a new conceptual model, through an ethic of care lens, to understand family. A Human-Centered Design strategy is employed, utilizing workshops to gather and deductively interpret data. A sample of 53 participants is recruited from two communities in South Africa. The Listening Guide approach is used to analyze the data, alongside thematic analysis, to identify overarching themes. The findings reveal tangible needs (material and physical requirements), as well as intangible needs (emotional and psychological support). The relation between these needs and harms highlights how care is shaped in families. While families endeavor to meet intangible needs, many fail to communicate these intangible needs, which also leads to harm. This is exacerbated when the primary caregiver within the family, the ‘glue’, has needs for care that are not met. In addition, the findings reveal the interrelatedness of care in family dynamics among family members, and help to explore the boundaries, capacities, and capabilities of what families do and how they care. Full article

(This article belongs to the Special Issue The Impact of Family Capabilities on the Wellbeing and Mental Health of Family Members)

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17 pages, 1038 KiB

Open AccessArticle

Pet Flea and Tick Control Exposure During Pregnancy and Early Life Associated with Decreased Cognitive and Adaptive Behaviors in Children with Developmental Delay and Autism Spectrum Disorder

by Amanda J. Goodrich, Daniel J. Tancredi, Yunin J. Ludeña, Ekaterina Roudneva, Rebecca J. Schmidt, Irva Hertz-Picciotto and Deborah H. Bennett

Int. J. Environ. Res. Public Health 2025, 22(7), 1149; https://doi.org/10.3390/ijerph22071149 - 19 Jul 2025

Viewed by 658

Abstract

Approximately 18% of U.S. children experience cognitive and behavioral challenges, with both genetic and environmental contributors. We examined if household insecticides, particularly those used in and around the home and on pets, are associated with neurodevelopmental changes. Data were from children aged 24–60 [...] Read more.

Approximately 18% of U.S. children experience cognitive and behavioral challenges, with both genetic and environmental contributors. We examined if household insecticides, particularly those used in and around the home and on pets, are associated with neurodevelopmental changes. Data were from children aged 24–60 months in the CHARGE study with the following classifications: autism spectrum disorder (ASD, n = 810), developmental delay (DD, n = 192), and typical development (TD, n = 531). Exposure to indoor, outdoor, and pet insecticides was reported for the period from three months pre-conception to the second birthday. Cognitive and adaptive functioning were assessed using the Mullen Scales of Early Learning and Vineland Adaptive Behavior Scales. Linear regression was used to evaluate associations by diagnostic group, adjusting for confounders. Flea/tick soaps, shampoos, and powders used during year two were significantly associated with lower cognitive and adaptive scores in children with ASD after FDR correction. Flea/tick skin treatments in early pregnancy were associated with reduced scores in the DD group, though not significant after correction, especially when used with high frequency. No associations were observed in TD children. These findings underscore the need to examine early-life exposure to non-agricultural insecticides as modifiable risk factors for neurodevelopment. Full article

(This article belongs to the Section Environmental Health)

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12 pages, 1120 KiB

Open AccessArticle

A Temporal Comparison of 50 Years of Australian Scuba Diving Fatalities

by John M. Lippmann

Int. J. Environ. Res. Public Health 2025, 22(7), 1148; https://doi.org/10.3390/ijerph22071148 - 19 Jul 2025

Viewed by 342

Abstract

Australian scuba fatalities over 50 years were examined to determine temporal changes over two consecutive periods, 1972–1999 and 2000–2021. The Australasian Diving Safety Foundation database and National Coronial Information System were searched to identify scuba deaths from 1972 to 2021. Historical data, police [...] Read more.

Australian scuba fatalities over 50 years were examined to determine temporal changes over two consecutive periods, 1972–1999 and 2000–2021. The Australasian Diving Safety Foundation database and National Coronial Information System were searched to identify scuba deaths from 1972 to 2021. Historical data, police and witness reports, and autopsies were recorded and comparisons made between the two periods. Of 430 total deaths, 236 occurred during 1972–1999 and 194 during 2000–2021, with average annual fatalities of 8.4 and 8.8, respectively. The proportion of males reduced (83% to 76%) and median ages rose (33 to 47 years) with a large rise in the percentage of casualties among people aged 45 years or older (24% to 57%). There were increases in certified divers (64% to 81%) and in the proportion of divers who were with a buddy at the time of their incident (17% to 27%), as well as a decrease in out-of-gas incidents (30% to 25%). A reduction in primary drowning (47% to 36%) was accompanied by more than a doubling of cardiac-related disabling conditions (12% to 26%). The substantial increase in casualties’ ages and of the proportions of casualties aged 45 or more and of females between the periods indicate the inclusion of a broader cohort of participants and ageing of longtime divers. The reduction in primary drowning was likely due to increased training and improvements in equipment, particularly BCDs and pressure gauges. The rise in cardiac-related deaths was due to an older and more obese cohort. Improved health education and surveillance and improved dive planning are essential to reduce such deaths. Full article

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16 pages, 315 KiB

Open AccessArticle

Development and Validation of the Intimate Partner Violence Workplace Disruptions Assessment (IPV-WDA)

by Kathryn Showalter, Laneshia Conner, Rebecca Bosetti, William Burrows and Rujeko Machinga-Asaolu

Int. J. Environ. Res. Public Health 2025, 22(7), 1147; https://doi.org/10.3390/ijerph22071147 - 19 Jul 2025

Viewed by 262

Abstract

A vast majority of survivors of intimate partner violence (IPV) experience economic abuse, including but not limited to, employment sabotage. The purpose of this study is to further understand IPV by testing a technology-inclusive abuser-initiated workplace disruption measurement in an exploratory factor analysis [...] Read more.

A vast majority of survivors of intimate partner violence (IPV) experience economic abuse, including but not limited to, employment sabotage. The purpose of this study is to further understand IPV by testing a technology-inclusive abuser-initiated workplace disruption measurement in an exploratory factor analysis (EFA) so that future researchers can better examine and address economic abuse. Using a sample of survivors (N = 312) employed in the nursing profession in the United States, who may be uniquely impacted by technology, we used complete data to examine experiences of abuser-initiated workplace disruptions, including those that utilized cellphones (e.g., excessive texting, harassment of coworkers, preventing educational advancement). The results revealed a two-factor structure: one containing a variety of direct and indirect workplace disruptions relevant to the nursing profession (73% of variance) and a second containing only cell-phone related harassment (9% of variance). Implications for healthcare employers seeking to protect employees from IPV, as well as policymakers, are included. Full article

(This article belongs to the Special Issue Models and Approaches to Workplace Health Promotion and Well-Being with Diverse Population Groups)

12 pages, 910 KiB

Open AccessArticle

Sexual Harassment of Cisgender Women University Students: How the Gender Composition of Colleges Relates to Differential Prevalence

by Natalie Q. Poole, Christopher J. Cannon, Amy L. Gabriel, Emma J. Briles and Matt J. Gray

Int. J. Environ. Res. Public Health 2025, 22(7), 1146; https://doi.org/10.3390/ijerph22071146 - 19 Jul 2025

Viewed by 326

Abstract

Gender harassment is the most common variant of sexual harassment and is often seen in male-dominated workplaces. Importantly, persistent gender harassment produces pronounced impairment in psychological and occupational domains. The current study aimed to examine the degree to which male dominated academic degree [...] Read more.

Gender harassment is the most common variant of sexual harassment and is often seen in male-dominated workplaces. Importantly, persistent gender harassment produces pronounced impairment in psychological and occupational domains. The current study aimed to examine the degree to which male dominated academic degree programs are associated with higher rates of sexual harassment compared to female dominated programs. Four academic fields were chosen for their gender disparity—business, engineering, health sciences, and education. Consistent with hypotheses, cisgender women students in the college of engineering were most likely to experience gender harassment by peers and faculty. Implications and future directions are discussed. Full article

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17 pages, 579 KiB

Open AccessArticle

The Global COVID-19 Pandemic Experience: Innovation Through Environmental Assessment and Seropositivity Surveillance

by Robert M. Park

Int. J. Environ. Res. Public Health 2025, 22(7), 1145; https://doi.org/10.3390/ijerph22071145 - 18 Jul 2025

Viewed by 364

Abstract

Objectives: To confirm a conjecture from year 2020 of the SARS-CoV-2 (COVID-19) pandemic suggesting policy alternatives to substantially reduce mortality burden. Methods: Data from a global COVID-19 database comparing different countries on cumulative mortality and vaccination were analyzed in conjunction with surveys of [...] Read more.

Objectives: To confirm a conjecture from year 2020 of the SARS-CoV-2 (COVID-19) pandemic suggesting policy alternatives to substantially reduce mortality burden. Methods: Data from a global COVID-19 database comparing different countries on cumulative mortality and vaccination were analyzed in conjunction with surveys of seropositivity. Predictions of final mortality burden under an alternate policy scenario for Japan were calculated and the COVID-19 outcomes for China were assessed. Results: By 2025, Western countries (US, UK, Brazil and Italy) had cumulative mortality rates in the range of 3339–3548 deaths per million, about 6-fold higher than East Asian and New Zealand ‘zero-COVID’ countries. Moderate virus suppression in Japan produced the lowest cumulative mortality of the countries analyzed; if earlier policies had been maintained, the predicted cumulative mortality rate by 2025 would be one-tenth that of the US, UK, Brazil and Italy and one-half to one-third that of other zero-COVID countries. For China, transitioning from a zero-COVID policy in 2022–2023, the estimated 2025 cumulative mortality was 1607/million, half that of Western countries. Conclusions: To minimize COVID-19 mortality would require: (1) Innovation on systematic sampling of ambient airborne virus exposure to sustain low but non-zero virus levels across entire populations, and (2) seropositivity assessment (instead of mass PCR testing for new cases) for calibrating exposure management, and tracking and protecting high-risk populations. Full article

(This article belongs to the Section Environmental Health)

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26 pages, 1514 KiB

Open AccessArticle

Adapting a Participatory Group Programme for Caregivers of Children with Complex Neurodisability from Low-, Middle-Income Countries to a High-Income Setting: Moving from “Baby Ubuntu” to “Encompass”

by Kirsten Prest, Kirsten Barnicot, Catherine Hurt, Frances Badenhorst, Aleksandra Borek, Melanie Whyte, Phillip Harniess, Alea Jannath, Rachel Lassman, Christopher Morris, Rachel Osbourne, Tracey Smythe, Cally J. Tann, Keely Thomas, Emma Wilson, Angela Harden and Michelle Heys

Int. J. Environ. Res. Public Health 2025, 22(7), 1144; https://doi.org/10.3390/ijerph22071144 - 18 Jul 2025

Viewed by 755

Abstract

The “Baby Ubuntu” programme is a well-established, low-cost, community-based intervention to support caregivers of children with complex neurodisability, like cerebral palsy, in low- and middle-income country (LMIC) contexts. This process-focused paper describes our utilisation of the ADAPT guidance to adapt “Baby Ubuntu” for [...] Read more.

The “Baby Ubuntu” programme is a well-established, low-cost, community-based intervention to support caregivers of children with complex neurodisability, like cerebral palsy, in low- and middle-income country (LMIC) contexts. This process-focused paper describes our utilisation of the ADAPT guidance to adapt “Baby Ubuntu” for use in ethnically and linguistically diverse, and economically deprived urban boroughs in the United Kingdom (UK). The process was guided by an adaptation team, including parents with lived experience, who explored the rationale for the intervention from local perspectives and its fit for this UK community. Through qualitative interviews and co-creation strategies, the perspectives of caregivers and healthcare professionals substantially contributed to the “Encompass” programme theory, drafting the content, and planning the delivery. Ten modules were co-produced with various topics, based on the “Baby Ubuntu” modules, to be co-facilitated by a parent with lived experience and a healthcare professional. The programme is participatory, allowing caregivers to share information, problem solve, and form supportive peer networks. The “Encompass” programme is an example of a “decolonised healthcare innovation”, as it aims to transfer knowledge and solutions developed in low- and middle-income countries to a high-income context like the UK. Piloting of the new programme is underway. Full article

(This article belongs to the Special Issue Health Intervention for Young Children with or at Risk for Disabilities)

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12 pages, 641 KiB

Open AccessArticle

Do Patients with Complaints Attributed to Chemicals in the Environment Trust in Biomonitoring as a Valid Diagnostic Tool? A Prospective, Observational Study from a German University Outpatient Clinic

by Claudia Schultz, Catharina Sadaghiani, Stefan Schmidt, Roman Huber and Vanessa M. Eichel

Int. J. Environ. Res. Public Health 2025, 22(7), 1143; https://doi.org/10.3390/ijerph22071143 - 18 Jul 2025

Viewed by 326

Abstract

Biomonitoring often yields normal results in patients who report environmental sensitivities, such as in multiple chemical sensitivity. This study examined whether biomonitoring results influence disease attribution and perception. Patients over 18 presenting for the first time to the University Environmental Medicine Outpatient Clinic [...] Read more.

Biomonitoring often yields normal results in patients who report environmental sensitivities, such as in multiple chemical sensitivity. This study examined whether biomonitoring results influence disease attribution and perception. Patients over 18 presenting for the first time to the University Environmental Medicine Outpatient Clinic in Freiburg with suspected complaints linked to heavy metals, wood preservatives, pesticides, solvents, or mold spores were included. Illness perceptions were assessed before and after biomonitoring using the Illness Perception Questionnaire (IPQ-R). Of 358 patients, 51 met inclusion criteria; 3 showed relevant findings, and 15 did not attribute their symptoms to environmental causes at baseline. The remaining 33 patients were analyzed. After receiving a normal biomonitoring result, only seven patients (21%) altered their illness attribution. These individuals also reported milder perceived consequences, less personal control over the illness, and showed lower levels of somatization and compulsiveness than those who maintained their original attribution. Most patients remained convinced of an environmental cause despite unremarkable findings. This suggests that a substantial subset of patients is strongly attached to an environmental explanation for their symptoms, with stable attribution linked to higher psychological symptom burden and a belief in personal control over the illness. Full article

(This article belongs to the Section Environmental Health)

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16 pages, 500 KiB

Open AccessArticle

Periodontal Health Knowledge of Schoolteachers: A Cross-Sectional Study

by Khansa Taha Ababneh, Fathima Fazrina Farook, Lama Alosail, Maram Ali Alqahtani, Norah Gharawi and Afrah Alossimi

Int. J. Environ. Res. Public Health 2025, 22(7), 1142; https://doi.org/10.3390/ijerph22071142 - 18 Jul 2025

Viewed by 325

Abstract

Background/Objectives: Schoolteachers play a central role in shaping their students’ beliefs and attitudes towards oral health. Our aim was to investigate the oral and periodontal health knowledge of schoolteachers in Riyadh and factors affecting this knowledge. Methods: Government schoolteachers from representative [...] Read more.

Background/Objectives: Schoolteachers play a central role in shaping their students’ beliefs and attitudes towards oral health. Our aim was to investigate the oral and periodontal health knowledge of schoolteachers in Riyadh and factors affecting this knowledge. Methods: Government schoolteachers from representative areas of Riyadh (n = 895) responded to a structured questionnaire. Descriptive statistics, t-tests, one-way analysis of variance, and multiple linear regression (p ≤ 0.05). Results: Teachers demonstrated good basic oral/periodontal health knowledge (mean score = 60.21 ± 10.68). Most knew that toothbrushing is necessary to preserve dental (78.66%) and periodontal (57.88%) health; that gingival bleeding (74.41%), swelling (64.25%), and abscess formation (52.96%) are signs of periodontal disease; about 63% identified dental biofilm as an etiologic factor, and 58% knew that periodontitis may cause gingival recession and influence systemic health (74.07%). However, only 38% knew that dental flossing is necessary to preserve periodontal health, and 66.03% believed that gingival health can be restored with a special toothpaste. Teachers who were female, older in age, worked in north Riyadh, and taught the intermediate stage demonstrated statistically significantly better knowledge than the other categories. Conclusions: The studied sample of schoolteachers possesses acceptable basic oral health knowledge but has inadequate knowledge of periodontal health. Factors influencing teachers’ knowledge were age, gender, region of work, and teaching stage. Full article

(This article belongs to the Section Health Care Sciences)

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25 pages, 324 KiB

Open AccessArticle

Psychological Flexibility and Inflexibility of University Students: An In-Depth Qualitative Study

by Wendy Cervantes-Perea, Jone Martínez-Bacaicoa and Manuel Gámez-Guadix

Int. J. Environ. Res. Public Health 2025, 22(7), 1141; https://doi.org/10.3390/ijerph22071141 - 18 Jul 2025

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Abstract

In the Hexaflex model of Acceptance and Commitment Therapy (ACT), psychological flexibility refers to the ability to openly embrace difficult thoughts and emotions while acting in alignment with personal values. In contrast, psychological inflexibility involves rigid avoidance and control strategies that hinder adaptive [...] Read more.

In the Hexaflex model of Acceptance and Commitment Therapy (ACT), psychological flexibility refers to the ability to openly embrace difficult thoughts and emotions while acting in alignment with personal values. In contrast, psychological inflexibility involves rigid avoidance and control strategies that hinder adaptive functioning. Although previously studied, more culturally relevant evidence is needed to inform interventions that promote well-being and mental health among Latin American students. This study explored manifestations of psychological flexibility and inflexibility in 15 undergraduate students from the University of Magdalena in Colombia (mean age = 20.13 years; 53.33% female) through semi-structured, face-to-face interviews (~45 min each). Data were analyzed using Interpretative Phenomenological Analysis (IPA), focusing on how participants described and made sense of their experiences. A total of 25 emergent themes were identified and grouped into 12 subordinate themes, mapped onto the 6 core ACT processes. The participants reported efforts to control or avoid distressing internal experiences, often resulting in difficulty acting in accordance with their values. The findings highlight a recurring ambivalence between avoidance and acceptance, and barriers to committed action, underscoring the dynamic interplay between flexibility and inflexibility. These results support the relevance of ACT-based interventions, such as structured group sessions that foster acceptance, mindfulness, and values-based behavior. Integrating this training into counseling and academic support services could enhance students’ well-being and performance. Future research should examine these dynamics longitudinally and across diverse contexts. Full article

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

14 pages, 1435 KiB

Open AccessArticle

Association Between Diet, Sociodemographic Factors, and Body Composition in Students of a Public University in Ecuador

by Angélica María Solís Manzano, María Victoria Padilla Samaniego, Verónica Patricia Sandoval Tamayo, Edgar Rolando Morales Caluña, Katherine Denisse Suarez Gonzalez, Tannia Valeria Carpio-Arias and Patricio Ramos-Padilla

Int. J. Environ. Res. Public Health 2025, 22(7), 1140; https://doi.org/10.3390/ijerph22071140 - 18 Jul 2025

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Abstract

Body composition is associated with multiple factors. The main objective of this study is to determine the association between diet and sociodemographic factors on the body structure and composition of university students at a public university in Ecuador. This cross-sectional study allowed for [...] Read more.

Body composition is associated with multiple factors. The main objective of this study is to determine the association between diet and sociodemographic factors on the body structure and composition of university students at a public university in Ecuador. This cross-sectional study allowed for the collection of detailed body composition and dietary data from 204 students (41.7% men and 58.3% women, with an average age of 23.3 ± 4.4 years). The study was conducted using validated questionnaires and bioimpedance techniques. Statistical analysis included ANOVA tests, complemented by a PCA-Biplot, to examine the relationships between study variables. Statistical analysis revealed that men’s birthplace had a significant impact on several body measurements, such as hip circumference and weight, but no significant differences were observed in body structure and composition based on nutrient intake. Furthermore, larger upper-arm circumference in women was correlated with higher fat intake. The results of the multivariate analysis indicated a differential influence of dietary components on body composition. The study highlights the need for nutritional intervention strategies and educational programs that consider the diversity of students’ backgrounds to promote healthy habits and mitigate the negative effects of eating habits and irregular physical activity patterns on their health and body composition. Full article

(This article belongs to the Section Health Care Sciences)

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21 pages, 2570 KiB

Open AccessArticle

Exploration of Providers’ Perceptions and Attitudes Toward Phage Therapy and Intentions for Future Adoption as an Alternative to Traditional Antibiotics in the US—A Cross-Sectional Study

by Subi Gandhi, Dustin Edwards, Keith Emmert and Bonnie Large

Int. J. Environ. Res. Public Health 2025, 22(7), 1139; https://doi.org/10.3390/ijerph22071139 - 18 Jul 2025

Viewed by 688

Abstract

Antibiotic resistance presents a global threat, making the swift development of alternative treatments essential. Phage therapy, which employs bacterial viruses that specifically target bacteria, shows promise. Although this method has been utilized for over a century, primarily in Eastern Europe, its use in [...] Read more.

Antibiotic resistance presents a global threat, making the swift development of alternative treatments essential. Phage therapy, which employs bacterial viruses that specifically target bacteria, shows promise. Although this method has been utilized for over a century, primarily in Eastern Europe, its use in the US remains limited. This study aimed to assess the awareness and willingness of US healthcare providers to adopt phage therapy in response to the growing issue of antibiotic resistance. A survey of 196 healthcare providers, primarily MDs and DOs, found that while 99% were aware of antimicrobial resistance, only 49% were knowledgeable about phage therapy as a treatment for resistant bacterial infections. Nonetheless, 56% were open to considering phage therapy, and this willingness was associated with prior knowledge, concerns about antibiotic resistance, previous training, and confidence in recommending it (p < 0.05). Our study of U.S. healthcare providers revealed key findings about their views on phage therapy as a potential alternative for treating bacterial infections. Credible information is essential to promoting phage therapy use among U.S. providers via educational initiatives, clinical guidance, and research dissemination to promote phage therapy use among U.S. providers. Evidence-based education and clinical guidance help providers make sound decisions on the appropriate and safe use of phage therapy. Full article

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12 pages, 530 KiB

Open AccessArticle

Diminished Social and Leisure Engagement in Community Dwelling-Older Adults with Apathy

by Katherine J. Valles, Emmeline Ayers, Joe Verghese and Mirnova E. Ceïde

Int. J. Environ. Res. Public Health 2025, 22(7), 1138; https://doi.org/10.3390/ijerph22071138 - 18 Jul 2025

Viewed by 362

Abstract

Background: Apathy predicts functional and cognitive decline in community-dwelling older adults. However, the behavioral correlates of apathy, which could promote cognitive decline have not been described. Our objective was to investigate the associations of apathy with leisure and social engagement. Methods: N = [...] Read more.

Background: Apathy predicts functional and cognitive decline in community-dwelling older adults. However, the behavioral correlates of apathy, which could promote cognitive decline have not been described. Our objective was to investigate the associations of apathy with leisure and social engagement. Methods: N = 538 older adults enrolled in the Central Control of Mobility in Aging study. We used the GDS3A, a 3-item subscale of the Geriatric Depression Scale, to define apathy and the frequency of participation in cognitive, physical, and social leisure activities. Linear regression models were conducted to assess the association between apathy and its behavioral correlates: social engagement and leisure activity participation. Covariates included age, gender, education level, multimorbidity, and dysphoria. Results: Apathy was present in 29.7% of participants and was significantly associated with less frequent participation in physical activity days per week (−1.688. p = 0.003) but not cognitive (−1.094, p = 0.252) or social (−0.654, p = 0.103) leisure activities. Apathy was also associated with a decreased social behavior composite score (−0.055, p < 0.001), Social Network Index (−0.478, p = 0.003), and Medical Outcomes Study Social Support scores (−0.26, p = 0.001). Conclusions: Our findings suggest that apathy presents with reduced participation in physical leisure activities and reduced social engagement, which may provide a way for clinicians and caregivers to identify apathy in the future. Full article

(This article belongs to the Special Issue The Role of Neighborhood Social Networks in Health Behaviors and Healthy Aging)

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14 pages, 359 KiB

Open AccessArticle

Association Between Physical Activity, Sedentary Time, and Quality of Life in Patients with Chagas Disease During COVID-19 Pandemic in Brazil: A Cross-Sectional Study

by Isis Gabrielli Gomes Xavier, Patrícia Mello Andrade, Rodrigo de Lima Vitor, Tayná Cruz Barros, Whesley Tanor Silva, Luciana Fernandes Portela, Marcelo Teixeira de Holanda, Luiz Henrique Conde Sangenis, Gilberto Marcelo Sperandio da Silva, Flavia Mazzoli-Rocha, Fernanda de Souza Nogueira Sardinha Mendes, Andréa Rodrigues da Costa, Marcelo Carvalho Vieira, Daniela Palheiro Mendes de Almeida, Cláudia Maria Valete, Alejandro Marcel Hasslocher-Moreno, Henrique Silveira Costa, Vitor Barreto Paravidino, Tatiana Rehder Gonçalves, Roberto Magalhães Saraiva and Mauro Felippe Felix Mediano Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2025, 22(7), 1137; https://doi.org/10.3390/ijerph22071137 - 18 Jul 2025

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Abstract

Background: COVID-19 led to social isolation, potentially reducing physical activity (PA), increasing sedentary time, and lowering quality of life (QoL). This study investigated the association between these factors in patients with Chagas disease (ChD) during the pandemic. Methods: This cross-sectional study included 187 [...] Read more.

Background: COVID-19 led to social isolation, potentially reducing physical activity (PA), increasing sedentary time, and lowering quality of life (QoL). This study investigated the association between these factors in patients with Chagas disease (ChD) during the pandemic. Methods: This cross-sectional study included 187 patients with ChD. PA and sedentary time were assessed by the IPAQ-short and QoL by the WHOQOL-Bref. The relationship between PA levels and sedentary time with QoL were assessed using unadjusted and adjusted generalized linear models. Results: The highest tertile of total PA was positively associated with the psychological (Exp β = 1.11; 95% CI: 1.02–1.22) and environmental (Exp β = 1.12; 95% CI: 1.01–1.23) QoL domains. The intermediate (Exp β = 1.12; 95% CI: 1.01–1.25) and highest (Exp β = 1.14; 95% CI: 1.02–1.27) tertiles of moderate-to-vigorous PA were positively associated with the physical domain. Similarly, both the intermediate (Exp β = 1.11; 95% CI: 1.01–1.22) and highest (Exp β = 1.12; 95% CI: 1.01–1.21) tertiles of moderate-to-vigorous PA were positively associated with the psychological domain. The highest tertile of sedentary time was associated with a decrease in the physical domain (Exp β = 0.88; 95% CI: 0.79–0.98). Conclusions: Higher levels of total and moderate-to-vigorous PA were associated with better QoL, while greater sedentary time was associated with poorer QoL. Full article

(This article belongs to the Special Issue One Size Does Not Fit All: New Strategies to Improve Overall Health and Physical Activity Behavior in Vulnerable Populations)

14 pages, 662 KiB

Open AccessArticle

Changes in Body Mass Index Among Korean Adolescents Before and After COVID-19: A Comparative Study of Annual and Regional Trends

by Seong Jun Ha

Int. J. Environ. Res. Public Health 2025, 22(7), 1136; https://doi.org/10.3390/ijerph22071136 - 18 Jul 2025

Viewed by 313

Abstract

This study aimed to longitudinally analyze changes in body mass index (BMI) among Korean middle and high school students before and after the COVID-19 pandemic. Data were obtained from the national-level Physical Activity Promotion System (PAPS), collected between 2018 and 2024. A total [...] Read more.

This study aimed to longitudinally analyze changes in body mass index (BMI) among Korean middle and high school students before and after the COVID-19 pandemic. Data were obtained from the national-level Physical Activity Promotion System (PAPS), collected between 2018 and 2024. A total of 171,705 adolescents aged 13 to 18 were included in the analysis (86,542 males and 85,163 females), with a mean age of 15.2 years (SD = 1.68). Time-series analysis and two-way analysis of variance (ANOVA) were conducted to examine differences in BMI by year, sex, region (capital vs. non-capital), and urban–rural classification. The results indicated a significant increase in BMI during the pandemic period (2020–2022), peaking in 2022, followed by a gradual decline thereafter. Notably, male students and those living in rural or non-capital areas consistently exhibited higher BMI levels, suggesting structural disparities in access to physical activity opportunities and health resources. This study employed the Socio-Ecological Model and the Health Equity Framework as theoretical lenses to interpret BMI changes not merely as individual behavioral outcomes but as consequences shaped by environmental and policy-level determinants. The findings underscore the need for equity-based interventions in physical education and health policy to mitigate adolescent health inequalities during future public health crises. Full article

(This article belongs to the Special Issue Advances in Primary Health Care and Community Health)

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11 pages, 305 KiB

Open AccessArticle

Teachers’ Perspectives on the Impact of an Outdoor-Based Self-Care Training Program on Student Mental Health

by Katie A. Bucher, Connor M. Moriarty, Adam Lazarchak and Russell K. McIntire

Int. J. Environ. Res. Public Health 2025, 22(7), 1135; https://doi.org/10.3390/ijerph22071135 - 18 Jul 2025

Viewed by 589

Abstract

As mental health disorders in the U.S. increase at an alarming rate, schools are looking for prevention and mitigation interventions for their students. This study reports teachers’ perspectives on the effectiveness of a school program situated at the intersection of self-care and nature-based [...] Read more.

As mental health disorders in the U.S. increase at an alarming rate, schools are looking for prevention and mitigation interventions for their students. This study reports teachers’ perspectives on the effectiveness of a school program situated at the intersection of self-care and nature-based interventions at a vocational technical high school. Eight classes received between one and four “Intro to Well-Being” sessions, designed to take students outside and develop self-awareness, sense of connection, and reduce stress. Upon the conclusion of the program, classroom teachers were interviewed to identify the perceptions of the sessions and their impact on student and classroom outcomes. Teachers described the sessions as beneficial to students’ expression of emotions, mindfulness skills, personal/social connections, and classroom atmosphere. Teachers also reflected on challenges and provided recommendations for future implementation. Outdoor-based self-care programs, administered at schools, may be a promising program model to support the social and emotional health of students. Full article

(This article belongs to the Special Issue Mental Health and Wellbeing of Children and Adolescents)

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2 pages, 184 KiB

Open AccessCorrection

Correction: Martin et al. The Health Literacy of First Year Physiotherapy and Speech Pathology Students and Their Perceived Future Roles in Supporting Their Clients’ Health Literacy. Int. J. Environ. Res. Public Health 2023, 20, 6013

by Romany Martin, Jade Cartwright and Marie-Louise Bird

Int. J. Environ. Res. Public Health 2025, 22(7), 1134; https://doi.org/10.3390/ijerph22071134 - 18 Jul 2025

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Abstract

The authors have requested that the following changes be made to the original publication [...] Full article

24 pages, 816 KiB

Open AccessReview

Implementation of Behavior Change Theories and Techniques for Physical Activity Just-in-Time Adaptive Interventions: A Scoping Review

by Parker Cotie, Amanda Willms and Sam Liu

Int. J. Environ. Res. Public Health 2025, 22(7), 1133; https://doi.org/10.3390/ijerph22071133 - 17 Jul 2025

Viewed by 513

Abstract

(1) Background: Physical activity (PA) is a key modifiable risk factor for chronic diseases, yet many adults do not meet PA guidelines. Just-in-time adaptive interventions (JITAIs), a type of mobile health (mHealth) intervention, offer tailored support based on an individual’s context to promote [...] Read more.

(1) Background: Physical activity (PA) is a key modifiable risk factor for chronic diseases, yet many adults do not meet PA guidelines. Just-in-time adaptive interventions (JITAIs), a type of mobile health (mHealth) intervention, offer tailored support based on an individual’s context to promote PA. Integrating behavior change techniques (BCTs) and theories is critical to the design of effective mHealth interventions. Understanding which BCTs and theories work best can inform future JITAI development. (2) Objective: The objective of this study is to examine how behavior change theories and BCTs are implemented in mHealth PA JITAIs and assess their relationship with PA-related outcomes. (3) Methods: This scoping review followed the PRISMA-ScR guidelines. A total of 29 studies were included. (4) Results: The most commonly used BCTs include prompts/cues (n = 29), goal-setting (behavior) (n = 15), and feedback on behavior (n = 14), while self-determination theory (n = 4) and social cognitive theory (n = 4) are the most commonly used theories. However, there is insufficient evidence as to which theories and BCTs are most effective in eliciting effective PA behavior change. (5) Conclusions: Clearer reporting and integration of BCTs and behavior change theories, along with optimized user interfaces, are needed to improve the intervention quality, replicability, and long-term effectiveness of PA JITAIs. Full article

(This article belongs to the Special Issue Challenges and Opportunities for Digital Health Interventions to Improve Health Services Quality)

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24 pages, 3050 KiB

Open AccessArticle

Assessing Occupational Safety Risks and Challenges Among Informal Welders in Pretoria West, South Africa

by Marvin Mashimbyi, Kgotatso Jeanet Seisa, Muelelwa Ramathuthu and Maasago Mercy Sepadi

Int. J. Environ. Res. Public Health 2025, 22(7), 1132; https://doi.org/10.3390/ijerph22071132 - 17 Jul 2025

Viewed by 496

Abstract

Background: Informal welders in Pretoria West face growing occupational safety risks due to hazardous working environments and limited regulatory oversight. Despite the high-risk nature of their work, many remain unaware of relevant safety legislation and inconsistently use personal protective equipment (PPE). This study [...] Read more.

Background: Informal welders in Pretoria West face growing occupational safety risks due to hazardous working environments and limited regulatory oversight. Despite the high-risk nature of their work, many remain unaware of relevant safety legislation and inconsistently use personal protective equipment (PPE). This study aimed to investigate the occupational safety risks, challenges, and levels of compliance with safety practices among informal welders in Pretoria West, South Africa. Methods: A cross-sectional mixed-methods approach was employed, incorporating both qualitative and quantitative designs. Data were collected from 40 male welders (aged 20–55 years) using structured questionnaires, observational checklists, and semi-structured interviews. Descriptive statistics were generated using Microsoft Excel, while thematic content analysis was applied to the qualitative data. Results: Eighty-five percent (85%) of welders reported using gas welding, and more than half had received training in welding and PPE use; however, 47.5% had no formal training. A high prevalence of work-related injuries was reported, including burns, cuts, and eye damage. Common safety concerns identified were burns (42.5%), electric shocks (35%), and malfunctioning equipment. Observational data revealed inconsistent PPE use, particularly with flame-resistant overalls and eye protection. Qualitative insights highlighted challenges such as demanding client expectations, hazardous physical environments, and inadequate equipment maintenance. Many sites lacked compliance with occupational safety standards. Conclusion: The study reveals critical gaps in safety knowledge, training, and PPE compliance among informal welders. These deficiencies significantly elevate the risk of occupational injuries. Strengthening occupational health and safety regulations, improving access to PPE, and delivering targeted training interventions are essential to safeguard the well-being of welders and those in their surrounding communities. Full article

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21 pages, 691 KiB

Open AccessSystematic Review

Breast Cancer Survivors’ Perception on Health Promotion and Healthy Lifestyle: A Systematic Review and Qualitative Meta-Synthesis

by Luca Guardamagna, Orejeta Diamanti, Giovanna Artioli, Lorenzo Casole, Matteo Bernardi, Francesca Bonadies, Enrico Zennaro, Gloria Maria Modena, Tiziana Nania and Federica Dellafiore

Int. J. Environ. Res. Public Health 2025, 22(7), 1131; https://doi.org/10.3390/ijerph22071131 - 17 Jul 2025

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Abstract

Aims: To systematically review and synthesize qualitative research exploring the Breast Cancer Survivors (BCSs)’ perception of health promotion interventions and informing strategies to mitigate recurrence risk within five years post-treatment and improve clinical outcomes. Specifically, this study addresses the question: “How do women [...] Read more.

Aims: To systematically review and synthesize qualitative research exploring the Breast Cancer Survivors (BCSs)’ perception of health promotion interventions and informing strategies to mitigate recurrence risk within five years post-treatment and improve clinical outcomes. Specifically, this study addresses the question: “How do women diagnosed with breast cancer perceive health promotion interventions for recurrence prevention?” Design: A systematic review and qualitative meta-synthesis were performed. Data Sources: A systematic search of scientific databases (CINAHL, MEDLINE, and Scopus) was undertaken in November 2024. The reference list was cross-referenced and hand-searched to identify additional articles. Review Methods: Studies were included if they met the following criteria: they were primary qualitative studies focusing on BCSs within five years post-treatment, involving participants who had completed surgery, radiotherapy, or chemotherapy in the same time frame, as this period is critical for monitoring recurrence and implementing health promotion interventions. Only studies published in peer-reviewed journals and written in Italian, English, French, or Spanish were considered, provided that an abstract and the full text were available. Moreover, eligible studies had to be conducted in high-income or middle-income countries. Studies were excluded if they focused exclusively on advanced or metastatic breast cancer, if they involved mixed cancer populations without reporting separate data for BCSs, or if they were non-qualitative studies or gray literature. The review study protocol was registered in the PROSPERO database (CRD42024626033). Results: The literature search identified 490 records, 13 articles from databases, and 3 articles identified via other methods (web and citation searching) that met inclusion criteria. A narrative synthesis approach allowed the emerging five themes: (I) Challenges, (II) Self-motivation and empowerment, (III) The relationships as a facilitator, (IV) Barriers to change, and (V) Proactive support strategies. Conclusions: Addressing internal and external factors that influence health behaviors is essential to improve adherence, reduce recurrence risk, and enhance quality of life. Tailored interventions, social support, and healthcare engagement are crucial in this effort. Impact: Our meta-synthesis highlighted significant challenges as well as valuable resources for health promotion among BCSs, suggesting practical and tailored approaches to improving the adoption of healthy behaviors, supported by relationships and targeted support strategies. Full article

(This article belongs to the Section Global Health)

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13 pages, 1243 KiB

Open AccessArticle

A Tandem MS Platform for Simultaneous Determination of Urinary Malondialdehyde and Diphenyl Phosphate

by Gabriela Chango, Diego García-Gómez, Carmelo García Pinto, Encarnación Rodríguez-Gonzalo and José Luis Pérez Pavón

Int. J. Environ. Res. Public Health 2025, 22(7), 1130; https://doi.org/10.3390/ijerph22071130 - 17 Jul 2025

Viewed by 324

Abstract

This study presents an advanced analytical method for the simultaneous quantification of malondialdehyde (MDA), a biomarker of oxidative stress, and diphenyl phosphate (DPhP), a metabolite of the organophosphate flame retardant triphenyl phosphate (TPhP), in human urine. The method integrates hydrophilic interaction liquid chromatography [...] Read more.

This study presents an advanced analytical method for the simultaneous quantification of malondialdehyde (MDA), a biomarker of oxidative stress, and diphenyl phosphate (DPhP), a metabolite of the organophosphate flame retardant triphenyl phosphate (TPhP), in human urine. The method integrates hydrophilic interaction liquid chromatography (HILIC), a type of liquid chromatography suitable for polar compounds, for MDA separation, and an online restricted access material (RAM), a preconcentration column, for DPhP isolation, achieving high specificity and sensitivity. Validation with certified urine samples confirmed its robustness across diverse analyte concentrations and complex biological matrices. The optimized clean-up steps effectively minimized carryover, allowing for high-throughput analysis. Application to 72 urine samples revealed a significant positive correlation (ρ = 0.702, p-value = 1.9 × 10⁻⁷) between MDA and DPhP levels, supporting a potential link between oxidative stress and TPhP exposure. The subset analysis demonstrated a statistically significant moderate positive correlation in women (ρ = 0.622, p-value = 0.020), although this result should be interpreted with caution because of the limited sample size (N = 14). This method provides a powerful tool for biomonitoring oxidative stress and environmental contaminants, offering valuable insights into exposure-related health risks. Full article

(This article belongs to the Special Issue Research on Environmental Exposure, Pollution, and Epidemiology)

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12 pages, 419 KiB

Open AccessFeature PaperArticle

An Exploratory Retrospective Analysis of Racial Disparities in Fall-Related Injuries Among Black and White Breast Cancer Survivors Receiving Chemotherapy

by Asmaa Namoos, Dina Ramadan, Rashema Meekins, Vanessa Sheppard and Nicholas Thomson

Int. J. Environ. Res. Public Health 2025, 22(7), 1129; https://doi.org/10.3390/ijerph22071129 - 17 Jul 2025

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Abstract

Purpose: This exploratory retrospective analysis examined racial disparities in fall-related injuries among Black and White breast cancer survivors who received chemotherapy, focusing on the risks associated with specific chemotherapy regimens. Methods: Using real-world data from the TriNetX research platform, we analyzed a cohort [...] Read more.

Purpose: This exploratory retrospective analysis examined racial disparities in fall-related injuries among Black and White breast cancer survivors who received chemotherapy, focusing on the risks associated with specific chemotherapy regimens. Methods: Using real-world data from the TriNetX research platform, we analyzed a cohort of 3223 Stage I–III breast cancer survivors with complete data on race, chemotherapy exposure, and fall-related injuries. The final sample included only Black and White patients treated with chemotherapy between 1 January 2019 and 31 December 2023. Fall events within six months post-chemotherapy were analyzed. Logistic regression models evaluated associations between chemotherapy type and fall risk by race. Results: Black breast cancer survivors experienced a significantly higher rate of fall-related injuries (14.7%) compared to White survivors (10.0%) (p < 0.001). The risk was especially elevated among Black patients receiving Cyclophosphamide, Docetaxel, and Carboplatin. Conclusion: This study highlights racial differences in chemotherapy-associated fall risk. While the findings are observational and limited by data availability, they underscore the need for more inclusive survivorship care and further investigation using detailed clinical and contextual variables. Real-world platforms like TriNetX can help identify early signals of disparities that merit prospective study. Full article

(This article belongs to the Special Issue Breast Health and Cancer Awareness: Addressing Breast Cancer Disparities from Etiology to Survivorship)

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Int. J. Environ. Res. Public Health, Volume 22, Issue 7 (July 2025) – 189 articles

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