International Journal of Environmental Research and Public Health

31 pages, 1800 KiB

Open AccessReview

Chemical Hazards in Products of Animal Origin in Cambodia from 2000 to 2023: A Systematic Review and Meta-Analysis

by Shwe Phue San, Linda Nicolaides, Delia Grace, Tumnoon Charaslertrangsi, Chhoun Chamnan, Shetty Seetharama Thombathu, Ra Thorng, Leab Kong, Sreymom Noeurn, Kuok Fidero, Che Ratana, Nazanin Zand and Rortana Chea

Int. J. Environ. Res. Public Health 2025, 22(8), 1299; https://doi.org/10.3390/ijerph22081299 - 19 Aug 2025

Abstract

Chemical hazards in food present a significant health risk. The objective of our review is to understand health risks associated with chemical contaminants in products of animal origin (POAO) in Cambodia, where there is no known published study. We followed the “Preferred Reporting [...] Read more.

Chemical hazards in food present a significant health risk. The objective of our review is to understand health risks associated with chemical contaminants in products of animal origin (POAO) in Cambodia, where there is no known published study. We followed the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines. A total of 23 reports were included for review. The findings are presented according to the PRISMA guidelines. The studies mostly focused on fishery products, with arsenic and mercury being the most frequently studied hazards. The evidence of banned substances such as chloramphenicol and certain organochlorine pesticides (OCPs), including chlordane and Mirex, was reported in fish and meat. Additionally, mercury levels were measured in beef, pork, viscera, and eggs, but the average concentration remained significantly below the hazard index. The average concentration of polycyclic aromatic hydrocarbons (PAH) in smoked fish exceeded the EU limits, ranging from 0.034 to 17.2 mg/kg, with an average mean concentration of 1.92 mg/kg. The pooled geometric means of arsenic and mercury in fish were 0.40 mg/kg (95% CI: 0.25–0.66) and ~0.14 mg/kg (95% CI: 0.087 to 0.223), respectively. The health risk of mercury contamination in fishery products needs the attention of the risk managers. However, industrial contaminants such as polybrominated diphenyl ethers (PBDEs) and butyl tin in marine fishes were lower than those reported elsewhere, such as Japan. We discuss the implications of the findings for human health and national food control systems (NFCS), the capacity of different agencies to undertake chemical risk assessment, the utility of systematic literature reviews (SLRs) for risk assessment and communication in low- and middle-income countries (LMICs), and the need for further research. Full article

32 pages, 1073 KiB

Open AccessArticle

Beyond Storytime: Oklahoma Public Libraries’ Comprehensive Approach to the Resilience of Refugee Children and Their Families Support

by Salma Akter and Suchismita Bhattacharjee

Int. J. Environ. Res. Public Health 2025, 22(8), 1298; https://doi.org/10.3390/ijerph22081298 - 19 Aug 2025

Abstract

Public libraries serve as vital community hubs that foster engagement, empowerment, and education, particularly for vulnerable populations, including refugee children and families. This study examines how Oklahoma’s public libraries contribute to refugee resilience and identifies challenges they face in providing these essential services. [...] Read more.

Public libraries serve as vital community hubs that foster engagement, empowerment, and education, particularly for vulnerable populations, including refugee children and families. This study examines how Oklahoma’s public libraries contribute to refugee resilience and identifies challenges they face in providing these essential services. Using a qualitative method approach, including 20 semi-structured interviews with library staff, questionnaire surveys, and observations conducted across three Oklahoma library systems (Metropolitan, Pioneer, and Tulsa City-County) the study explored programs, services, and strategies that support refugee adaptation and integration. Findings reveal that libraries excel in three key areas: cognitive services (language literacy, digital access, educational resources), socio-cultural services (community building, cultural exchange), and physiological services (safe spaces, welcoming environments). These services contribute to building human, social, and economic capital, with human capital consistently ranked as most crucial for refugee resilience. However, libraries face significant challenges, with language barriers, program gaps, and outreach limitations being the most prevalent obstacles. Additional barriers include facility constraints, transportation difficulties, resource limitations, and privacy concerns. The study proposes nine comprehensive guidelines for creating sustainable pathways to refugee resilience through enhanced library services, emphasizing proactive community engagement, staff training, multilingual resources, advocacy, strategic partnerships, tailored programming, transportation solutions, cultural competence, and welcoming environments. This study contributes to understanding how public libraries can function as inclusive institutions that support refugee children’s successful integration and development in their new communities. Full article

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

19 pages, 4882 KiB

Open AccessArticle

“Slowly but Steadily, You’re Running Out of Steam”: Aging Parents’ Caregiving Experiences Through Photovoice

by Martin Nagl-Cupal, Marlene Werner, Daniela Haselmayer and Thomas Falkenstein

Int. J. Environ. Res. Public Health 2025, 22(8), 1297; https://doi.org/10.3390/ijerph22081297 - 19 Aug 2025

Abstract

Aging parents caring for adult children with disabilities or other care needs face significant challenges and health-related issues over extended periods. The aim of this study was to explore the experiences of aging parents with caregiving responsibilities. This qualitative participatory study followed the [...] Read more.

Aging parents caring for adult children with disabilities or other care needs face significant challenges and health-related issues over extended periods. The aim of this study was to explore the experiences of aging parents with caregiving responsibilities. This qualitative participatory study followed the research process of a photovoice study. Thirteen parents, aged 51 to 76 years, of adult children with care needs, aged 20 to 49 years, participated in this study. The parents captured photographs depicting their daily lives which were contextualized and coded during group discussions. The data were analyzed using thematic analysis and reviewed collaboratively with the participants. Six key themes emerged in the data analysis. 1. mastering complexity, 2. being an expert and advocate, 3. balancing autonomy and care, 4. care as a lifelong journey, 5. standing on the margins of society, and 6. worrying about the future. This study underscores the urgent need for comprehensive and coordinated support systems that ensure the well-being of aging caregivers while addressing the evolving needs of their adult children. Full article

(This article belongs to the Special Issue Family Caregiving of Older Adults)

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22 pages, 3489 KiB

Open AccessArticle

Assessing Annoyance and Sleep Disturbance Related to Changing Aircraft Noise Context: Evidence from Tan Son Nhat Airport

by Thulan Nguyen, Tran Thi Hong Nhung Nguyen, Makoto Morinaga, Yasuhiro Hiraguri and Takashi Morihara

Int. J. Environ. Res. Public Health 2025, 22(8), 1296; https://doi.org/10.3390/ijerph22081296 - 19 Aug 2025

Abstract

This study examines the impact of aircraft noise on annoyance and sleep disturbances among residents near Tan Son Nhat Airport in Ho Chi Minh City, Vietnam, from 2019 to 2023. It aims to assess the specific effects of aircraft noise exposure on sleep [...] Read more.

This study examines the impact of aircraft noise on annoyance and sleep disturbances among residents near Tan Son Nhat Airport in Ho Chi Minh City, Vietnam, from 2019 to 2023. It aims to assess the specific effects of aircraft noise exposure on sleep quality, as well as changes in exposure due to reduced air traffic during the COVID-19 pandemic. Surveys conducted before and during the pandemic revealed that, despite lower noise levels, residents continued to report high levels of annoyance, indicating a complex exposure-response relationship. This study evaluates both the impact of aircraft noise levels and the role of non-acoustic factors in mitigating sleep disturbances and shaping residents’ responses over time. The study’s findings support the applicability of WHO guidelines in this context and emphasize the importance of considering both noise reduction and community engagement in noise management strategies. Full article

(This article belongs to the Special Issue Community Response to Environmental Noise)

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14 pages, 632 KiB

Open AccessArticle

“If You Haven’t Slept a Lot (…) You Don’t Want to Go Out for a Run, You Don’t Want to Ride a Bike, You Just Kind of Sit and You Just (…) Do Nothing”—Perceptions of 24-Hour Movement Behaviours Among Adolescents Living with Type 1 Diabetes

by Mhairi Patience, Alison Kirk, Xanne Janssen, James Sanders and Megan Crawford

Int. J. Environ. Res. Public Health 2025, 22(8), 1295; https://doi.org/10.3390/ijerph22081295 - 19 Aug 2025

Abstract

The importance of physical activity, sedentary behaviour, and sleep behaviour in adolescents with type 1 diabetes (T1D) has been explored in isolation. However, adolescents experience health benefits when these behaviours are balanced appropriately throughout the day, and are considered to be interconnected rather [...] Read more.

The importance of physical activity, sedentary behaviour, and sleep behaviour in adolescents with type 1 diabetes (T1D) has been explored in isolation. However, adolescents experience health benefits when these behaviours are balanced appropriately throughout the day, and are considered to be interconnected rather than isolated. The aim of this study was to investigate the perspectives of adolescents living with T1D towards these behaviours collectively. The participants were 15 adolescents (aged 11–18 years) with T1D, recruited using online methods and word of mouth. Online semi-structured interviews were transcribed using intelligent verbatim and analysed using thematic analysis. We identified the following four central themes and five subthemes: (1) sleep and physical activity are understood and valued above sedentary behaviour; (2) recognition of movement behaviours’ interconnection; (3) movement behaviours’ interaction with health outcomes (mood, glycaemic control, and glycaemic control as a barrier to movement behaviours); and (4) movement behaviours within the environmental context of the adolescent (school and caregivers). Adolescents with T1D are aware of the interconnectedness of each movement behaviour and the positive influence a balanced approach can have on mood and T1D management. The findings provide important information for future holistic interventions promoting healthy behaviours that target the adolescent, their school environment, and their caregivers. Full article

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15 pages, 706 KiB

Open AccessArticle

Using Functional Near-Infrared Spectroscopy to Elucidate Neurophysiological Mechanism of Action of Equine-Assisted Services: Proof-of-Concept Study

by Beth A. Lanning, Cory M. Smith, Cierra Ugale, Elena Nazarenko and William R. Marchand

Int. J. Environ. Res. Public Health 2025, 22(8), 1294; https://doi.org/10.3390/ijerph22081294 - 19 Aug 2025

Abstract

Equine-assisted services (EAS) are used for civilian and military trauma survivors to reduce depression and posttraumatic stress symptoms. While early scientific evidence supports the benefits of EAS, the neurophysiological mechanisms underlying these benefits are unknown. The specific aims of this exploratory study were [...] Read more.

Equine-assisted services (EAS) are used for civilian and military trauma survivors to reduce depression and posttraumatic stress symptoms. While early scientific evidence supports the benefits of EAS, the neurophysiological mechanisms underlying these benefits are unknown. The specific aims of this exploratory study were to determine (1) whether functional near-infrared spectroscopy (fNIRS) neuroimaging can be used to explore neural responses of EAS veteran participants and (2) the correlation between neural responses and psychological outcomes of the participants interacting with equines. Fifteen veterans participated in a 2-day EAS program consisting of four randomized activities. An fNIRS sensor cap was used to measure the oxygenated (O₂Hb), deoxygenated (hHb), and total hemoglobin (tHb) of the participants during each activity. The results indicated no significant differences for O₂Hb and tHb across the visits or activities, however, a significant difference in hHb was observed. There was an increase in hHb during the activities that included an equine, which indicated a greater cognitive load and attention. Further, data from pre-/post-psychometric assessments showed a significant improvement in participants’ trait anxiety, psychological flexibility, and positive and negative affect after interacting with the horse. Preliminary data revealed a potential association between the cognitive attention and psychological health of participants during an EAS session. Full article

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13 pages, 516 KiB

Open AccessArticle

Perception of Concern and Associated Factors During the COVID-19 Pandemic: An Epidemiological Survey in a Brazilian Municipality

by Adriano Pires Barbosa and Marília Jesus Batista

Int. J. Environ. Res. Public Health 2025, 22(8), 1293; https://doi.org/10.3390/ijerph22081293 - 19 Aug 2025

Abstract

The COVID-19 pandemic impacted mental health. This cross-sectional study analyzed the perception of concern related to the pandemic in Jundiaí-SP, June 2020. Participants consisted of residents of households selected by probability sampling and individuals with respiratory symptoms who sought Basic Health Units (UBS). [...] Read more.

The COVID-19 pandemic impacted mental health. This cross-sectional study analyzed the perception of concern related to the pandemic in Jundiaí-SP, June 2020. Participants consisted of residents of households selected by probability sampling and individuals with respiratory symptoms who sought Basic Health Units (UBS). The participants underwent rapid testing for SARS-CoV-2 and answered a questionnaire. The outcome was the perception of concern about pandemic and the independent variables were socioeconomic characteristics, behavioral variables, signs and symptoms, and rapid test results. Bivariate analysis was performed and variables with p < 0.20 were included in a binary logistic regression model (p < 0.05) using SPSS 20.0. A total of 2432 individuals participated in the study, including 1181 from UBS and 1251 from households. Females (OR: 1.42; CI: 1.18–1.71), black and mixed race participants (OR: 1.40; CI: 1.15–1.71), participants with an income up to 3 minimum wages (MW) (up to 1 MW: OR: 2.58; CI: 1.80–3.70; 1 to 3 MW: OR: 1.64; CI: 1.35–1.98), and younger participants (18–39 years: OR: 3.07; CI: 2.39–3.94; 40–59 years: OR: 2.42; CI: 1.89–3.10) were more concerned. Greater concern was perceived by more vulnerable individuals, regardless of testing positive for COVID-19 which is important to subsidize public mental health policies and crisis interventions, focusing on reducing race, gender and socioeconomic inequalities. Full article

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14 pages, 394 KiB

Open AccessArticle

Self-Reported Oral Health Among Elderly Immigrants Residing in Norway: A Cross-Sectional Study

by Wegdan Hasha, Stein Atle Lie, Anne N. Åstrøm and Manal Mustafa

Int. J. Environ. Res. Public Health 2025, 22(8), 1292; https://doi.org/10.3390/ijerph22081292 - 18 Aug 2025

Abstract

Immigrants represent 20.8% of Norway’s population, with 22.2% aged 50+. This study aimed to assess oral health-related behaviors and perceived oral health in relation to sociodemographic factors among elderly immigrants aged 50+. Methods: 174 participants (94% response rate). Data on sociodemographic, oral hygiene, [...] Read more.

Immigrants represent 20.8% of Norway’s population, with 22.2% aged 50+. This study aimed to assess oral health-related behaviors and perceived oral health in relation to sociodemographic factors among elderly immigrants aged 50+. Methods: 174 participants (94% response rate). Data on sociodemographic, oral hygiene, diet, snus use, xerostomia, and halitosis were collected using the self-reported questionnaire. p-value < 0.05 indicates statistical significance. Results: Participants’ mean age was 60.7, with 60% reporting poor self-perceived oral health, and over 64% had missing teeth. Participants reported poor oral hygiene habits (35.1%, n = 61), frequent sugar consumption (51.1%, n = 89), and smoking (16.1%, n = 28). Poor oral health was more common in those aged 60 and over (OR = 2.5, CI: 1.1–5.8) and with a narrow social network (OR = 3.8, CI: 1.7–8.5). Women had lower odds of sugar consumption (OR = 0.38, CI: 0.18–0.8) and smoking (OR = 0.27, CI: 0.09–0.7), but living in Norway for less than 3 years increased smoking odds (OR = 4.5, CI: 1.2–15.8). Moreover, being unmarried (OR = 5.5, p = 0.008), recent immigration (OR = 24.3, p < 001), and a narrow social network (OR = 4.7, p = 0.004) were associated with higher odds of missing teeth. Conclusions: Elderly immigrants in Norway reported poor oral health, tooth loss, and unhealthy dietary and hygiene habits, highlighting the need for targeted interventions. Full article

(This article belongs to the Section Global Health)

11 pages, 257 KiB

Open AccessArticle

Prevalence and Factors Associated with HIV Testing Among Men Aged 15–54 Years in Kenya—Evidence from the 2022 Demographic and Health Survey

by Ipeleng Caroline Victoria Melato, Alfred Musekiwa and Siphesihle Robin Nxele

Int. J. Environ. Res. Public Health 2025, 22(8), 1291; https://doi.org/10.3390/ijerph22081291 - 18 Aug 2025

Abstract

Sub-Saharan Africa bears the heaviest burden of HIV/AIDS. Kenya alone has an estimated 1.4 million people living with HIV. Therefore, this study determined HIV testing prevalence and associated factors among men aged 15–54 years in Kenya. The study is a secondary data analysis [...] Read more.

Sub-Saharan Africa bears the heaviest burden of HIV/AIDS. Kenya alone has an estimated 1.4 million people living with HIV. Therefore, this study determined HIV testing prevalence and associated factors among men aged 15–54 years in Kenya. The study is a secondary data analysis of the 2022 Kenya Demographic and Health Survey, a nationally representative population-based cross-sectional survey. A multivariable logistic regression model was used to determine factors associated with HIV testing. Survey weights were used to adjust analyses for unequal sampling probabilities. Out of 14,453 men included in the study, the prevalence of self-reported HIV testing was 73.5%, which was higher among men aged 30–34 years old compared to the 15–19 years (90.2% vs. 33.3%), married or living with a partner (89.1% vs. 55.5%), residing in urban areas (82.5% vs. 67.8%), with higher education (90.6% vs. 58.4%), employed (80.5% vs. 43.1%), richest (83.8% vs. 60.4%), and those with three or more sexual partners (81.7% vs. 68.0%) groups. Targeted interventions to encourage more men to participate in regular HIV testing are needed. This can be achieved by bringing HIV testing sites closer to males through HIV self-testing and community testing, particularly home-based testing. Full article

(This article belongs to the Special Issue Progress Toward the UNAIDS 95-95-95 Targets for HIV Care Cascade)

13 pages, 961 KiB

Open AccessArticle

Socioeconomic Disparities and Risk of Papillary Thyroid Cancer Associated with Environmental Exposure to Per- and Polyfluoroalkyl Substances (PFAS) in Florida

by Laura E. Wild, Nicholas DiStefano, Garrett Forman, Bianca I. Arocha, Ming S. Lee, Peter A. Borowsky, Elizabeth Franzmann, Natasha Solle, Alberto J. Caban-Martinez and Erin Kobetz

Int. J. Environ. Res. Public Health 2025, 22(8), 1290; https://doi.org/10.3390/ijerph22081290 - 18 Aug 2025

Abstract

The existing literature suggests that exposure to Per- and Polyfluoroalkyl Substances (PFAS) can increase Papillary Thyroid Cancer (PTC) risk by interfering with thyroid hormone signaling, leading to hormonal imbalances that promote carcinogenesis. In addition, significant disparities exist in environmental exposure. However, ecological evidence [...] Read more.

The existing literature suggests that exposure to Per- and Polyfluoroalkyl Substances (PFAS) can increase Papillary Thyroid Cancer (PTC) risk by interfering with thyroid hormone signaling, leading to hormonal imbalances that promote carcinogenesis. In addition, significant disparities exist in environmental exposure. However, ecological evidence of these associations has not been established within a statewide database of cancer outcomes. Therefore, this study investigated the relationship between socioeconomic conditions, environmental PFAS exposure, and PTC incidence in Florida using the state’s cancer registry. Data on facilities potentially releasing PFAS and ZIP codes with known PFAS drinking water contamination were retrieved from the EPA’s PFAS Analytic Tool. Proximity to PFAS sites and age-adjusted incidence by patient race/ethnicity were calculated by census tract. Lower socioeconomic status was associated with greater exposure to environmental PFAS. Census tracts with closer proximity to PFAS sites were more likely to have public water systems with PFAS contamination. Lastly, residential proximity to PFAS sites was positively associated with age-adjusted PTC incidence in Non-Hispanic Whites and Hispanics. These results demonstrate disparities in environmental exposure and suggest that exposure to PFAS may be an important factor for PTC risk at the population level and should be considered in the development of public health policies. Full article

(This article belongs to the Special Issue Environmental Epidemiology and Spatial Analysis)

11 pages, 335 KiB

Open AccessArticle

Out-of-Pocket Expenditure (OOPE) Among COVID-19 Patients by Insurance Status in a Quaternary Hospital in Karnataka, India

by Rajesh Kamath, Chris Sebastian, Varshini R. Jayapriya, Siddhartha Sankar Acharya, Ashok Kamat, Helmut Brand, Reshma Maria Cocess D’Souza, Prajwal Salins, Aswin Sugunan, Sagarika Kamath, Sangita G. Kamath and Sanjay B. Kini

Int. J. Environ. Res. Public Health 2025, 22(8), 1289; https://doi.org/10.3390/ijerph22081289 - 18 Aug 2025

Abstract

Out-of-pocket expenditure (OOPE) comprises 62% of national health expenditure in India. This heavy reliance on direct payments has engendered economic vulnerability and catastrophic financial pressures (typically defined as out-of-pocket spending exceeding a certain threshold of household income, leading to financial hardship) on households [...] Read more.

Out-of-pocket expenditure (OOPE) comprises 62% of national health expenditure in India. This heavy reliance on direct payments has engendered economic vulnerability and catastrophic financial pressures (typically defined as out-of-pocket spending exceeding a certain threshold of household income, leading to financial hardship) on households in a country where public health spending remains below targeted levels. The onset of the COVID-19 pandemic intensified these financial hardships further, as both total healthcare spending and OOPE experienced significant escalations due to the increased need for emergency care, vaccination efforts, and expanded health infrastructure. A retrospective, single-center study was conducted using data from COVID-19 patients admitted between June 2020 and June 2022. Patient data were collected from the Medical Records, IT, and Finance departments. A validated proforma was used for data extraction. Descriptive statistics were calculated, and the Shapiro–Wilk test was applied to assess normality of billing and OOPE data. Patients were stratified into three groups based on their insurance status, allowing for comparative analysis of OOPE percentages and absolute expenditures. The 2715 COVID-19 patients were categorized into three groups according to their health financing: those covered under AB-PMJAY (42.76%), private health insurance (22.16%), and the uninsured (35%). While the median billing amounts were comparable across these groups (ranging between INR 85,000 and INR 90,000), a substantial disparity was observed in terms of financial burden. All patients covered under AB-PMJAY incurred no OOPE, whereas privately insured patients had a median OOPE that constituted approximately 21% of their total billing amounts, with significant variability among different insurers. The uninsured group represented 35% of the cases and experienced the highest median OOPE, indicating substantial financial risk. The COVID-19 pandemic has revealed critical gaps in India’s health financing framework. This study emphasizes the strong financial protection provided by AB-PMJAY, while also exposing the limitations of private health insurance in shielding patients from substantial healthcare costs. As the country progresses toward universal health coverage, there is a pressing need to expand public health insurance schemes that are inclusive, equitable, and effectively implemented. Additionally, strengthening regulation and accountability in the private insurance sector is essential. The study findings reinforce that AB-PMJAY has been highly successful in reducing OOPE and enhancing financial risk protection. Although private insurance reduced OOPE, patients still faced considerable expenses. The stark difference in OOPE of 100% for uninsured patients, 21.16% for privately insured, and 0% for AB-PMJAY beneficiaries underscores the importance of further expanding AB-PMJAY to reach more vulnerable populations. Full article

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11 pages, 755 KiB

Open AccessArticle

Acute Glycemic and Hemodynamic Responses to Single- and Multi-Joint Resistance Exercises in Individuals with Type 2 Diabetes: A Pilot Randomized Crossover Study

by Rodrigo Sudatti Delevatti, Fábio Duarte da Silva, Filipe De Lucca Braga, Lucineia Orsolin Pfeifer and Maria Eduarda de Moraes Sirydakis

Int. J. Environ. Res. Public Health 2025, 22(8), 1288; https://doi.org/10.3390/ijerph22081288 - 18 Aug 2025

Abstract

Introduction: There is a lack of knowledge regarding the acute glycemic and blood pressure responses to resistance exercises that involve different amounts of muscle mass. Objective: To analyze the acute effects of single- and multi-joint resistance exercises on glycemic control and blood pressure [...] Read more.

Introduction: There is a lack of knowledge regarding the acute glycemic and blood pressure responses to resistance exercises that involve different amounts of muscle mass. Objective: To analyze the acute effects of single- and multi-joint resistance exercises on glycemic control and blood pressure in individuals with type 2 diabetes (T2DM). Methods: This is a pilot randomized crossover trial, including adults with T2DM of both genders. The participants performed three sessions (two experimental sessions: one with single-joint exercises (SIN) and the other with multi-joint exercises (MULTI); and a control session (CON)) in a randomized order, with outcomes being evaluated pre-exercise, immediately, 15 and 30 min after the sessions. Both sessions consisted of five exercises performed in three sets of 10 to 12 maximum repetitions. Analyses were performed by generalized estimation equations. Results: Fifteen adults (including eleven women) participated in this study. Both experimental sessions showed glycemic reductions immediately after the sessions (MULTI: −17 mg/dL; SIN: −29 mg/dL; p < 0.001), and these values were kept similar up to 30 min after the session. The control session presented a glycemic reduction immediately after the session (−18 mg/dL), which increased 15 min later (−29 mg/dL), stabilizing up to 30 min after the session. Systolic blood pressure was increased immediately after both experimental sessions, retuning to baseline values 15 min post-session. Diastolic blood pressure increased in the control session with time, without any alterations in the experimental sessions. Conclusions: Similar glycemic reductions were found in the experimental sessions, without superiority over the control session. Minimal changes were found in blood pressure. Full article

(This article belongs to the Special Issue New Advances in Diabetes)

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9 pages, 243 KiB

Open AccessArticle

Association of Financial Distress and Monthly Income with Smoking During the COVID-19 Pandemic Recession in Thailand: A Nationwide Cross-Sectional Study

by Chutarat Sathirapanya, Wit Wichaidit, Vijj Kasemsup, Vasin Pipattanachat and Rassamee Chotipanvithayakul

Int. J. Environ. Res. Public Health 2025, 22(8), 1287; https://doi.org/10.3390/ijerph22081287 - 18 Aug 2025

Abstract

(1) Background: Psychological distress causes increased smoking frequency. Thus, financial distress (FD), a type of psychological distress, during the COVID-19 pandemic recession is possibly associated with increased smoking frequency. We studied the association between disrupted employment or earnings-associated FD and the number of [...] Read more.

(1) Background: Psychological distress causes increased smoking frequency. Thus, financial distress (FD), a type of psychological distress, during the COVID-19 pandemic recession is possibly associated with increased smoking frequency. We studied the association between disrupted employment or earnings-associated FD and the number of cigarettes smoked daily, as well as the effects of pre-pandemic regular monthly incomes on the association. (2) Methods: We retrieved the collected data from a former nationwide and community-based study regarding the psycho-socio-economic characteristics of Thai people during the third wave of the COVID-19 pandemic in Thailand in 2021. The participants for this study were current smokers aged ≥ 18 years. General demographics, perceived FD, and pre-pandemic regular monthly incomes were analyzed. Descriptive statistics and multivariate logistic regression with sampling weight adjustments were the analyses used (p < 0.05). (3) Results: 849 current smokers were suitable for statistical analyses. We found that 664 (12.9%) of participants experienced FD, but it did not significantly affect smoking frequency. However, those who had FD and regularly earning ≥ THB 10,000 ($271.11 US) per month was significantly associated with increased daily cigarette use, after adjusting for age and sex (adjusted OR = 2.74; 95% CI = 1.18, 6.37, p = 0.020). (4) Conclusion: FD alone did not affect daily smoking frequency. Understanding the psycho-socio-economic factors is necessary for smoking control during the COVID-19 economic recession. Full article

15 pages, 633 KiB

Open AccessReview

Rehabilitating Soldiers for Load Carriage Tasks: An International Perspective

by Robin Orr, Joseph J. Knapik, Rachel Rodgers, Robyn Cassidy, Jacques Rousseau, Damien Van Tiggelen and Rodney Pope

Int. J. Environ. Res. Public Health 2025, 22(8), 1286; https://doi.org/10.3390/ijerph22081286 - 17 Aug 2025

Viewed by 137

Abstract

Soldiers are likely to suffer an injury and require rehabilitation at some stage of their career. Load carriage, whilst a fundamental requirement, is also a source of injury risk. To optimize the rehabilitation of soldiers and prepare them for a full return to [...] Read more.

Soldiers are likely to suffer an injury and require rehabilitation at some stage of their career. Load carriage, whilst a fundamental requirement, is also a source of injury risk. To optimize the rehabilitation of soldiers and prepare them for a full return to operational duty, load carriage requirements need to be considered throughout their rehabilitation pathway. In addition, injury risks associated with load carriage need to be considered to inform mitigation of reinjury. During the initial injury treatment stage, loss of key fitness elements associated with load carriage performance, being aerobic fitness and relative strength, need to be minimized. Any losses of these same elements of fitness then need to be considered in the overall reconditioning stage. Finally, with injury being a predictor of future load carriage injury, the conditioning stage must move beyond general occupational conditioning to include load carriage-specific conditioning to make the soldier physically resilient against future injury and confident of their capability. By synthesizing evidence from the latest research in load carriage, this narrative review provides pragmatic considerations and guidelines for optimizing soldier load carriage capability following injury. Full article

(This article belongs to the Special Issue New Trends in Work-Related Musculoskeletal Disorders and Health-Related Quality of Life)

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15 pages, 700 KiB

Open AccessArticle

Promotion of Health-Harming Products on Instagram: Characterizing Strategies Boosting Audience Engagement with Cigar Marketing Messages

by Ganna Kostygina, Hy Tran, Chandler C. Carter and Sherry L. Emery

Int. J. Environ. Res. Public Health 2025, 22(8), 1285; https://doi.org/10.3390/ijerph22081285 - 17 Aug 2025

Viewed by 65

Abstract

Social media promotion of harmful products (e.g., combustible tobacco) poses a public health threat. However, strategies that amplify exposure to and engagement with such content remain understudied. This study aims to characterize strategies boosting cigar, little cigar, and cigarillo (CLCC) marketing visibility, referrals, [...] Read more.

Social media promotion of harmful products (e.g., combustible tobacco) poses a public health threat. However, strategies that amplify exposure to and engagement with such content remain understudied. This study aims to characterize strategies boosting cigar, little cigar, and cigarillo (CLCC) marketing visibility, referrals, and engagement on Instagram. Using keyword rules, we collected publicly available CLCC-related Instagram posts from CrowdTangle for a six-year period from August 2016 to October 2021. Posts were categorized as commercial (e.g., posts by tobacco brands or vendors) or organic and were coded for consumer engagement (CE) strategies (e.g., presence of prompts to like/share) using a combination of machine learning methods and human coding. Temporal engagement trends were analyzed using metadata. A total of 320,488 CLCC-related public posts were collected, with 44.6% (n = 142,875) identified as overtly commercial. Of these, 33.5% (n = 47,832) contained CE cues, including discounts and giveaways for tagging peers, liking, commenting, or following CLCC brands and spokesperson/influencers accounts, as well as calls to participate in contests and polls. Overtly commercial CE messages consistently garnered more comments per post and likes per post than non-CE commercial posts. There was a significant upward trend in the rate of comments on CE posts, suggesting growing effectiveness in eliciting user interaction. The proliferation of and high level of engagement with cigar-related promotional messages on Instagram demonstrate the need for public health surveillance and regulation of the evolving strategies promoting CLCC marketing exposure, reach, and engagement on social media. Full article

(This article belongs to the Special Issue Evolving Role of Social Media in Health Communication)

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20 pages, 642 KiB

Open AccessArticle

Brazilian Clinical Psychologists’ Perceptions of Online Psychotherapy for Patients with Suicidal Behavior During the COVID-19 Pandemic: A Grounded Theory Study

by Natália Gallo Mendes Ferracioli, Elaine Campos Guijarro Rodrigues and Manoel Antônio dos Santos

Int. J. Environ. Res. Public Health 2025, 22(8), 1284; https://doi.org/10.3390/ijerph22081284 - 17 Aug 2025

Viewed by 84

Abstract

Online psychotherapy for patients with suicidal behavior was considered inappropriate by the Brazilian Federal Psychology Council prior to the COVID-19 pandemic. Due to the need for physical distancing, this restriction was temporarily suspended. This study aims to analyze the perceptions of Brazilian clinical [...] Read more.

Online psychotherapy for patients with suicidal behavior was considered inappropriate by the Brazilian Federal Psychology Council prior to the COVID-19 pandemic. Due to the need for physical distancing, this restriction was temporarily suspended. This study aims to analyze the perceptions of Brazilian clinical psychologists regarding online psychotherapy for patients with suicidal behavior in the context of the COVID-19 pandemic, to generate a theoretical understanding of this experience. It is a qualitative, exploratory, longitudinal study based on the Constructivist Grounded Theory framework. Ten clinical psychologists who conducted online psychotherapy for patients with suicidal behavior during the pandemic were interviewed at two moments, with an interval of approximately two years: the first round was conducted from December 2020 to March 2021, followed by a second round between November and December 2022. Data analysis led to four categories: (1) Reflecting on suicidal behavior; (2) Addressing specificities of online interventions; (3) Managing suicidal behavior in online psychotherapy; (4) Evaluating online psychotherapy for patients with suicidal behavior. The theoretical model “Pathways of care: main roads and access routes in online psychotherapy for suicidal behavior” was constructed. It was concluded that online psychotherapy for patients with suicidal behavior is complex and requires caution but is feasible and can be important in specific circumstances. This makes it an additional resource for suicide prevention and mental health promotion. Full article

(This article belongs to the Special Issue Mental Health in Healthcare: Challenges and Perspectives from the Past to the Future)

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19 pages, 614 KiB

Open AccessArticle

Effects of Outdoor and Household Air Pollution on Hand Grip Strength in a Longitudinal Study of Rural Beijing Adults

by Wenlu Yuan, Xiaoying Li, Collin Brehmer, Talia Sternbach, Xiang Zhang, Ellison Carter, Yuanxun Zhang, Guofeng Shen, Shu Tao, Jill Baumgartner and Sam Harper

Int. J. Environ. Res. Public Health 2025, 22(8), 1283; https://doi.org/10.3390/ijerph22081283 - 16 Aug 2025

Viewed by 221

Abstract

Background: Outdoor and household PM_2.5 are established risk factors for chronic disease and early mortality. In China, high levels of outdoor PM_2.5 and solid fuel use for cooking and heating, especially in winter, pose large health risks to the country’s aging [...] Read more.

Background: Outdoor and household PM_2.5 are established risk factors for chronic disease and early mortality. In China, high levels of outdoor PM_2.5 and solid fuel use for cooking and heating, especially in winter, pose large health risks to the country’s aging population. Hand grip strength is a validated biomarker of functional aging and strong predictor of disability and mortality in older adults. We investigated the effects of wintertime household and outdoor PM_2.5 on maximum grip strength in a rural cohort in Beijing. Methods: We analyzed data from 877 adults (mean age: 62 y) residing in 50 rural villages over three winter seasons (2018–2019, 2019–2020, and 2021–2022). Outdoor PM_2.5 was continuously measured in all villages, and household (indoor) PM_2.5 was monitored for at least two months in a randomly selected ~30% subsample of homes. Missing data were handled using multiple imputation. We applied multivariable mixed effects regression models to estimate within- and between-individual effects of PM_2.5 on grip strength, adjusting for demographic, behavioral, and health-related covariates. Results: Wintertime household and outdoor PM_2.5 concentrations ranged from 3 to 431 μg/m³ (mean = 80 μg/m³) and 8 to 100 μg/m³ (mean = 49 μg/m³), respectively. The effect of a 10 μg/m³ within-individual increase in household and outdoor PM_2.5 on maximum grip strength was 0.06 kg (95%CI: −0.01, 0.12 kg) and 1.51 kg (95%CI: 1.35, 1.68 kg), respectively. The household PM_2.5 effect attenuated after adjusting for outdoor PM_2.5, while outdoor PM_2.5 effects remained robust across sensitivity analyses. We found little evidence of between-individual effects. Conclusions: We did not find strong evidence of an adverse effect of household PM_2.5 on grip strength. The unexpected positive effects of outdoor PM_2.5 on grip strength may reflect transient physiological changes following short-term exposure. However, these findings should not be interpreted as evidence of protective effects of air pollution on aging. Rather, they highlight the complexity of air pollution’s health impacts and the value of longitudinal data in capturing time-sensitive effects. Further research is needed to better understand these patterns and their implications in high-exposure settings. Full article

(This article belongs to the Section Environmental Health)

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6 pages, 249 KiB

Open AccessBrief Report

Do Medical Students Suffer from Chronic Diseases? A Secondary Cross-Sectional Analysis of a Medical School in Portugal

by Filipe Prazeres, Diogo Maia and Marta Duarte

Int. J. Environ. Res. Public Health 2025, 22(8), 1282; https://doi.org/10.3390/ijerph22081282 - 16 Aug 2025

Viewed by 161

Abstract

Background/Objectives: There is still debate about students’ health in medical schools. The aim of this study was to assess the proportion of chronic diseases among medical students and analyze their predictors. Methods: We performed a secondary cross-sectional analysis using a database from a [...] Read more.

Background/Objectives: There is still debate about students’ health in medical schools. The aim of this study was to assess the proportion of chronic diseases among medical students and analyze their predictors. Methods: We performed a secondary cross-sectional analysis using a database from a single Portuguese university. The sociodemographic/clinical variables of 309 medical students were included. Logistic regression was performed to ascertain the effects of sex, age, medical course year, financial situation, and family history of chronic diseases on the likelihood of medical students having chronic disease. Results: Median age (Q1, Q3) was 21 (17, 43) years, with females comprising 79.9% of the sample. The distribution of students by school year was similar. The majority (65.7%) reported having sufficient money. Twenty-three percent suffered from chronic disease, and around forty percent had parents or siblings with chronic disease. In the regression model, only a family history of chronic disease was associated with a personal history of chronic disease. Medical students with parents or siblings who have a chronic disease are 3.3 times more likely to have a chronic disease themselves. Conclusions: Future interventions targeting the medical student population will be needed in Portugal to reduce the prevalence and burden of chronic diseases, particularly among those with a positive family history. Full article

(This article belongs to the Special Issue Multimorbidity in Primary Care: Prevalence, Management, and Health System Challenges)

19 pages, 1148 KiB

Open AccessArticle

A Gamified Digital Mental Health Intervention Across Six Sub-Saharan African Countries: A Cross-Sectional Evaluation of a Large-Scale Implementation

by Christopher K. Barkley, Charmaine N. Nyakonda, Kondwani Kuthyola, Polite Ndlovu, Devyn Lee, Andrew Dallos, Danny Kofi-Armah, Priscilla Obeng and Katherine G. Merrill

Int. J. Environ. Res. Public Health 2025, 22(8), 1281; https://doi.org/10.3390/ijerph22081281 - 15 Aug 2025

Viewed by 182

Abstract

Mental health conditions affect many young people in sub-Saharan Africa (SSA), where stigma is high and access to care is limited. Digital tools accessible on basic mobile phones offer a scalable way to promote mental health, but evidence on their effectiveness in SSA [...] Read more.

Mental health conditions affect many young people in sub-Saharan Africa (SSA), where stigma is high and access to care is limited. Digital tools accessible on basic mobile phones offer a scalable way to promote mental health, but evidence on their effectiveness in SSA is limited. This study evaluated the reach, feasibility, acceptability, and knowledge outcomes of Digital MindSKILLZ, an interactive voice response (IVR) mental health intervention implemented in the Democratic Republic of Congo, Ghana, Nigeria, Rwanda, Uganda, and Zambia. Over seven months, 700,138 people called the platform, and 425,395 (61%) listened to at least one message. Of these users, 63.6% were under 25 and 68.3% were from rural areas. The three content branches—mental health information, mental health skills, and soccer quizzes—were accessed by 36.5%, 46.4%, and 50.9% of users, respectively. Among users who accessed the mental health branch of the intervention, the mean number of messages completed was 7.6 out of 18 messages. In a follow-up survey, 91% of users understood the content, 85% would recommend the intervention, and 38% found the mental health content most helpful. Average knowledge scores were 62%, with lower scores on common disorders and stigma. The intervention showed strong reach and acceptability, but content and implementation improvements are needed to boost engagement and retention. Full article

(This article belongs to the Special Issue Advancing Youth Mental Health: Innovations, Integration, and Equity)

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25 pages, 549 KiB

Open AccessArticle

Environmental Exposures and COVID-19 Experiences in the United States, 2020–2022

by Elyssa Anneser, Thomas J. Stopka, Elena N. Naumova, Keith R. Spangler, Kevin J. Lane, Andrea Acevedo, Jeffrey K. Griffiths, Yan Lin, Peter Levine and Laura Corlin

Int. J. Environ. Res. Public Health 2025, 22(8), 1280; https://doi.org/10.3390/ijerph22081280 - 15 Aug 2025

Viewed by 141

Abstract

Certain environmental exposures are associated with COVID-19 incidence and mortality. To determine whether environmental context is associated with other COVID-19 experiences, we used data from the nationally representative Tufts Equity in Health, Wealth, and Civic Engagement Study data (n = 1785; three [...] Read more.

Certain environmental exposures are associated with COVID-19 incidence and mortality. To determine whether environmental context is associated with other COVID-19 experiences, we used data from the nationally representative Tufts Equity in Health, Wealth, and Civic Engagement Study data (n = 1785; three survey waves 2020–2022 for adults in the United States). Environmental context was assessed using self-reported climate stress and county-level air pollution, greenness, toxic release inventory site, and heatwave data. Self-reported COVID-19 experiences included willingness to vaccinate, health impacts, receiving assistance for COVID-19, and provisioning assistance for COVID-19. Self-reported climate stress in 2020 or 2021 was associated with increased COVID-19 vaccination willingness by 2022 (odds ratio [OR] = 2.35; 95% confidence interval [CI] = 1.47, 3.76), even after adjusting for political affiliation (OR = 1.79; 95% CI = 1.09, 2.93). Self-reported climate stress in 2020 was also associated with increased likelihood of receiving COVID-19 assistance by 2021 (OR = 1.89; 95% CI = 1.29, 2.78). County-level exposures (i.e., less greenness, more toxic release inventory sites, and more heatwaves) were associated with increased vaccination willingness. Air pollution exposure in 2020 was positively associated with the likelihood of provisioning COVID-19 assistance in 2020 (OR = 1.16 per µg/m³; 95% CI = 1.02, 1.32). Associations between certain environmental exposures and certain COVID-19 outcomes were stronger among those who identify as a race/ethnicity other than non-Hispanic White and among those who reported experiencing discrimination; however, these trends were not consistent. A latent variable representing a summary construct for environmental context was associated with COVID-19 vaccination willingness. Our results suggest that intersectional equity issues affecting the likelihood of exposure to adverse environmental conditions are also associated with health-related outcomes. Full article

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19 pages, 1013 KiB

Open AccessSystematic Review

Healthcare Service Utilisation Across Continuum of Care for Type 2 Diabetes Among Culturally and Linguistically Diverse Populations: A Systematic Review

by Mahfuzur Rahman, Resham B Khatri, Sjaan Gomersall, Mosharop Hossian and Asaduzzaman Khan

Int. J. Environ. Res. Public Health 2025, 22(8), 1279; https://doi.org/10.3390/ijerph22081279 - 15 Aug 2025

Viewed by 426

Abstract

Introduction: Healthcare service utilisation for type 2 diabetes (T2D) is suboptimal among people from culturally and linguistically diverse (CALD) backgrounds. Synthesised evidence on drivers influencing their healthcare access and utilisation across the continuum of care (CoC) is scarce. This review synthesised drivers of [...] Read more.

Introduction: Healthcare service utilisation for type 2 diabetes (T2D) is suboptimal among people from culturally and linguistically diverse (CALD) backgrounds. Synthesised evidence on drivers influencing their healthcare access and utilisation across the continuum of care (CoC) is scarce. This review synthesised drivers of accessing and utilising healthcare services across the CoC for T2D from the perspectives of people from CALD backgrounds and their healthcare service providers (HSPs). Methods: Five databases (Scopus, PubMed, Web of Science, CINAHL, and PsycINFO) were searched from inception to November 2023. This review was prospectively registered with PROSPERO (ID: CRD42023491560). The McGill Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of articles included in this systematic review. Studies were included if they were primary research involving people from CALD backgrounds and/or their HSPs, and reported data related to access to and utilisation of services across the CoC. The CoC framework was used to conduct a guided thematic analysis for qualitative findings and narrative synthesis was used to summarise quantitative findings. Results: Thirty-five studies were included: 31 qualitative, 3 quantitative, and 1 mixed-method. Psychosocial (e.g., fear of treatment) and sociocultural barriers (e.g., stigma) were reportedly encountered at diagnosis and initiation of treatment. Language and cultural barriers were expressed by most people with T2D and their HSPs, especially at the monitoring and adherence stages of the CoC. Trusted relationships with HSPs and the cultural competency of the HSPs were facilitators of continued monitoring and adherence and long-term care and management. No barriers or facilitators were identified for decision-making to enter the healthcare systems, screening, and first point of contact aspects of the CoC from the perspectives of either patients or HSPs. Conclusions: Although included articles were heavily skewed towards qualitative studies, the synthesised evidence on factors influencing access to and utilisation of healthcare services for T2D can inform policymaking by highlighting pathways to improved use of healthcare services among these groups. Full article

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

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16 pages, 754 KiB

Open AccessArticle

Thin-Ideal Internalisation and Weight Bias Internalisation as Predictors of Eating Pathology: The Moderating Role of Self-Compassion

by Gillian Montague, Taban Eidipour and Sharon L. Grant

Int. J. Environ. Res. Public Health 2025, 22(8), 1278; https://doi.org/10.3390/ijerph22081278 - 15 Aug 2025

Viewed by 132

Abstract

The internalisation of sociocultural ideals and beliefs about weight and shape has long been recognised as an important predictor of disordered eating. However, thin-ideal internalisation and weight bias internalisation (WBI) are generally examined separately in the literature and within sociocultural models of eating [...] Read more.

The internalisation of sociocultural ideals and beliefs about weight and shape has long been recognised as an important predictor of disordered eating. However, thin-ideal internalisation and weight bias internalisation (WBI) are generally examined separately in the literature and within sociocultural models of eating disorders. Additionally, self-compassion has been identified as a protective factor against disordered eating, but its role in mitigating the impact of the internalisation of these sociocultural ideals and beliefs has not been investigated. The current study aimed to investigate (1) the unique contribution of thin-ideal internalisation and WBI in predicting eating disorder cognitions and behaviours and (2) the role of self-compassion in moderating the relationship between thin-ideal/WBI and eating pathology. Four hundred and seventy-five (475) women completed an anonymous online survey. The results indicated that both thin-ideal internalisation and WBI uniquely contributed to the prediction of eating pathology after controlling for body mass index. Self-compassion buffered the effect of thin-ideal internalisation on restraint and the effect of WBI on eating concern. The results support consideration of both thin-ideal internalisation and WBI in sociocultural models of eating disorders and as targets for eating disorder interventions, particularly those based on self-compassion therapy. Full article

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

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14 pages, 374 KiB

Open AccessArticle

Content Analysis of Assessment Tools Used in Post-Stroke Rehabilitation: A Scoping Review with Linkage to the International Classification of Functioning

by Maria Heloiza Araujo Silva, Thaissa Hamana de Macedo Dantas, Ana Cecília de Medeiros Araújo, Diego de Sousa Dantas, Maria Isabelle de Araújo Dantas, Beatriz Cristina Medeiros de Lucena, Isabelly Cristina Rodrigues Regalado Moura and Aline Braga Galvão Silveira Fernandes

Int. J. Environ. Res. Public Health 2025, 22(8), 1277; https://doi.org/10.3390/ijerph22081277 - 15 Aug 2025

Viewed by 180

Abstract

Stroke rehabilitation requires comprehensive assessments aligned with the International Classification of Functioning, Disability, and Health (ICF) biopsychosocial model. Linking assessment tools to the ICF helps integrate this approach by identifying aspects of functioning they address. This study aimed to analyze the content of [...] Read more.

Stroke rehabilitation requires comprehensive assessments aligned with the International Classification of Functioning, Disability, and Health (ICF) biopsychosocial model. Linking assessment tools to the ICF helps integrate this approach by identifying aspects of functioning they address. This study aimed to analyze the content of the most used assessment tools for post-stroke rehabilitation through systematic linkage with the ICF. A scoping review was conducted, including (1) the identification of clinical trials on post-stroke rehabilitation published between 2014 and 2024 in the PubMed, LILACS, SciELO, and PEDro databases to select the most commonly used assessment tools, followed by (2) the ICF linkage methodology to map the most cited tools to the content of ICF categories and domains. From the 897 studies reviewed, 29 tools were identified—21 were newly linked and 8 had pre-existing ICF links. The analysis identified 261 ICF categories: 53% related to Activities, 31% to Body Functions, 15% to Participation, and 1% to Environmental Factors. No tool covered the Body Structure domain. The findings highlight a focus on Activities and Body Functions, reinforcing the need to integrate Participation and Environmental Factors into post-stroke rehabilitation assessments. The results offer an overview of ICF categories covered by each tool, supporting informed decisions in rehabilitation research and practice. Full article

(This article belongs to the Section Health Care Sciences)

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11 pages, 307 KiB

Open AccessArticle

Risk Factors for Locomotive Syndrome in Brazilian Older Adults: A Nested Case–Control Study

by Julia de Carvalho Galiano, Patricia de Castro Rodrigues, Fania Cristina dos Santos and Virginia Fernandes Moça Trevisani

Int. J. Environ. Res. Public Health 2025, 22(8), 1276; https://doi.org/10.3390/ijerph22081276 - 15 Aug 2025

Viewed by 217

Abstract

This study aimed to describe the risk factors for locomotive syndrome (LS) in Brazilian oldest old individuals. Study subjects were older adults aged ≥80 years who were cognitively healthy, independent for activities of daily living and had been followed since 2011 by a [...] Read more.

This study aimed to describe the risk factors for locomotive syndrome (LS) in Brazilian oldest old individuals. Study subjects were older adults aged ≥80 years who were cognitively healthy, independent for activities of daily living and had been followed since 2011 by a Brazilian cohort study entitled the Longevos Project. A nested case–control study evaluating demographic and clinical characteristics was conducted. Physical tests including the 5 times sit-to-stand, hand-grip strength, 4-m gait speed and two-step test were performed. The World Health Organization Quality of Life Questionnaire short form (WHOQOL-BREF) and Numerical Rating Scale plus Verbal Rating Scale were applied to assess quality of life (QOL) and chronic pain (CP), respectively. LS was diagnosed using the Brazilian version of the 25-question Geriatric Locomotive Function Scale (GLFS-25-p), and sarcopenia by the SARC-F screening tool. The study sample included 52 participants, had a mean age of 89.3 years (±3.9 years) and was predominantly female (76.9%). Of this sample, 24 were diagnosed with LS and 28 were not. The prevalence of osteoporosis (20%), osteoarthritis (22%), depression (13%) and use of a walking device (14%) was higher in the LS group. Participants with LS had worse performance in physical tests. A multivariate logistic regression analysis identified the main risk factors for LS as osteoporosis (OR 10.80, 95%CI 1.08–108.48) and presence of moderate-to-severe chronic musculoskeletal pain (OR 8.92, 95%CI 1.25–63.89). Full article

13 pages, 329 KiB

Open AccessArticle

Consumption of Ultra-Processed Foods and Metabolic Parameters in Type 2 Diabetes Mellitus: A Cross-Sectional Study

by Julia Bauer, Fernanda Oliveira Ayala, Aline Marcadenti, Rachel Helena Vieira Machado, Ângela Cristina Bersch-Ferreira, Maria Fernanda Souza Moreira, Mileni Vanti Beretta, Ana Maria Pandolfo Feoli and Fernanda Michielin Busnello

Int. J. Environ. Res. Public Health 2025, 22(8), 1275; https://doi.org/10.3390/ijerph22081275 - 14 Aug 2025

Viewed by 172

Abstract

Background: Understanding how food processing impacts type 2 diabetes (T2DM) control is essential for disease management. This study aimed to assess the association between ultra-processed food (UPF) consumption, as defined by the NOVA classification, and metabolic parameters in T2DM patients. Methods: This was [...] Read more.

Background: Understanding how food processing impacts type 2 diabetes (T2DM) control is essential for disease management. This study aimed to assess the association between ultra-processed food (UPF) consumption, as defined by the NOVA classification, and metabolic parameters in T2DM patients. Methods: This was a cross-sectional analysis using baseline data from the NUGLIC study, a multicenter randomized clinical trial. Multiple linear and Poisson regressions were used to evaluate associations between quintiles of processed and ultra-processed food consumption and glycated hemoglobin (HbA1c) as the primary outcome. Secondary outcomes included fasting glucose, lipid profile, body mass index (BMI), and waist circumference. Results: This study included 326 participants. UPF consumption accounted for approximately 16.4% of total daily energy intake. No significant linear associations were observed between higher consumption of industrialized foods and anthropometric or glycemic markers. However, intermediate and high consumption levels were associated with an increased total cholesterol (Q3: β = 26.6; Q4: β = 26.7) and LDL-cholesterol (Q4: β = 19.8; Q5: β = 17.5). Conclusion: In T2DM patients, a higher intake of processed and ultra-processed foods was linked to elevated cholesterol and LDL levels. These findings highlight potential cardiovascular risks but do not support causality due to the study’s cross-sectional design. Full article

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

22 pages, 573 KiB

Open AccessArticle

The Effects of Socioeconomic Contextual Factors on Racial Differences in Foster Care Placement Stability

by Leanne Heaton, William Sabol, Miranda Baumann, Arya Harison and Charlotte Goodell

Int. J. Environ. Res. Public Health 2025, 22(8), 1274; https://doi.org/10.3390/ijerph22081274 - 14 Aug 2025

Viewed by 191

Abstract

This study investigated how county- and state-level socioeconomic factors influence racial differences in placement stability outcomes for children in foster care. Using a sample drawn from the Adoption and Foster Care Analysis and Reporting System (AFCARS) covering 2012–2020, we employed linear mixed modeling [...] Read more.

This study investigated how county- and state-level socioeconomic factors influence racial differences in placement stability outcomes for children in foster care. Using a sample drawn from the Adoption and Foster Care Analysis and Reporting System (AFCARS) covering 2012–2020, we employed linear mixed modeling (LMMs) to nest individual- and case-level data within counties and states. Our analysis focused on Black and White children, examining how variables such as poverty, unemployment, public welfare expenditures, residential mobility, and family structure affect the number of placement moves experienced by children. The findings indicated that Black children experience higher rates of placement instability compared to White children, although the gap narrows over time. Key factors associated with improved stability included county-administered child welfare systems and higher rates of multigenerational households and owner-occupied housing, particularly benefiting Black children. In contrast, higher levels of Supplemental Nutrition Assistance Program (SNAP) participation and increased residential mobility were linked to greater instability. The implementation of program improvement plans (PIPs) during the third round of the Child and Family Services Reviews (CFSR-3) produced mixed outcomes, with PIPs contributing to a reduction in the racial gap primarily by increasing placement moves for White children. These findings underscore the importance of analyzing data by race and incorporating broader socioeconomic contexts into child welfare improvement strategies, while also emphasizing the need for localized, context-sensitive approaches to improve placement stability. Full article

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30 pages, 1107 KiB

Open AccessArticle

Prevalence of Antibiotic Resistance Bacteria in Manure, Soil, and Vegetables in Urban Blantyre, Malawi, from a Farm-to-Fork Perspective

by Amon Abraham, Andrew G. Mtewa, Chimwemwe Chiutula, Richard Lizwe Steven Mvula, Alfred Maluwa, Fasil Ejigu Eregno and John Njalam’mano

Int. J. Environ. Res. Public Health 2025, 22(8), 1273; https://doi.org/10.3390/ijerph22081273 - 14 Aug 2025

Viewed by 427

Abstract

The use of untreated livestock manure in urban agriculture sustains soil fertility but risks disseminating antimicrobial resistance (AMR) in resource-limited settings. This study characterized antibiotic-resistant bacteria (ARB) prevalence across manure–soil–vegetable pathways in Blantyre, Malawi. Using a cross-sectional design, we collected 35 samples (poultry/pig [...] Read more.

The use of untreated livestock manure in urban agriculture sustains soil fertility but risks disseminating antimicrobial resistance (AMR) in resource-limited settings. This study characterized antibiotic-resistant bacteria (ARB) prevalence across manure–soil–vegetable pathways in Blantyre, Malawi. Using a cross-sectional design, we collected 35 samples (poultry/pig manure, farm/home soils, Brassica rapa subsp. chinensis, Brassica rapa, and Amaranthus spp.) from five livestock farms. Microbiological analysis with API 20E identification and disk diffusion testing revealed clear differences in contamination: Escherichia coli dominated pig manure (52%) and farm soil (35%), with detection in vegetables suggesting possible transfer (e.g., 20% in Brassica rapa subsp. chinensis), while Klebsiella pneumoniae contaminated all sample types (peak: 60% vegetables and 67% home soils). All manure isolates exhibited sulfamethoxazole–trimethoprim resistance, with 50% of pig manure E. coli showing cefotaxime resistance. Soil isolates mirrored these patterns (100% ampicillin resistance in K. pneumoniae and 77% cefotaxime resistance in farm soil E. coli). Vegetables displayed severe multidrug resistance (100% E. coli and 80% K. pneumoniae resistant to ≥3 classes), including critical gentamicin resistance (100% E. coli). Composting for ≤6 weeks, as practiced on the studied farms, did not eliminate ARBs, suggesting that longer durations may be needed. Notably, this study provides the first phenotypic evidence of presumptive Pasteurella-like organisms on edible leafy vegetables, specifically 45% in Amaranthus spp. and 6.1% in Brassica rapa, suggesting a potential zoonotic transmission route from livestock farms that requires molecular confirmation. These findings demonstrate manure-amended farms as AMR reservoirs, necessitating extended composting and antibiotic stewardship to mitigate One Health risks. Full article

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15 pages, 301 KiB

Open AccessArticle

Assessment of the Syndemic Relationship Between Individual, Social, and Structural Determinants of Tuberculosis Among People Living in Johannesburg, South Africa

by Fiona Tsungirai Tanyanyiwa, Renay Helouise Van Wyk and Keitshepile Geoffrey Setswe

Int. J. Environ. Res. Public Health 2025, 22(8), 1272; https://doi.org/10.3390/ijerph22081272 - 14 Aug 2025

Viewed by 142

Abstract

Tuberculosis (TB) remains a critical public health issue in Johannesburg, South Africa, driven by a complex interplay of individual, social, and structural factors. This study assessed the syndemic relationship between these determinants to understand their collective impact on TB burden and treatment outcomes. [...] Read more.

Tuberculosis (TB) remains a critical public health issue in Johannesburg, South Africa, driven by a complex interplay of individual, social, and structural factors. This study assessed the syndemic relationship between these determinants to understand their collective impact on TB burden and treatment outcomes. A cross-sectional survey was conducted among TB patients attending selected clinics, examining behavioural risks (e.g., smoking, alcohol use, HIV co-infection), social conditions (poverty, overcrowding, stigma), and structural challenges (access to healthcare, migration status). The results revealed a significant co-occurrence of TB and HIV (56.1%), alongside high rates of smoking (33.1%) and alcohol use (45.2%). Unemployment (50.2%), inadequate housing, and limited healthcare access, particularly for undocumented migrants (26.2%), were also prominent. Factor analysis demonstrated a syndemic interaction between behavioural and social determinants, underscoring the compounded vulnerability of affected populations. The findings highlight the necessity of integrating medical interventions with social and structural reforms. Recommendations include TB-HIV co-management, substance abuse programmes, improved housing, and inclusive healthcare access. A multisectoral approach addressing both health and socioeconomic inequalities is critical for comprehensive TB control in urban South African contexts. Full article

13 pages, 465 KiB

Open AccessArticle

Evaluating Breastfeeding Self-Efficacy in Adolescents Attending a Co-Designed Breastfeeding Program: A Prospective Pilot Cohort Study

by Christina M. Cantin, Wendy E. Peterson, Amisha Agarwal, Jemila S. Hamid, Bianca Stortini and Nathalie Fleming

Int. J. Environ. Res. Public Health 2025, 22(8), 1271; https://doi.org/10.3390/ijerph22081271 - 14 Aug 2025

Viewed by 200

Abstract

Adolescents have lower rates of breastfeeding (BF) compared to older mothers. BF self-efficacy (SE) has been identified as an important factor influencing BF outcomes. An innovative BF program for young women was co-designed and implemented, which included staff training, a prenatal BF class, [...] Read more.

Adolescents have lower rates of breastfeeding (BF) compared to older mothers. BF self-efficacy (SE) has been identified as an important factor influencing BF outcomes. An innovative BF program for young women was co-designed and implemented, which included staff training, a prenatal BF class, and BF peer support. The objective of this prospective pilot cohort study was to evaluate the effectiveness of prenatal education and peer support in improving a young mother’s BF SE. Participants were pregnant adolescents recruited from a large urban non-profit social service outreach centre. The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) was administered to participants before and after participating in the BF program. BSES-SF scores were summed to determine a composite score and compared descriptively using median score. Un-aggregated, item-by-item, comparison of pre- versus post-BF program scores were also compared to examine improvements in SE. A total of 20 adolescent mothers (mean age = 16.6) attended the program. An increase in the total BSES-SF score was observed based on descriptively comparing the mean pre- versus post-intervention. Participation in tailored prenatal education classes and a peer-support program was associated with increased BSES-SF. Identifying mothers with low BF SE can enable healthcare professionals to implement targeted interventions in this at-risk population. Full article

(This article belongs to the Special Issue Health Promotion and Interventions for Marginalized Mothers and Children)

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11 pages, 849 KiB

Open AccessArticle

Prevalence of Preterm Birth in a Marginalized Roma Population—Quantitative Analysis in One of the Most Disadvantaged Regions of Hungary

by Kinga Pauwlik and Anita R. Fedor

Int. J. Environ. Res. Public Health 2025, 22(8), 1270; https://doi.org/10.3390/ijerph22081270 - 14 Aug 2025

Viewed by 311

Abstract

Preterm birth is a leading cause of perinatal morbidity and mortality and is particularly prevalent among socially disadvantaged female populations. This quantitative, cross-sectional study aimed to explore the prevalence of preterm birth in three segregated Roma communities in Hungary and to identify health [...] Read more.

Preterm birth is a leading cause of perinatal morbidity and mortality and is particularly prevalent among socially disadvantaged female populations. This quantitative, cross-sectional study aimed to explore the prevalence of preterm birth in three segregated Roma communities in Hungary and to identify health behavior and care factors associated with its occurrence. In our study, preterm birth was defined as delivery before 37 completed weeks of gestation (i.e., <259 days). Data were collected from 231 Roma women living in three municipalities of Szabolcs-Szatmár-Bereg County, one of Hungary’s most disadvantaged regions, using a structured interview questionnaire. The participants were women aged 18–65 years. Of these, 209 had been pregnant at least once in their lifetime. The questionnaire covered socio-demographic characteristics (age, level of education, employment status, housing conditions, marital status), health behaviors (smoking, alcohol consumption, drug use, vitamin supplementation, other substance use), antenatal care attendance, and birth outcomes (preterm birth, gestational age, low birth weight, newborn status). Statistical analyses included descriptive statistics, chi-square tests, and binary logistic regression with significance set at p < 0.05. Preterm birth was significantly more common among women who smoked, consumed alcohol or drugs during pregnancy, or had vaginal infections. Drug use showed the strongest association with a 22-fold increase in risk, followed by alcohol (nearly fivefold), smoking (over threefold), and infections (threefold). Although non-attendance at antenatal care was associated with increased risk, this relationship was not statistically significant. In the multivariate logistic regression model, alcohol consumption (OR = 1.744, p < 0.01), smoking (OR = 2.495, p < 0.01), drug use (OR = 25.500, p < 0.001), and vaginal infections (OR = 4.014, p < 0.01) during pregnancy were independently associated with an increased risk of preterm birth, whereas folic acid supplementation (OR = 0.448, p < 0.05) showed a significant protective effect. These findings highlight that preterm birth is intricately linked to socioeconomic disadvantage and adverse health behaviors. Culture-specific, community-based prevention strategies are essential to reduce perinatal risks in marginalized populations. Full article

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Int. J. Environ. Res. Public Health, Volume 22, Issue 8 (August 2025) – 141 articles

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