International Journal of Environmental Research and Public Health

11 pages, 252 KiB

Open AccessArticle

Hypertensive Disorders of Pregnancy Deaths: A Four-Year Review at a Tertiary/Quaternary Academic Hospital

by Zeenat L. Khan, Gaynor M. Balie and Lawrence Chauke

Int. J. Environ. Res. Public Health 2025, 22(7), 978; https://doi.org/10.3390/ijerph22070978 - 20 Jun 2025

Background: Hypertensive disorders of pregnancy (HDPs) are a major cause of maternal morbidity and mortality worldwide. Very little progress has been made in reducing HDP-related maternal deaths in low- and middle-income countries (LMICs), including South Africa, over the past decade. Aim: The aim [...] Read more.

Background: Hypertensive disorders of pregnancy (HDPs) are a major cause of maternal morbidity and mortality worldwide. Very little progress has been made in reducing HDP-related maternal deaths in low- and middle-income countries (LMICs), including South Africa, over the past decade. Aim: The aim of this study was to describe maternal deaths arising from HDPs at tertiary/quaternary hospital in Johannesburg, South Africa, with specific focus on maternal characteristics, management, timing of death, causes, and avoidable factors and to use the information to inform clinical practice. Methods: We conducted a retrospective review of patient clinical records covering the period 1 January 2015 to 31 December 2018. Data on maternal demographic and pregnancy characteristics, management, causes, and timing of death were extracted from the clinical records and transferred into a Microsoft Excel^® Spreadsheet and analysed using descriptive statistics. Results: During the study period, 70 maternal deaths were recorded, of which 23 (32.8%) were due to HDP-related complications. The majority of the maternal deaths, 20 (86.9%), occurred during the postpartum period, predominantly affecting Black African women, 23 (100%), with a median age of 27 years. Notably, 18 (78.2%) of the deceased had booked early and attended antenatal care (ANC). Eclampsia emerged as the most common final cause of death. Key avoidable factors included non-adherence to established protocols, particularly failure to initiate aspirin prophylaxis in at-risk women, as well as incorrect or inadequate administration of antihypertensive therapy and magnesium sulphate (MgSO₄) prophylaxis. Conclusions: HDP-related maternal deaths are largely preventable. They primarily result from poor quality of care due to a lack of adherence to evidence-based protocol. Full article

(This article belongs to the Special Issue SDG 3 in Sub-Saharan Africa: Emerging Public Health Issues)

18 pages, 832 KiB

Open AccessReview

Mental Health Outcomes Among Travestis and Transgender Women in Brazil: A Literature Review and a Call to Action for Public Health Policies

by David R. A. Coelho, Ana Luiza N. Ferreira, Willians Fernando Vieira, Alex S. Keuroghlian and Sari L. Reisner

Int. J. Environ. Res. Public Health 2025, 22(7), 977; https://doi.org/10.3390/ijerph22070977 - 20 Jun 2025

Abstract

Travestis and transgender women in Brazil face a disproportionate burden of mental health conditions, exacerbated by structural discrimination, violence, and social exclusion. This narrative review synthesizes evidence on the prevalence of depression, anxiety, suicidality, and substance use among travestis and transgender women in [...] Read more.

Travestis and transgender women in Brazil face a disproportionate burden of mental health conditions, exacerbated by structural discrimination, violence, and social exclusion. This narrative review synthesizes evidence on the prevalence of depression, anxiety, suicidality, and substance use among travestis and transgender women in Brazil, and examines intersecting social and health disparities. We searched PubMed, Embase, and PsycINFO in April 2025, identifying peer-reviewed studies in English or Portuguese reporting mental health outcomes or associated social determinants of health in this population. Thirty-one studies across twelve different cities (n = 7683) were included and grouped into two thematic domains. Reported prevalence ranged from 16–70.1% for depression, 24.8–26.5% for anxiety, and 25–47.3% for suicidality. Substance use was also highly prevalent, with studies reporting high rates of alcohol (21.5–72.7%), tobacco (56.6–61.6%), cannabis (19–68.9%), and cocaine/crack (6–59.8%) use. Discrimination, violence, economic hardship, and HIV were consistently associated with psychological distress and barriers to care. These findings underscore the urgent need to integrate mental health, gender-affirming care, and HIV services into Brazil’s Unified Health System (Sistema Único de Saúde–SUS), strengthen anti-discrimination and violence-prevention policies, and adopt inclusive public health strategies that prioritize the leadership and lived experiences of transgender, nonbinary, and gender diverse people, particularly amid rising political threats to gender-affirming care. Full article

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

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23 pages, 3173 KiB

Open AccessArticle

Emerging Contaminants in Source and Finished Drinking Waters Across Minnesota (U.S.) and Potential Health Implications

by Sarah M. Elliott, Aliesha L. Krall, Jane R. de Lambert, Maya D. Gilchrist and Stephen W. Robertson

Int. J. Environ. Res. Public Health 2025, 22(7), 976; https://doi.org/10.3390/ijerph22070976 - 20 Jun 2025

Abstract

Relatively little data exist regarding the presence of unregulated contaminants in drinking waters. We sampled source and finished drinking water from 98 community water supply systems throughout Minnesota (U.S.). Facilities were grouped into four networks based on water source and influences from anthropogenic [...] Read more.

Relatively little data exist regarding the presence of unregulated contaminants in drinking waters. We sampled source and finished drinking water from 98 community water supply systems throughout Minnesota (U.S.). Facilities were grouped into four networks based on water source and influences from anthropogenic activities. Measured contaminants were dependent on network and included some combination of pesticides, pharmaceuticals, per- and poly-fluoroalkyl substances (PFAS), benzotriazoles, hormones, wastewater indicators, and illicit drugs. Overall, the number of contaminants detected in samples ranged from 0 to 35 and concentrations ranged from 0.38 ng/L (progesterone) to 47,500 ng/L (bromoform). Fewer contaminants and lower concentrations were detected in finished water samples, compared to source waters. Significantly (p < 0.05) more PFAS and pesticides and higher sample total concentrations were observed in wells designated as vulnerable to contamination. To estimate potential human-health risk from exposure in drinking water, concentrations were compared against bioactivity information from the U.S. Environmental Protection Agency’s ToxCast database and state-based guidance values, when available. Although comparisons could be made for relatively few contaminants, concentrations in finished waters were at least an order of magnitude lower than screening thresholds. Results from this study were used to inform enhancement of the Minnesota Department of Health’s drinking water protection program. Full article

(This article belongs to the Section Environmental Health)

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16 pages, 319 KiB

Open AccessArticle

Sex Specificities in the Association Between Diet, Physical Activity, and Body Composition Among the Elderly: A Cross-Sectional Study in Florence, Italy

by Nora de Bonfioli Cavalcabo’, Luigi Facchini, Melania Assedi, Ilaria Ermini, Flavia Cozzolino, Emma Bortolotti, Calogero Saieva, Davide Biagiotti, Elisa Pastore, Benedetta Bendinelli, Giovanna Masala and Saverio Caini

Int. J. Environ. Res. Public Health 2025, 22(7), 975; https://doi.org/10.3390/ijerph22070975 - 20 Jun 2025

Abstract

The rising prevalence of elderly obesity in developed countries poses a public health challenge, since body composition changes during aging are associated with higher risks of chronic diseases. We cross-sectionally explored the relationship between diet, physical activity, and sex-specific differences in body composition [...] Read more.

The rising prevalence of elderly obesity in developed countries poses a public health challenge, since body composition changes during aging are associated with higher risks of chronic diseases. We cross-sectionally explored the relationship between diet, physical activity, and sex-specific differences in body composition among 378 elderly previously enrolled in the Florence European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Information on dietary habits and lifestyle was collected through validated questionnaires. Adherence to the Italian Mediterranean Index (IMI), Dietary Approaches to Stop Hypertension (DASH), and Greek Modified Mediterranean Diet (GMMD) a priori dietary patterns was calculated. Anthropometric measures were taken by trained personnel, and body composition parameters were estimated via bioelectrical impedance. In age- and energy-intake-adjusted regression models, adherence to the DASH and IMI patterns was associated with healthier body composition among women, while no significant relationship emerged among men. Fitness activities and total recreational physical activity revealed positive associations with healthier body composition (lower % fat mass, higher % muscle mass, and reduced waist circumference) in both sexes. These findings highlight the synergistic effect of diet and physical activity on body composition in the elderly and underscore the need for sex-specific interventions for promoting healthy aging. Full article

18 pages, 1170 KiB

Open AccessReview

What Is the Role of Industry-Based Intermediary Organisations in Supporting Workplace Mental Health in Australia? A Scoping Review

by Kristy Burns, Louise A. Ellis, Abilio De Almeida Neto, Carla Vanessa Alves Lopes and Janaki Amin

Int. J. Environ. Res. Public Health 2025, 22(7), 974; https://doi.org/10.3390/ijerph22070974 - 20 Jun 2025

Abstract

Despite increasing interest in workplace mental health, limited attention has been paid to the role of industry-based intermediary organisations in delivering mental health support. This scoping review addresses this gap by examining the mental health-related activities of industry intermediaries in Australia. A systematic [...] Read more.

Despite increasing interest in workplace mental health, limited attention has been paid to the role of industry-based intermediary organisations in delivering mental health support. This scoping review addresses this gap by examining the mental health-related activities of industry intermediaries in Australia. A systematic search of the peer-reviewed and grey literature from 2010 to 2023, supported by expert consultation and conducted in accordance with the PRISMA-ScR guidelines, identified 35 relevant records. Interventions were categorised using the WHO Guidelines on Mental Health at Work and evaluation activities coded according to the Conceptual Framework for Implementation Research. Organisational-level interventions were the most common (54%), followed by individual psychosocial support for distressed workers (40%). Mental health-specific intermediaries offered more WHO-recommended interventions and were more likely to evaluate their programs. Although evaluations suggested improvements in mental health literacy and high program acceptability, evidence of impact on worker health and organisational outcomes was limited. The findings suggest that intermediary organisations—including unions, business associations, and professional bodies—are well positioned to support tailored mental health strategies. However, the current lack of robust evaluations limits the understanding of their effectiveness. Future efforts should prioritise industry–research collaborations to strengthen the evidence base and inform sustainable investment in workplace mental health initiatives. Full article

(This article belongs to the Special Issue Work Psychology and Occupational Health: 2nd Edition)

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16 pages, 1230 KiB

Open AccessArticle

Examining the Link Between Problematic Smartphone Use and Substance Use Disorders Among College Students: Association Patterns Using Network Analysis

by Amanda Severo Lins Vitta, Wanderlei Abadio de Oliveira, Lucio Garcia de Oliveira, Laura Soares da Silva, Évelin Moreira Freires, Fernando Ferreira Semolini, Makilim Nunes Baptista, Claudio Romualdo, Hyoun S. Kim, Denise de Micheli, Adriana Scatena and André Luiz Monezi Andrade

Int. J. Environ. Res. Public Health 2025, 22(7), 973; https://doi.org/10.3390/ijerph22070973 - 20 Jun 2025

Abstract

This study examines the interplay between problematic smartphone use (PSU) and substance use disorders (SUDs) among Brazilian college students, also addressing associated emotional distress (e.g., depression, anxiety, and stress). A total of 3130 students (M_age = 23.6; SD_age = 5.34) participated in an [...] Read more.

This study examines the interplay between problematic smartphone use (PSU) and substance use disorders (SUDs) among Brazilian college students, also addressing associated emotional distress (e.g., depression, anxiety, and stress). A total of 3130 students (M_age = 23.6; SD_age = 5.34) participated in an online survey featuring validated measures for assessing PSU, alcohol and drug consumption, and emotional distress. Participants were categorized into problematic smartphone use (PSU) and non-problematic use (nPSU) groups. The prevalence of PSU was 46.9%, notably higher among female students, those lacking a religious affiliation, individuals living alone, and the unemployed. PSU individuals showed significantly elevated rates of alcohol, cannabis, and other illicit substance use, along with greater emotional distress. Network analysis revealed that weekly alcohol consumption and stress symptoms exhibited the highest centrality indices (e.g., stress with high betweenness; alcohol with strong expected influence), underscoring their key roles in connecting PSU and SUDs. These findings suggest that PSU and SUDs may share underlying emotional vulnerabilities, highlighting the need for integrated intervention strategies targeting both conditions concurrently. Full article

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

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14 pages, 715 KiB

Open AccessArticle

Preferences of South African Adolescents Living with HIV in the Western Cape Province Regarding the Use of Digital Technology for Self-Management

by Leonie Weyers, Talitha Crowley and Lwandile Tokwe

Int. J. Environ. Res. Public Health 2025, 22(7), 972; https://doi.org/10.3390/ijerph22070972 - 20 Jun 2025

Abstract

Adolescents living with HIV (ALHIV) face significant challenges in self-managing their chronic condition. Digital health technology (DHT) has become increasingly common and understanding ALHIVs’ preferences is essential for developing interventions tailored to this unique population. This study aimed to explore the preferences of [...] Read more.

Adolescents living with HIV (ALHIV) face significant challenges in self-managing their chronic condition. Digital health technology (DHT) has become increasingly common and understanding ALHIVs’ preferences is essential for developing interventions tailored to this unique population. This study aimed to explore the preferences of ALHIV regarding the use of DHT for self-management. A qualitative research approach with an exploratory and descriptive design was used. Participants were recruited using a purposive sampling method. Data were gathered through six nominal focus groups with 29 participants at two Community Health Centers in the Western Cape Province, South Africa. The participants were ALHIV aged 15–24 years. Discussions focused on current technology usage and the ranking of desired DHT features. The transcripts were analyzed using thematic analysis. Three main themes emerged: (1) everyday usage of digital technology where participants frequently used digital devices for communication, social media, and finding information; (2) the role of digital technology in self-management; a strong interest in digital technology that provides medication reminders, health education, and peer support; and (3) factors influencing digital technology, including the cost of data, limited connectivity, and issues of privacy related to participants’ HIV status. The ALHIV showed a strong willingness to use digital platforms for health information, reminders, and peer support, although concerns about connectivity, data cost, and privacy remain. These findings underscore the need for flexible, user-centered approaches when designing DHT interventions for self-management in South Africa. Full article

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15 pages, 534 KiB

Open AccessReview

Interventions by Rehabilitation Nurse Specialists in the Training of Informal Carers of Older People at Home with Chronic Diseases: A Scoping Review

by Ana Rita Bento, Ana Rita Duque, Nelson Gonçalves, Paulo Vaz, Susana Calção, Vanessa Benedito, Rogério Ferreira, César Fonseca and Celso Silva

Int. J. Environ. Res. Public Health 2025, 22(7), 971; https://doi.org/10.3390/ijerph22070971 - 20 Jun 2025

Abstract

Background: The aging population is increasing, leading to a greater need for home care for older adults, often provided by informal caregivers (ICs). These caregivers face numerous challenges, requiring adequate training and support. Objectives: This study aimed to map the main interventions performed [...] Read more.

Background: The aging population is increasing, leading to a greater need for home care for older adults, often provided by informal caregivers (ICs). These caregivers face numerous challenges, requiring adequate training and support. Objectives: This study aimed to map the main interventions performed by the Rehabilitation Nursing Specialist in empowering ICs of older adults at home. Methods: A scoping review was conducted following the Joanna Briggs Institute methodology. The search included seven articles published between 2019 and 2024, in Portuguese, English, and Spanish, available in the PubMed e CINHAL Ultimate databases. The descriptors used were (Rehabilitation Nursing) AND (Informal Caregivers OR Caregivers) AND (Elderly OR Aged) AND (mentoring OR Training. Results: The RNS interventions focused on training caregivers in technical skills (e.g., positioning, transfers, hygiene care, feeding, medication administration), preventing caregiver burden, managing behavioral and psychological symptoms of dementia, promoting self-care, and emotional support. Educational programs and the use of technologies (telehealth) were identified as effective strategies. Conclusions: RNS interventions are crucial for enhancing the skills and well-being of ICs, improving the quality of care provided to older adults at home, and reducing caregiver burden. Person-centered care, continuous support, and recognizing the caregiver’s role are fundamental aspects of these interventions. Full article

(This article belongs to the Special Issue The Health-Related Quality of Life of Older People with Chronic Disease)

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14 pages, 555 KiB

Open AccessArticle

Increasing Care Partners’ Capacity for Supporting Individuals Living with Dementia Through Bravo Zulu: Achieving Excellence in Relationship-Centered Dementia Care

by Jennifer Carson, Taniya J. Koswatta, Samantha Hoeper and Peter S. Reed

Int. J. Environ. Res. Public Health 2025, 22(7), 970; https://doi.org/10.3390/ijerph22070970 - 20 Jun 2025

Abstract

The need for person- and relationship-centered care (PCC/RCC) in Alzheimer’s disease and other dementias is well established. Recognizing the limitations of PCC in fully honoring the intricate interdependencies between care partners and persons living with dementia, a new training program called Bravo Zulu [...] Read more.

The need for person- and relationship-centered care (PCC/RCC) in Alzheimer’s disease and other dementias is well established. Recognizing the limitations of PCC in fully honoring the intricate interdependencies between care partners and persons living with dementia, a new training program called Bravo Zulu was developed. This comprehensive, 12-hour dementia training program aims to enhance personhood beliefs and self-efficacy among care partners, improving the experience of care and support for both people living with dementia and their care partners. Responses from 182 participants who completed the training were analyzed using paired t-tests to assess changes in personhood beliefs and self-efficacy. The Bravo Zulu training produced significant increases in both personhood beliefs and self-efficacy. Notably, healthcare professionals without prior care partner training exhibited the greatest gains in personhood beliefs, while participants who were not direct care partners showed substantial improvements in self-efficacy. Overall, these findings support the concept of tailoring dementia education to ensure care partners and healthcare professionals are able to provide culturally competent care that is aligned with the diverse backgrounds of people living with dementia. Expanding access to high-quality interactive programs such as Bravo Zulu can contribute to strengthening the dementia care workforce and improving care experiences for all involved. Full article

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

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Int. J. Environ. Res. Public Health, Volume 22, Issue 7 (July 2025) – 9 articles

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