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Int. J. Environ. Res. Public Health, Volume 22, Issue 9 (September 2025) – 110 articles

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18 pages, 590 KB  
Article
Latent Profile Analysis of Children’s Active Physical Recreation Patterns in Middle Childhood
by Stephanie C. Field, John T. Foley, Patti-Jean Naylor and Viviene A. Temple
Int. J. Environ. Res. Public Health 2025, 22(9), 1421; https://doi.org/10.3390/ijerph22091421 - 11 Sep 2025
Abstract
Understanding factors that influence physical activity participation in middle childhood is essential for developing effective interventions. To date, many studies have contributed valuable knowledge on the individual, or person-centered, factors that influence participation, such as motor competence and perceived motor competence. However, there [...] Read more.
Understanding factors that influence physical activity participation in middle childhood is essential for developing effective interventions. To date, many studies have contributed valuable knowledge on the individual, or person-centered, factors that influence participation, such as motor competence and perceived motor competence. However, there is an increasing body of literature in support of exploring participation through a broader lens, considering additional social ecological factors and their role in participation. Understanding the development of unique combinations of personal and environmental characteristics can shed light on participation patterns over time. Therefore, the aim of this study is to identify clusters of a longitudinal sample of children in grades 2, 3, 4, and 5 (n = 155; 55% girls) based on: motor skills; perceived physical competence; active physical recreation; and with whom and where participation occurs. Latent profile analysis results revealed a range of clusters within each grade, with a 3-cluster solution in grade 2, a 5-cluster solution in grade 3, a 4-cluster solution in grade 4, and a 6-cluster solution in grade 5. An analysis of the clusters revealed increasingly diverse clusters over time, with some clusters demonstrating paths toward engagement or disengagement in active physical recreation. The variation in clusters across grades indicates increasing diversity in personal and environmental factors through middle childhood. Recognizing this diversity can allow for teachers, coaches, and instructors to employ instructional styles to accommodate individuals’ differences and maximize participation in a range of physical activity contexts. Full article
28 pages, 821 KB  
Article
Psychological Dimensions of Professional Burnout in Special Education: A Cross-Sectional Behavioral Data Analysis of Emotional Exhaustion, Personal Achievement, and Depersonalization
by Paraskevi-Spyridoula Alexaki, Hera Antonopoulou, Evgenia Gkintoni, Nikos Adamopoulos and Constantinos Halkiopoulos
Int. J. Environ. Res. Public Health 2025, 22(9), 1420; https://doi.org/10.3390/ijerph22091420 - 11 Sep 2025
Abstract
Background and Objectives: Professional burnout threatens special education teachers’ well-being and educational service quality through three psychological dimensions: emotional exhaustion, depersonalization, and personal achievement. Limited studies have employed behavioral data analysis to examine burnout patterns in special education and their relationships with demographic [...] Read more.
Background and Objectives: Professional burnout threatens special education teachers’ well-being and educational service quality through three psychological dimensions: emotional exhaustion, depersonalization, and personal achievement. Limited studies have employed behavioral data analysis to examine burnout patterns in special education and their relationships with demographic factors and contemporary stressors. This study aimed to (1) identify burnout levels among Greek special education teachers, (2) determine demographic risk factors, and (3) examine relationships between burnout dimensions and COVID-19 psychological impact. Materials and Methods: A cross-sectional study surveyed 114 special education teachers from Achaia and Aitoloakarnania prefectures, Greece (response rate: 87.7%), using the Maslach Burnout Inventory–Educators Survey (MBI-ES) and demographic questionnaires. Behavioral data analysis integrates traditional statistics with advanced techniques, including cluster analysis and classification modeling. Results: Four distinct burnout profiles emerged: Low Burnout (36.8%), Moderate Emotional Exhaustion (30.7%), High Risk (21.9%), and Depersonalization-Dominant (10.5%). Overall burnout prevalence was low, with 73.7% showing minimal depersonalization and 67.5% maintaining high personal achievement. Employment status emerged as the strongest predictor of burnout risk. Emotional exhaustion was the primary predictor of COVID-19 psychological impact (r = 0.547, p < 0.001), explaining 29.9% of pandemic-related distress variance. Male substitute teachers demonstrated the highest vulnerability to depersonalization, while experienced female permanent teachers showed resilience patterns. Conclusions: Behavioral data analysis revealed distinct burnout patterns enabling personalized interventions. Emotional exhaustion serves as both a key vulnerability factor and primary intervention target. These findings support targeted approaches to occupational health with implications for educational policy. Limitations include cross-sectional design and regional sampling. Future longitudinal studies should validate these patterns across diverse educational contexts. Full article
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17 pages, 262 KB  
Article
Drivers of and Barriers to Behavioural Change to Support Public Health and Social Wellbeing in Mbire District, Zimbabwe
by Davison Munodawafa, Pepukai Manjeru and Lioyd Goronga
Int. J. Environ. Res. Public Health 2025, 22(9), 1419; https://doi.org/10.3390/ijerph22091419 - 11 Sep 2025
Abstract
Foundational behaviours across health, education, sanitation, and energy use remain suboptimal in Mbire District, Zimbabwe. This qualitative formative study examined drivers of and barriers to five priority behaviours: birth notification and registration (BNR), exclusive breastfeeding (EBF), early childhood development education (ECDE), open-defecation-free (ODF) [...] Read more.
Foundational behaviours across health, education, sanitation, and energy use remain suboptimal in Mbire District, Zimbabwe. This qualitative formative study examined drivers of and barriers to five priority behaviours: birth notification and registration (BNR), exclusive breastfeeding (EBF), early childhood development education (ECDE), open-defecation-free (ODF) practices, and efficient use of energy (EUE). Between 15 January and 30 March 2023, we conducted 15 focus group discussions (n = 180 participants) and 20 key informant interviews (n = 20 participants). Data were thematically analysed in QDA Miner 6 (Cohen’s κ = 0.82). Drivers of positive behaviours included leadership support, peer networks, and radio/village meetings, while barriers included bureaucratic requirements, cultural norms, and financial constraints. We recommend a multi-sectoral Social and Behavioural Change (SBC) approach integrating community events, subsidies, and culturally sensitive communication. These findings provide actionable evidence to inform district-level programming and contribute to achieving Zimbabwe’s national development targets and relevant Sustainable Development Goals. Full article
(This article belongs to the Special Issue Health Inequalities in Primary Care)
13 pages, 708 KB  
Article
Differences in Posture, Neck Angle, and Body Discomfort During Various Electronic Device Usage with Virtual Classroom
by Roongnapa Intaruk and Praphatson Sengsoon
Int. J. Environ. Res. Public Health 2025, 22(9), 1418; https://doi.org/10.3390/ijerph22091418 - 11 Sep 2025
Abstract
Background: Prolonged use of electronic devices in virtual classrooms can influence posture, neck angle, and body discomfort. Recent evidence suggests that not only “incorrect” postures but also sustained static positions, regardless of being ergonomically correct, contribute to musculoskeletal strain. However, limited studies have [...] Read more.
Background: Prolonged use of electronic devices in virtual classrooms can influence posture, neck angle, and body discomfort. Recent evidence suggests that not only “incorrect” postures but also sustained static positions, regardless of being ergonomically correct, contribute to musculoskeletal strain. However, limited studies have directly compared posture and discomfort across different types of devices in a virtual classroom setting. Objective: To evaluate differences in posture, neck angle, and body discomfort among female university students during the use of three electronic devices (smartphone, tablet, notebook) in a virtual classroom for 20 min. Methods: Twenty-four healthy female participants (aged 18–23 years) completed three randomized sessions using a smartphone, tablet, or notebook in a virtual classroom task. Posture was assessed using the Rapid Upper Limb Assessment (RULA), neck angle was measured via motion analysis, and body discomfort was rated with a standardized visual analog scale. Statistical analyses were performed using repeated-measures ANOVA with Bonferroni correction, with effect sizes reported. Results: Significant differences were observed in posture (RULA scores: smartphone 5.12 ± 1.26; tablet 4.62 ± 1.35; notebook 4.21 ± 1.32, p < 0.05), neck angle (smartphone 32.48 ± 11.81 and tablet 36.93 ± 7.97, p > 0.05; notebook 39.30 ± 7.82, p > 0.05), and body discomfort of all regions (VAS: smartphone 1.08 ± 1.69; tablet 1.06 ± 1.75; notebook 1.01 ± 1.66, p < 0.05). Although all devices induced discomfort after 20 min of sustained posture, the smartphone condition showed the greatest neck flexion and discomfort. Conclusion: This study demonstrates that sustained posture during virtual classroom activities leads to increased neck angle deviation and body discomfort, with device type influencing the magnitude of these effects. These findings highlight the importance of postural variability and active breaks, rather than relying solely on maintaining a “correct” posture, to reduce musculoskeletal strain in technology-based learning environments. Full article
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22 pages, 3570 KB  
Review
Sex and Gender Influences on the Impacts of Disasters: A Rapid Review of Evidence
by Carol Muñoz-Nieves, Lorraine Greaves, Ella Huber, Andreea C. Brabete, Lindsay Wolfson and Nancy Poole
Int. J. Environ. Res. Public Health 2025, 22(9), 1417; https://doi.org/10.3390/ijerph22091417 - 11 Sep 2025
Abstract
Both sex-related factors and gender-related factors affect the immediate and long term mental and physical health impacts of disasters, including those resulting from public health emergencies, climate-related events, and naturally occurring phenomena. These include sex-specific biological, physiological and genetic processes, mechanisms underlying reproduction, [...] Read more.
Both sex-related factors and gender-related factors affect the immediate and long term mental and physical health impacts of disasters, including those resulting from public health emergencies, climate-related events, and naturally occurring phenomena. These include sex-specific biological, physiological and genetic processes, mechanisms underlying reproduction, disease outcomes, and stress, immune, and trauma responses. Gendered factors such as roles, relations, identity, and institutional policies that have an impact on caregiving, occupation, gender-based violence, and access to healthcare, also influence the impacts of disasters and emergencies. Sex/gender factors interact with a range of social determinants to affect the equitability of impacts. A rapid review was conducted to examine evidence from Australia, Canada, countries from the European Union, New Zealand, the United Kingdom (UK), and the United States of America (USA) on the influence of sex- and gender-related factors in the context of disasters, such as COVID-19, earthquakes, floods, hurricanes, and wildfires. This article describes and categorizes this evidence with attention to real-world impacts of the interactions between sex, gender, and other equity related factors. Broad considerations for improving research and practices to support more sex and gender research in this area and ultimately, to improve emergency and disaster management, are discussed. Full article
(This article belongs to the Section Environmental Health)
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13 pages, 291 KB  
Article
Effectiveness of Ethnic-Cultural Educational Strategies for the Promotion of Breastfeeding
by José Fabián Hidrobo-Guzmán, Gladys Edelmira Morejón-Jácome, Edison Daniel Cárdenas-Robles, Lizbeth Dayana Pilco-Vargas, Doménica Vanesa Posso López and Estefany Tatiana Iguago Angamarca
Int. J. Environ. Res. Public Health 2025, 22(9), 1416; https://doi.org/10.3390/ijerph22091416 - 11 Sep 2025
Abstract
Introduction: The implementation of pedagogical tactics with ethnic-cultural approaches represents essential mechanisms for promoting breastfeeding, ensuring greater effectiveness in knowledge dissemination. These are supported by cultural ideologies that integrate didactic processes tailored to the beliefs and practices of each ethnic group, thus facilitating [...] Read more.
Introduction: The implementation of pedagogical tactics with ethnic-cultural approaches represents essential mechanisms for promoting breastfeeding, ensuring greater effectiveness in knowledge dissemination. These are supported by cultural ideologies that integrate didactic processes tailored to the beliefs and practices of each ethnic group, thus facilitating greater acceptance and adherence to health recommendations. Objective: The study aims to analyze the effectiveness of culturally sensitive educational strategies from the prenatal stage at the Quiroga Health Center, Ecuador, exploring how indigenous cultural dynamics influence the receptivity of education. Methodology: The research is quantitative, quasi-experimental, and employs a descriptive, documentary, bibliographic, and analytical cross-sectional cohort design to thoroughly analyze collected data and identify cause-and-effect factors influencing breastfeeding knowledge and practice. Results: The effectiveness of the educational intervention in promoting cognitive awareness of breastfeeding was confirmed using the McNemar statistic applied to related samples. Conclusions: Breastfeeding knowledge levels are closely tied to reproductive history, a constantly evolving process affected by various social factors. Health education is implemented and strengthened through teaching programs as these strategies can significantly contribute to maternal and child health promotion, adapting to the specific needs and contexts of each community. Full article
13 pages, 614 KB  
Article
Radiological Findings of Chest X-Rays During the Hajj Seasons 1444–1445 H/2023–2024 G: Diagnostic Quality and Gender Differences in Interpretation Concordance
by Ghadah Sulaiman Alsaleh, Abdulaziz Almosabahi, Abdulaziz S. Alhomod, Mohamed Elgaria, Haifa Alharbi, Mohamed Sabry, Mohammed Elttanikhy, Ebtsam Kamal, Hassel Mohammed Alasmary, Khalid Alsuhaibani, Fahad A. Alamri, Reem Hasan and Anas Khan
Int. J. Environ. Res. Public Health 2025, 22(9), 1415; https://doi.org/10.3390/ijerph22091415 - 11 Sep 2025
Abstract
Background: Mass gatherings like the Hajj pilgrimage present unique challenges for radiological services, with high patient volumes and increased respiratory disease risks necessitating reliable chest X-ray interpretation. Objectives: The objective of this study is to assess the diagnostic quality, abnormality rates, [...] Read more.
Background: Mass gatherings like the Hajj pilgrimage present unique challenges for radiological services, with high patient volumes and increased respiratory disease risks necessitating reliable chest X-ray interpretation. Objectives: The objective of this study is to assess the diagnostic quality, abnormality rates, and peer-review concordance of chest X-rays in patients transferred during the Hajj seasons of 1444–1445 H/2023–2024 G, with an additional focus on gender-based differences in radiological interpretation. Methods and Materials: A cross-sectional analysis of 2093 chest X-rays from Hajj healthcare facilities was conducted. Two blinded radiologists independently reinterpreted images using standardized criteria. Data included demographic variables, radiographic findings (quality, opacities, nodules, cardiomegaly, effusions), and tuberculosis likelihood. Results: Among interpretable films (89.7% acceptable quality), 69.2% showed abnormalities, primarily opacities (56.4%) and cardiomegaly (27.0%). Tuberculosis was considered probable by radiographic appearance in 21.0% of cases. Peer review demonstrated 94.2% overall concordance. Regression analysis identified the presence of any abnormality (OR = 10.67, p < 0.001) and female gender (OR = 2.97, p = 0.003) as significant independent predictors of interpretive discordance. A trend towards higher discordance was noted for pulmonary nodules, though it was not statistically significant (9.4% vs. 5.6%, p = 0.062). Conclusions: While chest X-rays proved reliable for Hajj screening, gender disparities in interpretation and challenges in certain assessments, such as nodule evaluation, highlight opportunities to refine radiological protocols in mass gatherings. Full article
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12 pages, 417 KB  
Article
The Use of Telerehabilitation Among Libyan Physiotherapists During the COVID-19 Pandemic: A Cross-Sectional Study
by Sami Elmahgoub, Adel El Taguri, Amira Ben Said, Farah Abu Khadra, Aseel Aburub and Ákos Levente Tóth
Int. J. Environ. Res. Public Health 2025, 22(9), 1414; https://doi.org/10.3390/ijerph22091414 - 10 Sep 2025
Abstract
Background: The COVID-19 pandemic has significantly disrupted healthcare delivery globally, particularly affecting physiotherapy practices that rely on close patient interactions. Objectives: This study investigates the knowledge and readiness of Libyan physiotherapists to adopt telerehabilitation during the pandemic. Methodology: A cross-sectional [...] Read more.
Background: The COVID-19 pandemic has significantly disrupted healthcare delivery globally, particularly affecting physiotherapy practices that rely on close patient interactions. Objectives: This study investigates the knowledge and readiness of Libyan physiotherapists to adopt telerehabilitation during the pandemic. Methodology: A cross-sectional questionnaire-based study was conducted on a total of 109 physiotherapists who were recruited through convenience sampling from public and private hospitals, with a demographic distribution of 54 males and 55 females, aged 25 to 55 years. Results: Approximately 64% of physiotherapists reported being impacted by COVID-19. Among the participants, 67.9% indicated they had limited knowledge of telerehabilitation, whereas only 32.1% were familiar with the concept. Of those who were knowledgeable, only 57.1% had actually practiced telerehabilitation, and just 35% successfully integrated it into their patient management strategies. Key barriers to implementation included poor internet connectivity (71.6%) and high technology costs (38.5%). Conclusions: Our study highlights the importance of telerehabilitation for the future of physical therapy, particularly for patients with chronic conditions. Proper staff training, robust IT infrastructure, and patient education are all essential for enhancing the quality of service physiotherapists deliver in today’s evolving healthcare landscape. Full article
14 pages, 306 KB  
Article
Association Between Adverse Childhood Experiences, Intimate Partner Violence, and Nutritional Inadequacy Among Women in an Urban Brazilian Setting
by Nathália Miguel Teixeira Santana and Franciéle Marabotti Costa Leite
Int. J. Environ. Res. Public Health 2025, 22(9), 1413; https://doi.org/10.3390/ijerph22091413 - 10 Sep 2025
Abstract
Adult women’s nutritional status reflects a complex interplay of biological, social, and environmental determinants. This study aimed to analyze the association between adverse childhood experiences (ACEs), intimate partner violence (IPV), and inadequate nutritional status among women in Vitória, Espírito Santo, Brazil. We conducted [...] Read more.
Adult women’s nutritional status reflects a complex interplay of biological, social, and environmental determinants. This study aimed to analyze the association between adverse childhood experiences (ACEs), intimate partner violence (IPV), and inadequate nutritional status among women in Vitória, Espírito Santo, Brazil. We conducted a cross-sectional, population-based survey with 1.073 women aged 18 years or older. The body mass index (BMI) is categorized into adequate weight and inadequate weight, with the latter comprising excess weight and extremes of weight (underweight or obesity). Experience of violence was measured with ACEs and IPV. Logistic regression analyses were performed to identify associations, adjusting for sociodemographic variables. Women who reported ACEs, such as parental divorce/separation and living with family members who used alcohol, illicit drugs, or prescription drugs, were 1.4 times more likely to be excess weight compared with those who did not experience ACEs (OR = 1.37; 95%CI:1.02–1.83; p = 0.035 and OR = 1.35; 95%CI:1.01–1.80; p = 0.041, respectively). Among those with extreme BMI values, the association with parental divorce/separation also remained significant after adjustment (OR = 1.59; 95%CI: 1.13–2.25; p = 0.009). These findings suggest that ACEs have lasting effects throughout life, influencing body weight in adult women and contributing to inadequate dietary status at both the lower and upper limits. Full article
(This article belongs to the Special Issue The Management of Nutrition and Obesity: Second Edition)
11 pages, 1441 KB  
Article
Occupational Exposure to Diesel Particulate Matter in Western Australian Mining: A Retrospective Analysis and Challenges to Future Compliance
by Matthew Oosthuizen, Kerry Staples, Adelle Liebenberg, Kiam Padamsey, Marcus Cattani, Andy McCarthy and Jacques Oosthuizen
Int. J. Environ. Res. Public Health 2025, 22(9), 1412; https://doi.org/10.3390/ijerph22091412 - 10 Sep 2025
Abstract
De-identified diesel particulate matter (DPM) exposure data (n = 24,459) was obtained from the Western Australian mining regulator to assess compliance with the current Workplace Exposure Standard (WES) of 0.1 mg/m3, measured as submicron elemental carbon, and a proposed limit [...] Read more.
De-identified diesel particulate matter (DPM) exposure data (n = 24,459) was obtained from the Western Australian mining regulator to assess compliance with the current Workplace Exposure Standard (WES) of 0.1 mg/m3, measured as submicron elemental carbon, and a proposed limit of 0.01 mg/m3, assessed as respirable elemental carbon. R and R-Studio were used to generate summary statistics comparing compliance to the current and proposed limits, stratified by industry and occupational groups. To examine temporal trends, a zero-adjusted gamma model was used to assess whether expected sample means changed over the past ten years, using commodity and location as covariates. DPM exposures have declined significantly over the past decade, and modelling indicates compliance with the current WES. However, the proposed limit introduces both a lower limit and a different sampling method, which present challenges. The sector most affected by these changes is underground gold mining. Several occupational groups, such as ground/roof support, shotfirer, long hole drill and blast, and production and services, are at highest risk of non-compliance. Meeting future exposure limits will require enhanced control strategies, including, cleaner fuels, reduction or elimination of diesel-powered machinery in underground operations and appropriate and regulated use of respiratory protective equipment when assessing compliance. Full article
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12 pages, 828 KB  
Article
Quality over Quantity: The Association Between Daily Social Interactions and Loneliness
by Siyun Peng and Adam R. Roth
Int. J. Environ. Res. Public Health 2025, 22(9), 1411; https://doi.org/10.3390/ijerph22091411 - 10 Sep 2025
Abstract
Understanding what aspects of daily life protect against loneliness is increasingly important for promoting well-being among older adults. This study investigates how different types of everyday social interactions are associated with chronic loneliness. We analyze data that were collected via in-home surveys and [...] Read more.
Understanding what aspects of daily life protect against loneliness is increasingly important for promoting well-being among older adults. This study investigates how different types of everyday social interactions are associated with chronic loneliness. We analyze data that were collected via in-home surveys and an ecological momentary assessment module from a probability-based sample of 272 adults aged 55 and older residing in Indiana. Participants were prompted four times per day over the course of seven days to report on their current activities and social experiences. Contrary to common assumptions, the quantitative measures of daily social interactions, such as the proportion of moments spent alone, the proportion of moments spent socializing, and the mean number of interaction partners during the study period were not significantly related to loneliness. However, the qualitative measures of social interactions—specifically, the presence of bonding social capital (e.g., emotional closeness) and the absence of stressful interactions—were associated with lower levels of loneliness. These findings underscore the importance of emotionally meaningful engagement and social strain over the sheer frequency or quantity of interactions, suggesting that the quality of daily social experiences is a key factor in supporting mental well-being in later life. Full article
(This article belongs to the Section Behavioral and Mental Health)
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14 pages, 1144 KB  
Article
Green Landscapes of Care: The Potential of Gardens to Support the Well-Being of Asylum Seekers in Ireland
by Felicity Daly, Sally Ann Lenehan and Jacqui O’Riordan
Int. J. Environ. Res. Public Health 2025, 22(9), 1410; https://doi.org/10.3390/ijerph22091410 - 10 Sep 2025
Abstract
Engaging vulnerable migrants in nature-based activities demonstrates that access to green space can provide a safe place to process trauma, allowing vulnerable forced migrants to enhance their sense of subjective well-being, to breathe and to be. Framed by the feminist ethics of care [...] Read more.
Engaging vulnerable migrants in nature-based activities demonstrates that access to green space can provide a safe place to process trauma, allowing vulnerable forced migrants to enhance their sense of subjective well-being, to breathe and to be. Framed by the feminist ethics of care concept of ‘universal care’, this qualitative study utilised semi-structured interviews, focus group discussion and participant observation to explore asylum seekers’ opportunities for giving and receiving care for people and planet in green spaces outside of institutional international protection accommodation, particularly among those who have access to community gardens. This research contributes to understanding the multigenerational benefits of green space and the potential of forms of horticultural therapy to support the health and well-being of vulnerable forced migrants of all ages. This research has implications for how care for international protection applicants could be enhanced in Ireland and elsewhere through expanding access to safe and inclusive green spaces. It provides a model of a landscape of care support mitigation of pre- and post-migration trauma and mental stress. Full article
(This article belongs to the Special Issue Migrant Health and Newly Emerging Public Health Issues)
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17 pages, 400 KB  
Article
Evaluating Indigenous Identity and Stress as Potential Barriers to Accessing On-Campus Healthcare for Indigenous Students at a Large Southwestern University
by William O. Carson, Michelle Valenti, Kendrick Begay, Scott Carvajal, Stephanie Russo Carroll, Nicole P. Yuan and Felina M. Cordova-Marks
Int. J. Environ. Res. Public Health 2025, 22(9), 1409; https://doi.org/10.3390/ijerph22091409 - 10 Sep 2025
Abstract
Introduction: This study examined the relationship between Indigenous identity, perceived stress, and healthcare utilization for Indigenous students on-campus. Methods: Potential participants included undergraduate and graduate Indigenous students from Tribal Nations within the United States. Participants were recruited through community partnerships and in person [...] Read more.
Introduction: This study examined the relationship between Indigenous identity, perceived stress, and healthcare utilization for Indigenous students on-campus. Methods: Potential participants included undergraduate and graduate Indigenous students from Tribal Nations within the United States. Participants were recruited through community partnerships and in person communication. This survey included the Perceived Stress Scale (PSS-10), the Multiethnic Identity Measure (MEIM), and university Campus Health Service Health and Wellness Survey. Results: 153 Indigenous students from United States-based Tribal Nations participated in this survey. While there appears to be a relationship between Indigenous identity, perceived stress, and Campus Health utilization, the results were not significant for the second tertile (OR: 1.1 (0.4, 2.7)) or third tertile (1.4 (0.5, 3.3)). Students who reported “Yes” or “Unsure” to questions on if their insurance needed them to go outside of the university were far less likely to use Campus Health (Yes OR: 0.2 (0.08–0.5)); (Unsure OR: 0.09 (0.03–0.3)) and CAPS (Yes OR: 0.2 (0.09–0.6)); (Unsure OR: 0.2 (0.04–0.4)). Discussion: This study saw a complex relationship between Indigenous identity, perceived stress, and campus health utilization; however, the findings are not statistically significant. There are distinctions in on campus health care usage when adjusting for undergraduate or graduate student status and health insurance literacy. Conclusion: The research findings offer many promising avenues for future work around Indigenous identity, affordability of healthcare, and importance of health literacy. Full article
(This article belongs to the Special Issue Advances in Indigenous and American Indian and Alaska Native Health and Wellness: 2nd Edition)
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14 pages, 707 KB  
Systematic Review
Health Effects from Secondhand Exposure to E-Cigarettes: A Systematic Review of Peer-Reviewed Articles from 2004–2024
by Roengrudee Patanavanich, Chawaphat Thatasawakul, Kamolnut Youngcharoen, Veerapattra Soponvashira and Panpetch Pichetsin
Int. J. Environ. Res. Public Health 2025, 22(9), 1408; https://doi.org/10.3390/ijerph22091408 - 10 Sep 2025
Abstract
Background: Since the emergence of e-cigarettes on the market in the early 2000s, the prevalence of e-cigarette use has increased globally. The health risks of using e-cigarettes have been increasingly revealed; however, the health effects on non-users exposed to e-cigarettes are less [...] Read more.
Background: Since the emergence of e-cigarettes on the market in the early 2000s, the prevalence of e-cigarette use has increased globally. The health risks of using e-cigarettes have been increasingly revealed; however, the health effects on non-users exposed to e-cigarettes are less known. Methods: A systematic review was conducted of peer-reviewed articles from 2004 to October 2024 from PubMed and Embase. We focused on the studies that described health outcome measures among non-smokers/vapers exposed to secondhand e-cigarettes. We excluded animal studies and those that did not include human participants. We also omitted studies with financial conflicts of interest with the tobacco industry. Results: Of the 8635 studies we found in our search, 16 were included in the final review. Study designs included in our review included a case study, a cohort, eight experimental, four cross-sectional studies, and two observational studies. Health outcome measures were self-reported health symptoms and biomarkers. Ten out of fourteen studies examined respiratory health risks, six described immunological effects, two examined cardiovascular risks, and one explored mental health effects. Self-reported health symptoms such as bronchitis, shortness of breath, asthma, throat irritations, ear infections, and mental health disorders were observed among secondhand e-cigarette exposures when compared with controls. Biomarker measures varied among studies, except for cotinine concentrations of non-smokers/vapers exposed to secondhand e-cigarettes, which were likely to be higher than non-exposed. However, all studies encountered potential limitations. Conclusions: Our review found that secondhand e-cigarette exposure is not harmless and may have negative health consequences. However, higher-quality prospective studies remain essential to examine long-term secondhand exposure. Full article
(This article belongs to the Section Environmental Health)
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15 pages, 291 KB  
Article
Oral Health in Young Adults: The Impact of Socioeconomic Factors and Health Literacy
by Lene Marita Steinvik, Gro Eirin Holde and Linda Maria Stein
Int. J. Environ. Res. Public Health 2025, 22(9), 1407; https://doi.org/10.3390/ijerph22091407 - 9 Sep 2025
Abstract
Oral diseases remain prevalent, although most of them can be prevented. Oral health inequities represent a critical problem of social injustice worldwide. Health literacy has emerged as a potential determinant of oral health disparities, comparable in impact to socioeconomic factors. This study explored [...] Read more.
Oral diseases remain prevalent, although most of them can be prevented. Oral health inequities represent a critical problem of social injustice worldwide. Health literacy has emerged as a potential determinant of oral health disparities, comparable in impact to socioeconomic factors. This study explored the impact of socioeconomic factors and health literacy on oral health in young adults in Norway using data from the third wave of the Fit Futures study (n = 705), which included questionnaires and clinical oral examinations. Measures included self-reported oral health, oral health-related quality of life (OIDP-8), caries experience (DMFT), gingivitis (BOP), health literacy (HLS-Q12) and socioeconomic factors. Multivariable logistic regression analyses showed that lower health literacy was associated with poorer self-reported oral health (OR: 0.95, 95% CI: 0.93–0.98) and lower oral health-related quality of life (OR: 0.94, 95% CI: 0.90–0.98). Higher health literacy was associated with a greater caries experience (OR: 1.05, 95% CI: 1.01–1.09). Lower educational attainment was associated with less favorable outcomes across all oral health measures (OR: 1.7–2.6, all p < 0.05). These findings suggest that both health literacy and education influence oral health. Interventions aimed at enhancing health literacy and reducing barriers should be tested to empower young people and support their long-term oral health. Full article
(This article belongs to the Special Issue Reducing Health Disparities: The Role of Health Literacy and Health Promotion)
10 pages, 400 KB  
Article
Bacterial Contamination in Dental Unit Water Lines at Primary Health Care Centers (2022–2023): A Nationwide Study
by Abrar Jamal and Eiman Alawadhi
Int. J. Environ. Res. Public Health 2025, 22(9), 1406; https://doi.org/10.3390/ijerph22091406 - 9 Sep 2025
Abstract
Background: Dental unit water lines (DUWLs) can harbor microbial contamination, posing risks for cross-infection to patients and dental staff. This study assessed the prevalence of bacterial contamination in DUWLs at primary healthcare centers in Kuwait during 2022–2023 and examined variation by year, governorate, [...] Read more.
Background: Dental unit water lines (DUWLs) can harbor microbial contamination, posing risks for cross-infection to patients and dental staff. This study assessed the prevalence of bacterial contamination in DUWLs at primary healthcare centers in Kuwait during 2022–2023 and examined variation by year, governorate, and sampling outlet. Methods: A retrospective cross-sectional analysis was conducted using 3290 water test results from six governorates. Data were obtained from the Environmental Health Department, Ministry of Health, and analyzed using STATA 17. Contamination was defined as a total plate count (TPC) > 100 CFU/mL or presence of coliforms, Escherichia coli, Pseudomonas aeruginosa, or fecal streptococci. Descriptive and logistic regression analyses were performed. Results: Overall contamination prevalence was 16.8%. Rates were higher in 2023 (19.8%) than in 2022 (13.7%) and higher in Mubarak Alkabeer governorate (23%) and cup filler outlets (18.9%). Logistic regression showed significantly increased odds of contamination in 2023 (OR = 1.6; 95% CI: 1.3–2.0), Mubarak Alkabeer (OR = 1.4; 95% CI: 1.1–1.9), and cup fillers (OR = 1.3; 95% CI: 1.1–1.6). P. aeruginosa was detected in 1.3% of samples. Conclusions: One in six DUWL samples exceeded Kuwait’s strict microbial safety threshold. Findings highlight spatial and procedural variations in contamination and underscore the need for enhanced disinfection protocols, preventive maintenance, and targeted staff training to ensure waterline safety. Full article
(This article belongs to the Section Environmental Health)
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8 pages, 264 KB  
Brief Report
Mentalization in Asylum Seekers with Post-Traumatic Stress Disorder
by Massimiliano Aragona, Marcella Cavallo, Federica Ferrari, Giovanna Laurendi and Gianluca Nicolella
Int. J. Environ. Res. Public Health 2025, 22(9), 1405; https://doi.org/10.3390/ijerph22091405 - 9 Sep 2025
Abstract
This study explores the relationship between post-traumatic stress disorder (PTSD) and the two major dimensions of mentalization (self and other-oriented) in asylum seekers resettled in Italy. It is important because it is the first study addressing the role of mentalization in asylum seekers [...] Read more.
This study explores the relationship between post-traumatic stress disorder (PTSD) and the two major dimensions of mentalization (self and other-oriented) in asylum seekers resettled in Italy. It is important because it is the first study addressing the role of mentalization in asylum seekers with PTSD. Twenty asylum seekers scoring above the cut-off for the PTSD Checklist for DSM-5 (PCL-5) were contrasted to twenty asylum seekers without PTSD on mentalization and somatization. The Certainty About Mental States Questionnaire (CAMSQ) and the Bradford Somatic Inventory (BSI-21) were used to assess mentalization and somatization, respectively. Pearson correlations and multiple regression analyses were conducted to examine the overall association between variables. Asylum seekers with PTSD had significantly higher scores than those without PTSD on somatization (p = 0.03), and significantly lower scores on self-oriented mentalization (p < 0.05) than those without PTSD. These results show that asylum seekers with PTSD have reduced self-oriented mentalizing abilities, while the other-oriented component of mentalization appears less involved. This study shows that mentalization deserves more research for the possibly crucial role of reduced self-oriented mentalization in asylum seekers’ suffering. If these findings are confirmed by future studies, they could be used to tailor interventions for asylum seekers and refugees with PTSD. Full article
(This article belongs to the Special Issue Global Migrants and Refugees: Recent Trends, Health Inequities and Aging)
11 pages, 256 KB  
Article
MMR Vaccination Coverage and Epidemiological Patterns in Al-Baha, Saudi Arabia, 2020–2024: Analysis of Suspected and Laboratory-Confirmed Cases
by Anwar Alomari and Mona Al-Qahtani
Int. J. Environ. Res. Public Health 2025, 22(9), 1404; https://doi.org/10.3390/ijerph22091404 - 8 Sep 2025
Abstract
Background: High national MMR coverage in Saudi Arabia coexists with sporadic measles, mumps, and rubella cases. Local data are needed to describe vaccination coverage among the reported cases and patterns of laboratory-confirmed infections. Objectives: This study was conducted to describe MMR vaccination coverage [...] Read more.
Background: High national MMR coverage in Saudi Arabia coexists with sporadic measles, mumps, and rubella cases. Local data are needed to describe vaccination coverage among the reported cases and patterns of laboratory-confirmed infections. Objectives: This study was conducted to describe MMR vaccination coverage among the reported suspected cases and patterns of laboratory-confirmed measles, mumps, and rubella in Al-Baha, Saudi Arabia, from January 2020 to August 2024, and to examine associations between demographics, residence, vaccination status, and case classification. Methods: We conducted a retrospective analysis of surveillance records from the Al-Baha Communicable Disease Reporting System. We summarized the demographics, vaccination history, and final classification for 295 reported suspected cases. Inferential analyses (chi-square and logistic regression) used laboratory-confirmed cases only. Statistical significance was p < 0.05. Results: Of 295 reported suspected cases, 239 (81.0%) were discarded after investigation, and 52 (17.6%) were confirmed (including 50 laboratory-confirmed and two epidemiologically confirmed), with 3 (1.0%) remaining under review at analysis. Among all reported cases, the vaccination status was ≥2 doses, 57.6% (n = 170), one dose, 19.0% (n = 56), and unvaccinated/unknown, 23.4% (n = 69). Among the laboratory-confirmed infections, measles was clustered in unvaccinated/unknown, mumps was clustered in single-dose recipients, and rubella was in ≥2-dose recipients. In multivariable models, males had higher odds of a laboratory-confirmed infection, and rural residence was associated with increased odds. The confidence intervals were wide due to small numbers. Conclusions: Reported surveillance data show persistent laboratory-confirmed MMR infections in Al-Baha with demographic and geographic disparities. The findings support targeted efforts to complete two-dose schedules, strengthen rural access, and improve immunization record systems. The results are associations and not causal measures of vaccine effectiveness, and should be interpreted in light of small confirmed case counts. Full article
(This article belongs to the Section Global Health)
22 pages, 1429 KB  
Article
The Structure of Demand, Control, and Stability-Support Underlying the Job Content Questionnaire (JCQ) 2.0—An Innovative Tool for Assessing Multilevel Work Characteristics
by Maren Formazin, BongKyoo Choi, Maureen F. Dollard, Jian Li, Sarven S. McLinton, Wilfred Agbenyikey, Sung-il Cho, Irene Houtman and Robert Karasek
Int. J. Environ. Res. Public Health 2025, 22(9), 1403; https://doi.org/10.3390/ijerph22091403 - 8 Sep 2025
Abstract
Dominant theories in the field of occupational stress have so far mainly focused only on job task level psychosocial factors. Our novelty was to move the field forward by testing a new multilevel conceptualization of workplace health-related psychosocial factors, captured in the new [...] Read more.
Dominant theories in the field of occupational stress have so far mainly focused only on job task level psychosocial factors. Our novelty was to move the field forward by testing a new multilevel conceptualization of workplace health-related psychosocial factors, captured in the new JCQ 2.0 tool. The JCQ 2.0 tool assesses the theoretical constructs Demand (D), Control (C) and Stability-Support (S-S) at the task and the organizational level in accordance with the Associationalist Demand/Control (ADC) Model. We aimed for a first step to assess the generalizability of the framework by collecting data in four different countries (Korea, China, Australia, and Germany). Using structural equation modeling, the task level three-factor DCS structure was largely confirmed across all four countries (with one exception: skill discretion was an indicator of both control and demand). The organizational level, three-factor DCS-S structure was tested and confirmed in the German data only (only data with sufficient scales). Similarly, the multilevel DCS-S model could only be tested with the German data only and was largely confirmed with the three organizational level factors (D, C, and S-S) as antecedents to their task level analogues (with one exception: supervisor support was an indicator of organizational rather than task level support). The findings provide a first step to advancing existing knowledge by providing preliminary support for a multilevel DCS model. Further multilevel longitudinal research is required to verify the main findings and explain some of the nuances uncovered here. Full article
(This article belongs to the Section Behavioral and Mental Health)
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15 pages, 283 KB  
Article
Prevalence of Foot Diseases and Injuries and Their Associations with Demographic and Health-Related Factors Among Umrah Pilgrims in 2024 G (1445 H)
by Ghadah Sulaiman Alsaleh, Bayan Hashim Alsharif, Fahad A. Alamri, Jumanah Alhazmi, Lamis Alabdullatif and Anas Khan
Int. J. Environ. Res. Public Health 2025, 22(9), 1402; https://doi.org/10.3390/ijerph22091402 - 8 Sep 2025
Abstract
Background: Foot injuries are common among Umrah pilgrims due to prolonged walking, overcrowded conditions, and inadequate preventive measures, such as inappropriate footwear or walking barefoot. Despite their potential impact on mobility and overall pilgrimage experience, these conditions remain underreported and insufficiently addressed [...] Read more.
Background: Foot injuries are common among Umrah pilgrims due to prolonged walking, overcrowded conditions, and inadequate preventive measures, such as inappropriate footwear or walking barefoot. Despite their potential impact on mobility and overall pilgrimage experience, these conditions remain underreported and insufficiently addressed in public health strategies. Objectives: This study aims to assess the prevalence and types of foot problems among Umrah pilgrims, examine their associations with demographic characteristics and comorbidities, analyze the utilization of medical attention for foot pain, and assess the use of preventive measures to reduce foot-related health risks during the pilgrimage. Methods: A cross-sectional study was conducted throughout the 2024 G (1445 H) Umrah season at the Grand Mosque, Makkah. The study recruited 1138 Umrah pilgrims aged 18 and older who performed the pilgrimage. A structured questionnaire was administered to collect data on demographic characteristics, chronic diseases, foot conditions, medical-attention-seeking behavior, and preventive practices. Pilgrims with pre-existing foot conditions were excluded from participation. Results: Foot diseases were reported by 46% of participants. The most common foot injuries included sprains/strains (18.7%) and muscle pain/cramps (4.9%), with the leg and forefoot being the most affected areas. Significant associations were observed between foot diseases and lower education levels (p = 0.03), chronic liver disease (p = 0.04), and cardiovascular disease (p = 0.04). Despite the high prevalence of foot-related conditions, only 9.6% sought medical attention, and 14.9% reported using preventive measures. Conclusions: The study highlights a substantial burden of foot problems among Umrah pilgrims, with limited utilization of healthcare services and preventive strategies. Targeted interventions, including educational campaigns and improved screening for high-risk individuals, are essential for enhancing foot health and ensuring a safer pilgrimage experience. Full article
25 pages, 2434 KB  
Article
Recreational Performance Evaluation of Urban Forests: Spatial, Socio-Cultural, and Public Health-Related Perspectives
by Zeynep Pirselimoğlu Batman and Elvan Ender Altay
Int. J. Environ. Res. Public Health 2025, 22(9), 1401; https://doi.org/10.3390/ijerph22091401 - 8 Sep 2025
Abstract
Urban forests are natural habitat areas within urban ecosystems that enhance physical, mental, and social well-being. By integrating natural and cultural values into the urban landscape, these areas offer individuals opportunities to interact with nature and engage in various recreational activities. Recreational activities [...] Read more.
Urban forests are natural habitat areas within urban ecosystems that enhance physical, mental, and social well-being. By integrating natural and cultural values into the urban landscape, these areas offer individuals opportunities to interact with nature and engage in various recreational activities. Recreational activities increase physical activity levels, help reduce stress, strengthen mental health, and foster social interaction, thereby significantly protecting and improving public health. This study aims to evaluate the recreational performance of urban forests—an essential component of the urban ecosystem—through a multidimensional approach. In this context, ecological (topography, vegetation, water resources, soil structure, climate), physical (accessibility, infrastructure, area size), social (activity diversity, usage intensity, community events), and cultural (landscape values, urban identity, conservation status of cultural landscapes) factors were considered as key indicators. Bursa Atatürk Urban Forest was selected as the study area, and the methodology integrated SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis with weighted multi-criteria decision-making techniques. In addition, the qualitative data obtained were supported by statistical analysis methods to reveal the relationships among the criteria quantitatively. Through this holistic approach, the recreational performance of the urban forest was evaluated scientifically, leading to the conclusion that the area’s strengths should be preserved, its weaknesses improved, and its cultural landscape values managed sustainably. The study provides a valuable decision-support framework capable of guiding strategic planning for the future. Full article
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17 pages, 314 KB  
Article
Conceptualising a Community-Based Response to Loneliness: The Representational Anchoring of Nature-Based Social Prescription by Professionals in Marseille, Insights from the RECETAS Project
by Lucie Cattaneo, Alexandre Daguzan, Gabriela García Vélez and Stéphanie Gentile
Int. J. Environ. Res. Public Health 2025, 22(9), 1400; https://doi.org/10.3390/ijerph22091400 - 7 Sep 2025
Viewed by 246
Abstract
Background: Urban loneliness is rising worldwide and is a recognised public-health threat. Nature-Based Social Prescriptions (NBSPs), guided group activities in natural settings, are being piloted in six cities through the EU project RECETAS. However, in new contexts such as Marseille, its implementation is [...] Read more.
Background: Urban loneliness is rising worldwide and is a recognised public-health threat. Nature-Based Social Prescriptions (NBSPs), guided group activities in natural settings, are being piloted in six cities through the EU project RECETAS. However, in new contexts such as Marseille, its implementation is constrained by professionals’ limited knowledge of the concept. Objectives: (i) Exploring how professionals in Marseille (France) conceptualise NBSPs; (ii) Identifying perceived facilitators and barriers to implementing NBSPs among residents facing social isolation and loneliness. Methods: Twelve semi-structured interviews were conducted with health, social-care, and urban–environment professionals selected via network mapping and snowball sampling. Verbatim transcripts underwent inductive thematic analysis informed by Social Representation Theory, with double coding to enhance reliability. Results: Five analytic themes emerged: (1) a holistic health paradigm linking nature, community, and well-being; (2) stark ecological inequities with limited green-space access in deprived districts; (3) work challenges due to the urgent needs of individuals facing significant socio-economic challenges in demanding contexts; (4) a key tension between a perceived top-down process and a preference for participatory approaches; (5) drivers and obstacles: strong professional endorsement of NBSPs meets significant systemic and institutional constraints. Conclusions: Professionals endorse NBSPs as a promising approach against loneliness, provided programmes tackle structural inequities and adopt participatory governance. Results inform the Marseille RECETAS pilot and contribute to global discussions on environmentally anchored health promotion. Full article
(This article belongs to the Special Issue Public Health Consequences of Social Isolation and Loneliness)
11 pages, 523 KB  
Article
Race-Specific Impact of Telehealth Advance Care Planning on Cost of Dementia: A Cost Prediction Study
by Peter S. Reed, Yonsu Kim, Jay J. Shen, Sai Kosaraju, Mingon Kang, Jennifer Carson, Iulia Ioanitoaia Chaudhry, Sarah Kim, Connor Jeong, Yena Hwang and Ji Won Yoo
Int. J. Environ. Res. Public Health 2025, 22(9), 1399; https://doi.org/10.3390/ijerph22091399 - 7 Sep 2025
Viewed by 249
Abstract
Identifying strategies to enhance patient engagement and to control healthcare costs promotes a responsive and efficient healthcare system. The aim of this study is to predict healthcare cost savings associated with delivering telehealth advance care planning (ACP) to patients living with dementia. Two [...] Read more.
Identifying strategies to enhance patient engagement and to control healthcare costs promotes a responsive and efficient healthcare system. The aim of this study is to predict healthcare cost savings associated with delivering telehealth advance care planning (ACP) to patients living with dementia. Two Geriatrics Workforce Enhancement Programs delivered training to primary care providers on using telehealth to provide ACP. Using electronic health records data from 6344 dual-eligible Medicare/Medicaid patients receiving telehealth primary care from trained providers in an urban safety net system, persons living with dementia (n = 401) were identified by extracting ICD-10 codes. The primary outcome was the estimated hospitalization-associated cost, with a key independent variable of ACP billing status. Multiple linear regressions and machine learning techniques estimated the impact of telehealth ACP on hospitalization-associated costs with a differential analysis by race. Compared to non-Hispanic Whites, hospitalization costs among Hispanic elders were higher by USD 14,232.40. Costs for non-English speakers or those having increased comorbidities were higher by USD 27,346.60 and USD 26,072.70, respectively. Overall, receiving ACP was associated with lower costs of USD 23,928.84. Dementia patients seen by primary care providers in a system receiving training to offer ACP via telehealth realized significant cost savings, with marked differences among those of non-White racial backgrounds. Full article
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14 pages, 966 KB  
Article
Health Communication in Times of Pandemics: A Framework for Increased Community Participation in Infection Prevention
by Ahmed Alobaydullah and Andrew Scott LaJoie
Int. J. Environ. Res. Public Health 2025, 22(9), 1398; https://doi.org/10.3390/ijerph22091398 - 7 Sep 2025
Viewed by 616
Abstract
Introduction: Pandemic communication faces significant challenges due to the dynamic nature of disease outbreaks, societal influences, and evolving communication platforms. Effective non-pharmaceutical interventions (NPIs) depend on robust health communication strategies. This study aims to develop a conceptual model to guide NPIs communication during [...] Read more.
Introduction: Pandemic communication faces significant challenges due to the dynamic nature of disease outbreaks, societal influences, and evolving communication platforms. Effective non-pharmaceutical interventions (NPIs) depend on robust health communication strategies. This study aims to develop a conceptual model to guide NPIs communication during pandemics, grounded in widely applied risk communication theories. Methods: Using Jabareen’s conceptual framework analysis method, this study synthesized interdisciplinary literature from public health, psychology, and risk communication. The method involves mapping data sources and concept categorization and integration. We examined Crisis and Emergency Risk Communication (CERC), the Social Amplification of Risk Framework (SARF), and Social Cognitive Theory (SCT) to develop a comprehensive NPIs communication framework. Results: The Pandemic Behavioral Prevention Framework delineates pandemic communication into five phases: pre-crisis, initial event, maintenance, resolution, and evaluation. It emphasizes targeting vulnerable populations, addressing trust deficits, and leveraging effective communication channels. Key concepts such as self-efficacy, vicarious learning, and social risk amplification are integrated to enhance public adherence to NPIs. Conclusion: The framework bridges gaps in pandemic communication by integrating risk and health communication principles, fostering trust, and addressing social determinants of health. It highlights the importance of pre-crisis education and the utilization of social media for targeted messaging. Full article
(This article belongs to the Special Issue Pandemic Preparedness: Lessons from COVID-19, Arboviral Outbreaks, and Other Emerging Infectious Diseases)
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13 pages, 514 KB  
Article
Prolonged Exposure to Antiretroviral Therapy and Risk of Developing Hypertension Among HIV-Infected Clinic Attendees: A Pilot Study in Rural Eastern Cape Province, South Africa
by Teke Apalata, Urgent Tsuro and Olufunmilayo Olukemi Akapo
Int. J. Environ. Res. Public Health 2025, 22(9), 1397; https://doi.org/10.3390/ijerph22091397 - 7 Sep 2025
Viewed by 715
Abstract
Antiretroviral therapy (ART) has significantly improved outcomes in individuals with human immunodeficiency virus (HIV), yet its long-term cardiovascular effects, especially on hypertension risk, remain debated. This pilot study investigated hypertension risk factors in HIV-positive patients undergoing ART and aimed at hypothesis generation rather [...] Read more.
Antiretroviral therapy (ART) has significantly improved outcomes in individuals with human immunodeficiency virus (HIV), yet its long-term cardiovascular effects, especially on hypertension risk, remain debated. This pilot study investigated hypertension risk factors in HIV-positive patients undergoing ART and aimed at hypothesis generation rather than drawing definitive causal conclusions. Seventy HIV-infected adults without baseline hypertension were enrolled and followed. Hypertension was defined using the 2017 ACC/AHA guidelines by the South African Hypertension Society. Data on demographic, anthropometric, metabolic, inflammatory, coagulation, and HIV-related variables were collected. Cox regression analysis identified independent predictors of hypertension. Participants had a median age of 37 years (IOR = 10.96), with 84.3% being female. After a median ART exposure of 61.01 months (range: 2–164), 27 individuals (38.6%) developed high blood pressure. In multivariable Cox models adjusting for metabolic syndrome and BMI, age ≥ 35 years was associated with a 2.2-fold higher hypertension risk (Hazard Ratio [HR]: 2.2; 95% Confidence Interval [CI]: 1.04–4.55; p = 0.04). Elevated triglycerides significantly increased risk, with a 7.9-fold higher likelihood of hypertension (HR: 7.9; 95% CI: 1.04–59.5; p = 0.046). ART regimen type, whether initial or current, did not independently predict hypertension. In conclusion, hypertension is prevalent during ART. We hypothesized that traditional cardiovascular risk factors, notably age ≥35 years and hypertriglyceridemia, were key independent predictors, emphasizing the need for routine cardiovascular risk assessment in HIV management. Full article
(This article belongs to the Special Issue HIV Care Engagement and Quality of Life Among People Living with HIV)
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13 pages, 508 KB  
Article
Patterns of mHealth Engagement and Identification of Facilitators and Barriers to Mobile Health Applications for People Who Use Opioids
by Lauren Dayton, Haley Bonneau, Grace Yi, Melissa Davey-Rothwell and Carl Latkin
Int. J. Environ. Res. Public Health 2025, 22(9), 1396; https://doi.org/10.3390/ijerph22091396 - 6 Sep 2025
Viewed by 375
Abstract
Mobile health (mHealth) applications represent low-cost, scalable interventions with broad reach and are valuable for people who use opioids (PWUO), a population that often experiences low retention in traditional research studies. This study examines engagement patterns with the OASIS app, an mHealth app [...] Read more.
Mobile health (mHealth) applications represent low-cost, scalable interventions with broad reach and are valuable for people who use opioids (PWUO), a population that often experiences low retention in traditional research studies. This study examines engagement patterns with the OASIS app, an mHealth app prompting PWUO in Baltimore, Maryland, to report daily on substance use locations and overdose prevention behaviors over 14 days. Between December 2022 and September 2023, 210 PWUO participated. Engagement was measured by survey completion, with high engagement defined as completing at least 75% of surveys. The median number of surveys completed was 9.0 (mean: 7.57), and 29.4% of participants demonstrated high engagement. Logistic regression models showed that residential stability was significantly associated with higher engagement (adjusted odds ratio [aOR]: 4.90; 95% CI: 1.35, 17.84), while weekly or more frequent injection drug use was associated with lower engagement (aOR: 0.31; 95% CI: 0.11, 0.89). Mobile device proficiency and other demographics were not significantly associated with engagement, likely due to mandatory in-person training reducing tech barriers. Results indicate that PWUO can meaningfully engage with mHealth apps, especially when supported by structural factors, such as stable housing. Full article
(This article belongs to the Section Behavioral and Mental Health)
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25 pages, 858 KB  
Article
Chronic Pain Prevalence and Psychosocial Burden in the Italian Population from the 2019 European Health Interview Survey
by Alice Maraschini, Michael Tenti, William Raffaeli, Laura Iannucci, Lidia Gargiulo, Alessandra Burgio, Giada Minelli, Corrado Fagnani, Emanuela Medda, Maurizio Ferri, Miriam Salemi and Virgilia Toccaceli
Int. J. Environ. Res. Public Health 2025, 22(9), 1395; https://doi.org/10.3390/ijerph22091395 - 6 Sep 2025
Viewed by 381
Abstract
Chronic pain (CP) is a global healthcare concern requiring careful monitoring. In Italy, the most recent CP prevalence estimates date back to 2003. In this work, we analyzed data from the 2019 European Health Interview Survey, based on a representative sample of the [...] Read more.
Chronic pain (CP) is a global healthcare concern requiring careful monitoring. In Italy, the most recent CP prevalence estimates date back to 2003. In this work, we analyzed data from the 2019 European Health Interview Survey, based on a representative sample of the Italian population (n = 44,492), to update national CP prevalence estimates and evaluate its psychosocial burden. CP was detected using a validated questionnaire. Our results show that approximately 10.5 million adults (24.1%) suffer from CP; prevalence and intensity are higher among females and increase with age. In 54.3% of cases, CP was triggered by a diagnosed disease, while 13.6% remain undiagnosed and 14.8% do not seek treatment for CP. Severe CP accounts for 29.4% of cases. Individuals with severe CP are significantly more likely to experience difficulties in social participation (OR 4.82; CI 4.41–5.27), increased work absences (OR 4.18; CI 3.53–4.94), depression (OR 7.10; CI 6.22–8.11), and greater use of primary (OR 2.90; CI 2.64–3.18) and specialist healthcare (OR 2.63; CI 2.40–2.89) as well as diagnostic procedures (OR 2.27; CI 2.07–2.49). Among subjects diagnosed with depression or severe chronic anxiety, CP seems to reduce access to mental health care (OR 0.75; CI 0.61–0.92) and increase abandonment due to financial barriers (OR 1.57; CI 1.07–2.31). Unlike a few countries (e.g., Spain and Denmark) that have recorded a generally increasing trend in CP prevalence, our figures confirm a quite stable national epidemiological pattern. Our estimates underscore the need for careful management of CP and its psychosocial burden. Since data were collected just before the COVID-19 pandemic, they may represent a crucial baseline for monitoring post-pandemic trends. Full article
(This article belongs to the Special Issue Trends in Chronic Pain Assessment and Treatment: Essential Aspects for Rehabilitation and Clinical Management)
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22 pages, 1029 KB  
Review
Loneliness by Design: The Structural Logic of Isolation in Engagement-Driven Systems
by Lauren Dwyer
Int. J. Environ. Res. Public Health 2025, 22(9), 1394; https://doi.org/10.3390/ijerph22091394 - 6 Sep 2025
Viewed by 298
Abstract
As the prevalence of public discourse pertaining to loneliness increases, digital interventions, such as artificial intelligence companions, are being introduced as methods for fostering connection and mitigating individual negative experiences of loneliness. These tools, while increasing in volume and popularity, operate within and [...] Read more.
As the prevalence of public discourse pertaining to loneliness increases, digital interventions, such as artificial intelligence companions, are being introduced as methods for fostering connection and mitigating individual negative experiences of loneliness. These tools, while increasing in volume and popularity, operate within and are shaped by the same engagement-driven systems that have been found to contribute to loneliness. This meta-narrative review examines how algorithmic infrastructures, which are optimized for retention, emotional predictability, and behavioural nudging, not only mediate responses to loneliness but participate in its ongoing production. Flattening complex social dynamics into curated, low-friction interactions, these systems gradually displace relational agency and erode users’ capacity for autonomous social decision making. Drawing on frameworks from communication studies and behavioural information design, this review finds that loneliness is understood both as an emotional or interpersonal state and as a logical consequence of hegemonic digital and technological design paradigms. Without addressing the structural logics of platform capitalism and algorithmic control, digital public health interventions risk treating loneliness as an individual deficit rather than a systemic outcome. Finally, a model is proposed for evaluating and designing digital public health interventions that resist behavioural enclosure and support autonomy, relational depth, systemic accountability, and structural transparency. Full article
(This article belongs to the Special Issue Public Health Consequences of Social Isolation and Loneliness)
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14 pages, 757 KB  
Article
Burnout Syndrome Among Dental Students in Clinical Training: A Multicenter Cross-Sectional Study in Ecuador
by Luis Chauca-Bajaña, Andrea Ordoñez Balladares, Ivonne Alison Carrión Bustamante, Andrea Carolina Sánchez Salcedo, Juan Suárez-Palacios, Xavier Andrés Villao-León, Francisco Jorge Morán Peña, Rita Carolina Egüés Cevallos, Roberto Tolozano-Benites and Byron Velásquez Ron
Int. J. Environ. Res. Public Health 2025, 22(9), 1393; https://doi.org/10.3390/ijerph22091393 - 6 Sep 2025
Viewed by 426
Abstract
Burnout syndrome, caused by chronic unmanaged stress, is common among health sciences students, and dental students in clinical training are particularly vulnerable due to the intense cognitive, emotional, and practical demands. This multicenter cross-sectional study assessed burnout and related factors in 312 students [...] Read more.
Burnout syndrome, caused by chronic unmanaged stress, is common among health sciences students, and dental students in clinical training are particularly vulnerable due to the intense cognitive, emotional, and practical demands. This multicenter cross-sectional study assessed burnout and related factors in 312 students in their 8th–10th semesters at three Ecuadorian universities using the Maslach Burnout Inventory and a questionnaire on physical and emotional symptoms. High emotional exhaustion affected 79.5% of students, high depersonalization 54.5%, and low personal accomplishment 11.5%, with an overall burnout prevalence of 8.01%. No statistically significant associations were found with university or academic semester, although students studying or working more than 30 h per week showed a non-significant trend toward higher risk (OR = 3.39; p = 0.208), and the model’s predictive capacity was low (AUC = 0.645). Frequently reported physical symptoms included lower back pain (41.35%), neck pain (35.9%), and headaches (30.45%). These findings reveal that burnout, often accompanied by physical discomfort, affects a significant number of dental students, highlighting the need for institutional strategies such as psychological support and curricular adjustments to reduce stress and improve overall well-being. Full article
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15 pages, 476 KB  
Article
Exploring Women’s Perceived Quality of Antenatal Care: A Cross-Sectional Study in The Netherlands
by Evelien Cellissen, Marijke Hendrix, Maaike Vogels-Broeke, Luc Budé and Marianne Nieuwenhuijze
Int. J. Environ. Res. Public Health 2025, 22(9), 1392; https://doi.org/10.3390/ijerph22091392 - 6 Sep 2025
Viewed by 409
Abstract
Evaluating antenatal care quality involves understanding women’s experiences and their impact on pregnancy outcomes. This study examines how pregnant women in the Netherlands perceive the quality of antenatal care and which factors are related to these perceptions, with a focus on continuity of [...] Read more.
Evaluating antenatal care quality involves understanding women’s experiences and their impact on pregnancy outcomes. This study examines how pregnant women in the Netherlands perceive the quality of antenatal care and which factors are related to these perceptions, with a focus on continuity of care. We conducted a cross-sectional study (2019–2020) among 1165 pregnant women (>32 weeks). Perceived quality of care was measured using the Pregnancy and Childbirth Questionnaire. Experienced continuity of care was measured using the Nijmegen Continuity Questionnaire. Regression analyses explored associated factors across both community and hospital care settings. Most women reported moderate-to-high levels of perceived quality. Personal continuity from community midwives, team continuity, and the presence of a coordinating care professional were associated with higher perceived quality. The use of a maternity care plan showed no association. Our findings suggest that involvement of a community midwife enhances perceived quality of antenatal care. Key contributing factors include continuity of care and experiencing a coordinating care professional. Full article
(This article belongs to the Special Issue Improving the Quality of Maternity Care)
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