International Journal of Environmental Research and Public Health

13 pages, 384 KB

Open AccessArticle

The Influence of Elementary School Personnel’s Achievement Goal Orientation on CPR Education Immersion and Self-Management

by Tae-Young Moon, Hyeon-Ji Lee and Mi-Young Choi

Int. J. Environ. Res. Public Health 2026, 23(2), 260; https://doi.org/10.3390/ijerph23020260 - 19 Feb 2026

Abstract

Despite mandatory cardiopulmonary resuscitation (CPR) training for elementary school personnel in South Korea, current programs are often delivered as uniform, compliance-oriented sessions that prioritize procedural completion over sustained engagement and self-regulated practice. However, little empirical evidence explains why some participants remain actively engaged [...] Read more.

Despite mandatory cardiopulmonary resuscitation (CPR) training for elementary school personnel in South Korea, current programs are often delivered as uniform, compliance-oriented sessions that prioritize procedural completion over sustained engagement and self-regulated practice. However, little empirical evidence explains why some participants remain actively engaged and capable of self-managing CPR skills after mandatory training, while others do not. In this study, immersion in CPR education refers to learners’ cognitive and behavioral engagement during training, reflecting their concentration and active participation in learning activities. Accordingly, this study aimed to examine how achievement goal orientation influences CPR education immersion and self-management among elementary school educational officials. A survey was conducted from March to June 2024 with 150 teachers and administrative staff in Gangwon Province, South Korea. Data were analyzed using correlation and multiple regression analyses. The results showed significant positive correlations among achievement goal orientation, CPR education immersion, and self-management. Both self-goal and task goal orientations significantly increased CPR education immersion, whereas only task goal orientation positively influenced self-management. In addition, both cognitive and behavioral immersion significantly predicted self-management These findings suggest that mastery-oriented motivation is associated with deeper engagement during CPR training and stronger self-management, supporting motivationally informed instructional design rather than compliance-focused delivery. Full article

12 pages, 602 KB

Open AccessSystematic Review

Cost and Length of Hospitalization Associated with Dental Infections: A Systematic Review

by Somayeh Parvizi, Albert Yaacoub, Stephen Cox, Carlos Marcelo da Silva Figueredo and Mafaz Ullah

Int. J. Environ. Res. Public Health 2026, 23(2), 259; https://doi.org/10.3390/ijerph23020259 - 18 Feb 2026

Abstract

Objectives: This study aimed to investigate the cost of hospitalization and length of stay (LOS) associated with dental infections and their impact on healthcare resources. Materials and Methods: Web of Science, Medline via Ovid, and Google Scholar were searched for articles published from [...] Read more.

Objectives: This study aimed to investigate the cost of hospitalization and length of stay (LOS) associated with dental infections and their impact on healthcare resources. Materials and Methods: Web of Science, Medline via Ovid, and Google Scholar were searched for articles published from 2013 to 2023 using relevant MeSH terms. A descriptive summary was produced to describe study characteristics, and selected studies were analyzed to evaluate financial implications and hospitalization outcomes. Results: After removing duplicates, 125 articles were screened, with 25 read in full and 9 excluded. Sixteen retrospective studies were included, encompassing 156,487 patients. Hospital length of stay ranged from 1.15 to 10 days, and hospitalization costs ranged from AUD 2402 to USD 47,836.60. Variability in outcomes appeared to be influenced by infection severity, healthcare infrastructure, and geographic setting. Conclusions: Dental infections impose a substantial and variable burden on healthcare systems. These findings emphasize the need for timely intervention, preventive strategies, and standardized management protocols to reduce clinical complications and financial strain on healthcare services. Full article

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

13 pages, 381 KB

Open AccessArticle

Content Validation and Perceived Value of Text Messages to Promote Physical Activity Among U.S. Older Adults and Care Partners

by Oluwaseun Adeyemi, Tracy Chippendale, Gbenga Ogedegbe, Dowin Boatright and Joshua Chodosh

Int. J. Environ. Res. Public Health 2026, 23(2), 258; https://doi.org/10.3390/ijerph23020258 - 18 Feb 2026

Abstract

Background: Motivational text messages can encourage increased physical activity. This study aimed to validate motivational text messages among older adults and care partners and to assess differences in perceived motivational value between the two groups. Methods: We designed nine motivational text messages to [...] Read more.

Background: Motivational text messages can encourage increased physical activity. This study aimed to validate motivational text messages among older adults and care partners and to assess differences in perceived motivational value between the two groups. Methods: We designed nine motivational text messages to capture nine distinct physical activity scenarios. For this cross-sectional observational study, we enrolled 14 content experts, 310 older adults, and 305 care partners. Content experts assessed the relevance, while the older adults and care partners assessed the perceived motivational value of each text message on a 5-point Likert scale. We computed the item content validity index and assessed differences in perceived motivational value among older adults and care partners using quantile regression while adjusting for sociodemographic and health characteristics. Results: The item content validity index ranged from 0.86 to 1.00. The median (interquartile range) perceived motivational value for each text message was 4.0 (3.0–5.0), and there were no statistically significant differences in reported motivational values between older adults and care partners. Conclusion: We present nine content-validated text messages with high motivational value for older adults and care partners that can be integrated into technology-based intervention studies and may improve physical activity behavior in both groups. Full article

(This article belongs to the Special Issue Public Health Perspectives on Physical Exercise for Adults and Older People)

12 pages, 1562 KB

Open AccessArticle

Strengthening Civil Registration Through Grassroots Health Institutions in India

by Sheetal Verma, Somnath Jana, Ritul Kamal, Laxmi Kant Dwivedi and Shiva S. Halli

Int. J. Environ. Res. Public Health 2026, 23(2), 257; https://doi.org/10.3390/ijerph23020257 - 18 Feb 2026

Abstract

Civil registration of births and deaths underpins people’s legal identity, access to essential services, and evidence-based policy. Over the last two decades, the expansion of the National Health Mission (NHM) and the dramatic increase in institutional deliveries have created new opportunities to link [...] Read more.

Civil registration of births and deaths underpins people’s legal identity, access to essential services, and evidence-based policy. Over the last two decades, the expansion of the National Health Mission (NHM) and the dramatic increase in institutional deliveries have created new opportunities to link maternal healthcare with critical event documentation. Primary health centres (PHCs) and community health centres (CHCs), which are frequently the initial point of contact for rural households, are emerging as important places for birthing and registration. Despite their expanding importance, the particular role of these grassroots facilities in birth registration results has not been thoroughly investigated. This study addresses that gap by assessing their role in increasing registration coverage among children under the age of five. We analyzed nationally representative data from the National Family Health Survey rounds 4 (2015–2016) and 5 (2019–2021). This study focused on children under five, examining the association between place of delivery and registration status. Descriptive analysis and multivariable logistic regression estimated the odds of registration across delivery settings. Pooled data from both survey rounds captured temporal shifts, and predicted probabilities were calculated for institutional deliveries, adjusting for socio-demographic covariates. The proportion of institutional births occurring in PHCs and CHCs rose from 30.5% to 34.7% between the two survey rounds. Registration among children delivered in these facilities increased from 80.8% to 90.2%, the highest gain among all delivery settings. Regression analysis showed that births in PHCs/CHCs were associated with 38% higher odds of being registered compared to private facilities. States designating PHCs and CHCs as official registrars, such as Delhi, Rajasthan, and Uttar Pradesh, reported the greatest improvements. Lower-level government health facilities are not only advancing safe delivery but also acting as pivotal nodes for civil registration. Their dual function creates a scalable model for integrating healthcare with legal identity creation, supporting equity and accelerating progress toward Sustainable Development Goal 16.9. Full article

(This article belongs to the Section Health Care Sciences)

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21 pages, 895 KB

Open AccessArticle

Clinicogenomic Insights for Progression-Free Survival in Prostate Cancer

by Kelvin Ofori-Minta, Bofei Wang, Jonathon E. Mohl, Abhijit Mandal and Ming-Ying Leung

Int. J. Environ. Res. Public Health 2026, 23(2), 256; https://doi.org/10.3390/ijerph23020256 - 18 Feb 2026

Abstract

Prostate cancer (PrCa), the second most common cancer diagnosed in men globally, remains a critical challenge in precision oncology. While PrCa can be deadly, it is highly treatable if detected early. Identifying associative factors influencing disease progression risks can help inform preliminary steps [...] Read more.

Prostate cancer (PrCa), the second most common cancer diagnosed in men globally, remains a critical challenge in precision oncology. While PrCa can be deadly, it is highly treatable if detected early. Identifying associative factors influencing disease progression risks can help inform preliminary steps that will further the expedition of clinical therapeutic intervention decisions, which will improve treatment outcomes. While conventional PrCa progression assessment tools rely heavily on a few clinical parameters, the importance of genomic information is increasingly recognized. In this study, we evaluate the prognostic value of patients’ clinicogenomic profiles in modeling progression-free survival (PFS) of PrCa. Three survival models, namely the penalized Cox model, random survival forest, and a deep learning survival neural network, were deployed with extensive tuning applied to a dataset for a cohort of 494 patients with PrCa. This dataset, compiled from public data in The Cancer Genome Atlas (TCGA) accessed via cBioPortal, consists of relevant clinical features and single-nucleotide variant information on likely PrCa-related genes. The survival models demonstrated satisfactory discriminatory performance, with Harrell’s concordance index ranging from approximately 0.80 to 0.87 on held-out test data, indicating their ability to rank patients according to their relative progression risk among patients, while exhibiting distinct dynamics, all three models consistently identified clinical variables that indicated neoadjuvant treatment history, neoplasm cancer status, and tumor recurrence as well as the gene MYH6 as important predictor variables for PrCa PFS. Our findings suggest the incorporation of genomic data into the survival modeling workflow, thereby allowing the use of integrated clinicogenomics information to gain insights into progression risks for patients with PrCa. Full article

(This article belongs to the Special Issue Proceedings of the 2024 and 2025 Research Centers in Minority Institutions (RCMI) Consortium National Conferences)

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17 pages, 352 KB

Open AccessArticle

Cannabis and Psychedelics Among U.S. Young Adults: Use, Messaging Exposure, Perceptions, and Legalization Support

by Carla J. Berg, Cassidy R. LoParco, Darcey M. McCready, Laura C. Schubel, Patricia A. Cavazos-Rehg, Erin Kasson, Shriya Thakkar, Diane M. Ndisebuye and Y. Tony Yang

Int. J. Environ. Res. Public Health 2026, 23(2), 255; https://doi.org/10.3390/ijerph23020255 - 17 Feb 2026

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Abstract

This study assessed the correlates of cannabis and psychedelic use and legalization support among young adults in the United States (US). Using 2025 data among adults ages 18–34 (n = 3227), we assessed cannabis and psychedelic message exposure and perceptions, mental health [...] Read more.

This study assessed the correlates of cannabis and psychedelic use and legalization support among young adults in the United States (US). Using 2025 data among adults ages 18–34 (n = 3227), we assessed cannabis and psychedelic message exposure and perceptions, mental health symptoms (Patient Health Questionnaire-4 [PHQ-4]), and adverse childhood experiences (ACEs) in relation to past-6-month cannabis use (40.5%), past-year psychedelic use (11.9%), and legalization support. Relative to cannabis, psychedelics showed less legalization support, promotional and risk-message exposure, and social acceptability and higher perceived addictiveness and harm (p’s < 0.001). Factors associated with cannabis use and greater legalization support included: lower perceived addictiveness (aOR = 0.88, CI = 0.83–0.93; B = −0.04, SE = 0.01) and harm (aOR = 0.75, CI = 0.71–0.80; B = −0.16, SE = 0.01), higher social acceptability (aOR = 1.25, CI = 1.19–1.33; B = 0.19, SE = 0.01), and higher PHQ-4 (aOR = 1.04, CI = 1.01–1.07); more ACEs (aOR = 1.10, CI = 1.06–1.14) and more promotional (aOR = 1.08, CI = 1.01–1.17) and risk-message exposure (aOR = 1.27, CI = 1.17–1.39) were associated with use. Factors associated with psychedelic use and greater legalization support included: more promotional-message exposure (aOR = 1.61, CI = 1.36–1.91; B = 0.09, SE = 0.04), lower addictiveness (aOR = 0.87, CI = 0.78–0.97; B = −0.03, SE = 0.02) and harm (aOR = 0.74, CI = 0.66–0.82; B = −0.19, SE = 0.02), higher acceptability (aOR = 1.59, CI = 1.47–1.73; B = 0.15, SE = 0.01), and higher PHQ-4 (aOR = 1.06, CI = 1.02–1.11; B = 0.02, SE = 0.01); more risk-message exposure (aOR = 1.29, CI = 1.08–1.54) and ACEs (aOR = 1.15, CI = 1.09–1.21) were associated with use. Perceptions and mental health may influence cannabis and psychedelic use and legalization support, and message exposure may be particularly relevant in shaping psychedelic use and legalization support. Thus, information is crucial to ensure population understanding of the risks, benefits, and overall population impacts of cannabis and psychedelic use and legalization. Full article

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

14 pages, 307 KB

Open AccessArticle

“I Just Glove up and Do What Has to Be Done”: A Mixed-Methods Exploration of Dementia Care Challenges and Care Management Strategies

by Amanda N. Leggett, Natasha Nemmers, Sophia Tsuker, Laura N. Gitlin and Helen C. Kales

Int. J. Environ. Res. Public Health 2026, 23(2), 254; https://doi.org/10.3390/ijerph23020254 - 17 Feb 2026

Viewed by 49

Abstract

Family care partners for persons living with dementia (PLwD) adopt a variety of care management strategies to navigate care. We utilize a convergent parallel mixed-methods design to integrate family care partners’ descriptions of care challenges and associated management approaches. Primary family care partners [...] Read more.

Family care partners for persons living with dementia (PLwD) adopt a variety of care management strategies to navigate care. We utilize a convergent parallel mixed-methods design to integrate family care partners’ descriptions of care challenges and associated management approaches. Primary family care partners for PLwD (n = 100) were interviewed about their management of a care challenge (qualitative), the PLwD’s function, behavior and cognition (quantitative), and their management strategies (qualitative/quantitative). Care challenges and strategies were compared across qualitative content analysis and t-tests. Care partners providing more functional (r = 0.34, p < 0.01) and cognitive (r = 0.30, p < 0.01) care used more active management strategies, whereas care partners providing greater behavioral care (r = 0.34, p < 0.001) reported more criticism, with similar themes seen qualitatively. Active management may be required when dementia severity increases, yet criticism may emerge with greater behavioral severity. Because criticism is associated with more negative outcomes, future interventions should help care partners practice more adaptive behavioral management. Full article

(This article belongs to the Special Issue Family Caregiving of Older Adults: 2nd Edition)

29 pages, 480 KB

Open AccessArticle

A Theory-Based Approach to Predict Stress Relaxation Behavior Among South Asian Americans: A Cross-Sectional Study

by Manoj Sharma, Asma Awan, Vikash Patel, Badrunnisa Hanif, Aastha Poudel, Tooba Laeeq and Sandhya Wahi-Gururaj

Int. J. Environ. Res. Public Health 2026, 23(2), 253; https://doi.org/10.3390/ijerph23020253 - 17 Feb 2026

Viewed by 61

Abstract

South Asian Americans experience multifaceted sociocultural and acculturative stressors that influence mental well-being, yet few studies have applied contemporary behavioral theories to understand relaxation behaviors in this population. This cross-sectional study examined predictors of initiating and sustaining relaxation behaviors using the Multi-Theory Model [...] Read more.

South Asian Americans experience multifaceted sociocultural and acculturative stressors that influence mental well-being, yet few studies have applied contemporary behavioral theories to understand relaxation behaviors in this population. This cross-sectional study examined predictors of initiating and sustaining relaxation behaviors using the Multi-Theory Model (MTM) of health behavior change. A web-based survey of 271 South Asian adults incorporated the Perceived Stress Scale (PSS-10), MTM constructs, and sociodemographic characteristics. Reliability was high across MTM subscales (Cronbach’s α = 0.81–0.93). Structural equation modeling demonstrated acceptable fit (CFI > 0.90, TLI > 0.90, RMSEA < 0.08, SRMR < 0.08). Hierarchical regressions revealed that among participants practicing relaxation (n = 202), behavioral confidence significantly predicted initiation (β = 0.481, p < 0.001), followed by participatory dialogue (β = 0.194, p < 0.05) and changes in the physical environment (β = 0.242, p < 0.01). Emotional transformation strongly predicted sustenance (β = 0.395, p < 0.001), along with practice for change (β = 0.307, p < 0.05) and changes in the social environment (β = 0.210, p < 0.05). MTM constructs explained 69.8% of initiation variance and 70.4% of sustenance variance. Among non-practitioners, participatory dialogue predicted initiation (β ≈ 0.18–0.34, p < 0.05), and emotional transformation predicted sustenance (β = 0.570, p < 0.001). These findings underscore MTM’s strong predictive utility and support culturally tailored interventions enhancing confidence, emotional regulation, and social/environmental supports to promote relaxation behaviors in South Asian communities in the United States. Full article

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

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24 pages, 2307 KB

Open AccessArticle

Operationalizing Co-Design in Exercise Interventions with Indigenous Peoples in Australia: Development and Cultural Adaptation of the PrIDE Tools

by Morwenna Kirwan, Connie Henson, Blade Bancroft-Duroux, Kerri Colegate, Cheryl Taylor, David Meharg, Neale Cohen and Kylie Gwynne

Int. J. Environ. Res. Public Health 2026, 23(2), 252; https://doi.org/10.3390/ijerph23020252 - 17 Feb 2026

Viewed by 35

Abstract

Indigenous Australians experience a disproportionate burden of type 2 diabetes mellitus and cardiovascular disease. While clinician-led, community-based exercise programs are effective in general populations, limited peer-reviewed evidence is available describing culturally adapted exercise interventions with Indigenous Australians that transparently reports governance, cultural adaptation, [...] Read more.

Indigenous Australians experience a disproportionate burden of type 2 diabetes mellitus and cardiovascular disease. While clinician-led, community-based exercise programs are effective in general populations, limited peer-reviewed evidence is available describing culturally adapted exercise interventions with Indigenous Australians that transparently reports governance, cultural adaptation, and theoretical design. This paper reports the co-design and development of tools for the Preventing Indigenous Cardiovascular Disease and Diabetes through Exercise (PrIDE) study, an adaptation of the Beat It program that incorporates wearable technology. Using the Co-design Health Research and Innovation Model, four tools were developed with Indigenous governance through a Consumer Advisory Group and a project-specific Consumer User Panel. Three tools were culturally adapted—the PrIDE Exercise Program, the Strong Spirit Strong Self self-efficacy assessment, and Keep Your Heart Strong educational materials—and a newly developed tool, the Success Plan. Cultural adaptations were prospectively documented using the Model for Adaptation Design and Impact, and all tools were assessed using the Aboriginal and Torres Strait Islander Quality Appraisal Tool. Behavior change mechanisms were mapped using the COM-B model. This paper provides transparent documentation of culturally adapted theory-informed tool development to support reproducibility and knowledge translation. The evaluation of effectiveness, acceptability, and psychometric properties will be reported following PrIDE implementation. Full article

(This article belongs to the Special Issue Scaling Up Physical Activity Interventions in the Prevention of Chronic Diseases)

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11 pages, 428 KB

Open AccessArticle

Higher Rates of Emergency Oral Health Care Presentations Among Indigenous Australians: A Comparative Public Health Study

by Neeraj Vyas, Simranjit Cheema, Rachel Scobie, Barbie Fusitu’a, Gary Low, Albert Yaacoub, Muhammad Irshad, Stephen Cox and Mafaz Ullah

Int. J. Environ. Res. Public Health 2026, 23(2), 251; https://doi.org/10.3390/ijerph23020251 - 17 Feb 2026

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Abstract

Background: This study compared the reasons for dental presentations between Indigenous and non-Indigenous Australian adults at the Nepean Centre for Oral Health, NSW, Australia. Methods: A retrospective cohort study was conducted on adult patients presenting between 1 July and 31 December 2019. Clinical [...] Read more.

Background: This study compared the reasons for dental presentations between Indigenous and non-Indigenous Australian adults at the Nepean Centre for Oral Health, NSW, Australia. Methods: A retrospective cohort study was conducted on adult patients presenting between 1 July and 31 December 2019. Clinical notes were audited and categorized as either ‘emergency’ (pain, dental infection, dental trauma, loose teeth or dental implants, bleeding) or ‘conservative’ (dental check-ups, examinations, prosthodontic, restorative, periodontal, or non-emergency endodontic therapy). Results: A total of 4663 patients met the inclusion criteria; 61.6% were female, and 6.4% were identified as Indigenous Australians. Overall, 41.3% of presentations were for emergency dental care. Indigenous Australians were significantly more likely to present for dental emergencies compared with non-Indigenous (58.2% vs. 40.2%; χ²(1, N = 4663) = 53.4, p < 0.00001; OR = 2.07, 95% CI: 1.64–2.63), and were also more likely to undergo emergency tooth extractions (p < 0.05). Conclusions: Indigenous Australians demonstrated a higher proportion of emergency and oral surgery-related presentations and underwent tooth extractions as the primary treatment compared to their non-Indigenous counterparts. These findings suggest a higher burden of oral disease and delayed access to general dental services among Indigenous Australians, highlighting the need for targeted and culturally appropriate public health interventions. Full article

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9 pages, 395 KB

Open AccessReview

Mental Health, Trauma, and Cardiovascular Risk Within South Asian Diaspora

by Jyoti Sinha

Int. J. Environ. Res. Public Health 2026, 23(2), 250; https://doi.org/10.3390/ijerph23020250 - 17 Feb 2026

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Abstract

South Asian immigrants in the United States face disproportionate cardiovascular disease (CVD) risks, rooted in multidimensional trauma stemming from immigration stress, sociocultural stigma, and systemic discrimination. This paper situates these health disparities within a broader public mental health crisis, examining the intricate relationship [...] Read more.

South Asian immigrants in the United States face disproportionate cardiovascular disease (CVD) risks, rooted in multidimensional trauma stemming from immigration stress, sociocultural stigma, and systemic discrimination. This paper situates these health disparities within a broader public mental health crisis, examining the intricate relationship between chronic psychological stress, intergenerational trauma, and CVD outcomes. Applying theoretical frameworks such as intersectionality and allostatic load, we explore how cumulative biopsychosocial consequences contribute to the co-morbidity of CVD and mental health disorders in South Asian communities. The study highlights SAWC-Boston’s community-based public mental health intervention, which employs culturally grounded, trauma-informed strategies to address these complex health challenges. This intervention serves as a model for addressing health disparities through community-centered approaches. Full article

(This article belongs to the Special Issue Multidimensional Trauma and Its Impact on Public Mental Health)

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20 pages, 654 KB

Open AccessArticle

Using Sport to Build Inclusion Between Mainstream and Special Schools for Students with Intellectual Disabilities in Eastern Europe

by Roy McConkey, Sabine Menke, Eva Gazova, Emilia Ispas and Joanna Styczeń-Lasocka

Int. J. Environ. Res. Public Health 2026, 23(2), 249; https://doi.org/10.3390/ijerph23020249 - 17 Feb 2026

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Abstract

Children with intellectual disabilities experience social exclusion in all countries of the world. This is compounded too by their attendance at special schools in more affluent countries, especially those with a history of segregation. The article describes how sport was used to bring [...] Read more.

Children with intellectual disabilities experience social exclusion in all countries of the world. This is compounded too by their attendance at special schools in more affluent countries, especially those with a history of segregation. The article describes how sport was used to bring together students from special schools with their non-disabled peers in neighboring mainstream schools based around the Special Olympics Unified Champion Schools^® program. A process evaluation was undertaken by the first author using interviews and questionnaires with 21 Special Olympics personnel and teachers from both mainstream and special schools. Based on their direct experiences, a process model was developed that could assist other sports organizations and schools to implement similar initiatives to advance the social inclusion of students with intellectual disabilities. Moreover the health outcomes from sports could be further enhanced if people with intellectual disabilities had greater access and inclusion in public health and primary care services. The process model outlined here might well be adapted to promote equity of access to healthcare which remains sadly lacking internationally. Full article

(This article belongs to the Section Global Health)

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21 pages, 5540 KB

Open AccessEssay

Walking for Health: Franz Tappeiner (1816–1902), Meran, and the Origins of Public Health-Oriented Physical Activity

by Christian J. Wiedermann, Patrick Rina, Ulrike Kindl and Doris Hager von Strobele Prainsack

Int. J. Environ. Res. Public Health 2026, 23(2), 248; https://doi.org/10.3390/ijerph23020248 - 16 Feb 2026

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Abstract

Background/Objectives: Franz Tappeiner (1816–1902) is often celebrated as a pioneer of alpine medicine and the founder of Tappeiner Promenade in Meran (South Tyrol, Italy). However, his legacy extends far beyond the scenic infrastructure, encompassing a comprehensive vision of physical activity as a public [...] Read more.

Background/Objectives: Franz Tappeiner (1816–1902) is often celebrated as a pioneer of alpine medicine and the founder of Tappeiner Promenade in Meran (South Tyrol, Italy). However, his legacy extends far beyond the scenic infrastructure, encompassing a comprehensive vision of physical activity as a public health intervention. His multidisciplinary practice anticipated the principles of contemporary rehabilitation, preventive medicine, and climate-sensitive public health. Methods: This historical public health analysis, combining biographical, contextual, and material–spatial approaches, reinterprets Tappeiner’s writings, institutional engagements, and civic projects through the lens of modern public health frameworks. Drawing on primary materials (e.g., published articles, autobiographical fragments, and commemorative texts) and recent evidence from rehabilitation and environmental health research, these contributions were contextualized. Results: Tappeiner’s early focus on infectious disease prevention (e.g., cholera and tuberculosis) transitioned into a strategic emphasis on recovery and behavioral therapy through environmental design. The walking therapy model of Max Joseph Oertel, locally realized in the Tappeiner Promenade, prefigured modern concepts such as structured green rehabilitation, walkability, and urban-health citizenship. His systematic integration of graded walking into civic infrastructure represents one of the earliest documented examples of embedding physical activity promotion at the population level. He contributed substantial personal funds to the path’s construction, embedding therapeutic gradients, curating vegetation, and promoting inclusive design to support convalescence. Contemporary research supports the intuition that green, low- to moderate-intensity walking improves cardiometabolic health, psychological well-being, and functional capacity. Moreover, his integrative ethos, merging clinical medicine, civic ethics, and spatial intervention, parallels contemporary eco-social models of public health. Conclusions: Franz Tappeiner’s career exemplifies a still-relevant model of physician leadership that is empirically grounded, socially accountable, and ecologically attuned, with physical activity promotion embedded as a central element of his public health vision. His work invites reflection on how medical professionals can shape not only individual care but also urban environments and collective health futures. Full article

(This article belongs to the Special Issue Physical Activity, Body–Mind Training and Well-Being in Community Settings)

19 pages, 1414 KB

Open AccessArticle

Impacts of Social Environments on Neighborhood Depression Incidence: Fully Accounting for Spatial Effects

by Peter Congdon and Esmail Abdul-Fattah

Int. J. Environ. Res. Public Health 2026, 23(2), 247; https://doi.org/10.3390/ijerph23020247 - 16 Feb 2026

Viewed by 95

Abstract

Neighborhood variations in depression, an important aspect of the overall mental health burden, have been linked both to environmental context (e.g., area crime, neighborhood cohesion), and to area socio-demographic composition. Previous models seeking to explain such spatial variations in mental health, such as [...] Read more.

Neighborhood variations in depression, an important aspect of the overall mental health burden, have been linked both to environmental context (e.g., area crime, neighborhood cohesion), and to area socio-demographic composition. Previous models seeking to explain such spatial variations in mental health, such as those based on Bayesian disease mapping, follow a standard approach defined by: spatially stationary effects of area predictors; predictor effects neglecting potential spatial spillover; and a spatially structured residual to account for unmodelled spatial dependencies. In a study of depression incidence in England neighborhoods, we consider the gains from an alternative strategy, allowing nonstationary environmental impacts; spillover effects of environmental factors, and a non-stationary spatial intensity. We focus particularly on impacts of socio-behavioral environments, namely neighborhood cohesion and crime. We find these to be major influences on neighborhood depression incidence, and also find major gains in model performance by explicitly considering non-stationarity and spillovers. Allowing context heterogeneity, varying spatial intensity and spillover are shown to enhance the impacts of socio-behavioral environments on depression incidence, and such findings have broader relevance to disease mapping regression. Public health policy framing may therefore need to be tailored to locally specific environmental impacts, and to inter-agency collaboration across arbitrary boundaries. Full article

(This article belongs to the Special Issue How and Why Do Neighbourhood Environments Affect Population Mental Health?)

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11 pages, 346 KB

Open AccessArticle

Feasibility of Using College Students to Increase Cancer Screening Behaviors Among Their Parents

by Caitlin C. Abar, Logan Robert Kayser, Amanda Lewis, Hannah Randolph and Beau Abar

Int. J. Environ. Res. Public Health 2026, 23(2), 246; https://doi.org/10.3390/ijerph23020246 - 16 Feb 2026

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Abstract

This study evaluated the feasibility of using college students to encourage cancer screening among their parents or other close adults. Methods: A sample of college students were surveyed on their willingness to discuss cancer screening with their parents and their perceived importance of [...] Read more.

This study evaluated the feasibility of using college students to encourage cancer screening among their parents or other close adults. Methods: A sample of college students were surveyed on their willingness to discuss cancer screening with their parents and their perceived importance of cancer screening. Individuals reporting high levels (≥7/10) on each were offered a brief intervention (i.e., basic cancer screening information) and a follow-up survey. Results: A total of 189 students completed the baseline survey. A subset of 92 students met intervention criteria (49%), with 54 of 92 accepting (59%). Of those who accepted, 19 of 54 were reached at follow-up (35%). Roughly half of those reached engaged in cancer screening discussions with a parent, most speaking with their mother. Open-ended feedback was positive and commonly focused on the desire for additional knowledge. Conclusions: Results demonstrate that college students are a promising target for future intergenerational intervention work. Full article

(This article belongs to the Collection Health Behaviors, Risk Factors, NCDs and Health Promotion)

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15 pages, 595 KB

Open AccessArticle

Physical Activity During Pregnancy: Associations Between Levels and Types of Physical Activity and Low Back Pain–Related Disability in Portuguese Pregnant Women

by Isabel Teixeira, Paula Clara Santos, Clarinda Festas and Diana Bernardo

Int. J. Environ. Res. Public Health 2026, 23(2), 245; https://doi.org/10.3390/ijerph23020245 - 15 Feb 2026

Viewed by 185

Abstract

Low back pain (LBP) is one of the most prevalent musculoskeletal conditions during pregnancy and frequently impairs daily living activities and quality of life. The association between different levels and types of physical activity (PA) and LBP-related functional disability remains insufficiently explored. This [...] Read more.

Low back pain (LBP) is one of the most prevalent musculoskeletal conditions during pregnancy and frequently impairs daily living activities and quality of life. The association between different levels and types of physical activity (PA) and LBP-related functional disability remains insufficiently explored. This study aimed to examine the association between PA levels and types and functional disability among pregnant women with LBP. A cross-sectional analytical study was conducted involving 192 Portuguese pregnant women. Data were collected through an online questionnaire comprising the Pregnancy Physical Activity Questionnaire and the Oswestry Disability Index (ODI). Most participants engaged predominantly in light-intensity or sedentary activity (69.1%), with minimal participation in vigorous activity (0.8%). Functional disability was generally mild (mean ODI = 11.5 ± 7.35); however, 42.2% of participants reported moderate disability and 11.0% severe disability. Advancing gestational age showed weak associations with increased domestic activity (r = 0.146, p = 0.044), decreased occupational activity (r = −0.295, p = 0.001), and higher functional disability scores (r = 0.142, p = 0.049). Parity was associated with differences in total PA levels (p = 0.005) and domestic activity (p = 0.001). Higher ODI scores were weakly associated with light-intensity and sedentary activity (r = 0.144, p = 0.047), whereas severe disability demonstrated a moderate association with sedentary behavior (r = 0.529, p = 0.014). Overall, lower levels of PA, particularly sedentary behavior, were weakly associated with higher LBP-related disability; however, the observed associations were generally weak and should be interpreted with caution considering the cross-sectional design. Full article

(This article belongs to the Special Issue Advances in Women’s Health and Pelvic Health: Lifelong Care)

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15 pages, 330 KB

Open AccessArticle

Do Higher-Quality Regulatory Measures Promote a Healthier School Food Environment?

by Ana Carolyne Lima Lino Sandes, Ariene Silvado Carmo, Larissa L. Mendes and Mariana C. de Menezes

Int. J. Environ. Res. Public Health 2026, 23(2), 244; https://doi.org/10.3390/ijerph23020244 - 14 Feb 2026

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Abstract

This present study analyzed the association between the presence and quality of regulatory measures and the promotion of healthy eating in canteens of 2241 private elementary and secondary schools located in 27 Brazilian state capitals. Three strategic axes were evaluated: food and nutrition [...] Read more.

This present study analyzed the association between the presence and quality of regulatory measures and the promotion of healthy eating in canteens of 2241 private elementary and secondary schools located in 27 Brazilian state capitals. Three strategic axes were evaluated: food and nutrition education (implementation of actions promoting healthy eating), food commercialization (healthiness index, number of unprocessed, minimally processed or processed foods and culinary preparations based on these foods—UMPCP; ultra-processed foods and culinary preparations based on these foods—UpCP; comparison of UMPCP versus UpCP variety; and prohibition of food sales), and marketing communication strategies (advertising strategies for UMPCP and UpCP). The presence and quality of municipal and state regulations in force up to the month prior to data collection were assessed using a score, with a score ≥8 indicating higher quality. Analyses were conducted using binary logistic regression and adjusted generalized linear models in Stata 17.0. More than half of the canteens (51.1%) were located in areas without regulations, and only 17.8% had high-quality regulations. Canteens in areas with regulations, especially those with a score ≥8, had 1.73 times higher odds of implementing food and nutrition education actions, 2.49 times higher odds of prohibiting the sale of certain foods, and 36% lower odds of selling a higher variety of UpCP compared to UMPCP. The healthiness index was higher, the number of UpCP sold was lower, and the number of UMPCP sold was higher, while the adoption of advertising strategies was less frequent in canteens with higher-quality regulations. These findings indicate that the presence and particularly the quality of regulatory measures is associated with healthier school food environments, highlighting the positive impact of well-structured public policies. Full article

(This article belongs to the Special Issue Bridging the Gap in Studies on the Food Environment: The State of the Art in Low- and Middle-Income Countries (LMICs): 2nd Edition)

16 pages, 332 KB

Open AccessReview

Physical Activity Interventions for Mental Health Among Youth in South Africa: A Scoping Review

by Osia Livhuwani Munyangane, Lebogang Faith Thaga and Ronald Vele

Int. J. Environ. Res. Public Health 2026, 23(2), 243; https://doi.org/10.3390/ijerph23020243 - 14 Feb 2026

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Abstract

Mental health problems are increasing among young people in South Africa due to diverse determinants such as, poverty, social shame, and lack of proper access to health services. Although physical activity is a low-cost and non-medical way to help improve mental health, its [...] Read more.

Mental health problems are increasing among young people in South Africa due to diverse determinants such as, poverty, social shame, and lack of proper access to health services. Although physical activity is a low-cost and non-medical way to help improve mental health, its effects in rural areas are still not clearly understood. A scoping review was carried out following the PRISMA-ScR guidelines. We systematically searched three online databases (PubMed, CINAHL, and Google Scholar) for studies published from 2014 through 2025. Studies met eligibility criteria if they targeted youth aged 14–35 years living in rural South Africa and reported on physical activity interventions designed for mental health. Two reviewers independently carried out data extraction and came up with the overall result. Overall, 42,384 records were identified, of which only 12 studies met all the specified criteria. The findings of the study were that participation in organised forms of physical activity (including school-based aerobic sessions, community-based walking groups, and charity training programmes) was associated with reductions in mental health issues. Even with these issues, the findings show that physical activity can be a useful, efficient, and practical way to support mental health among rural South African youth. To improve the evidence, strong trials, community-based plans, and sessions at schools and clinics are needed. In addition, policy cooperation across health, education, and sports sectors is essential for lasting impact. Full article

(This article belongs to the Special Issue Mental Health and Health Promotion in Young People)

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25 pages, 1065 KB

Open AccessArticle

Objective Physical Activity and Sedentary Behaviour Patterns Among Informal Carers in the BCS70 Cohort

by Eilidh Russell, Alison Kirk, Mark D. Dunlop, Dwight C. K. Tse and Kieren Egan

Int. J. Environ. Res. Public Health 2026, 23(2), 242; https://doi.org/10.3390/ijerph23020242 - 14 Feb 2026

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Abstract

While the health benefits of physical activity (PA) and reduced sedentary behaviour (SB) are well established, informal carers remain an under-researched group. Despite being known to face many barriers to PA, informal carers’ activity levels remain unclear due to mixed findings from previous [...] Read more.

While the health benefits of physical activity (PA) and reduced sedentary behaviour (SB) are well established, informal carers remain an under-researched group. Despite being known to face many barriers to PA, informal carers’ activity levels remain unclear due to mixed findings from previous research. Specifically, objective PA and SB levels of informal carers in Great Britain are currently unknown. The aim of this study was to examine PA and SB among informal carers using accelerometer data from the ‘Age 46’ Survey of the 1970 British Cohort Study (BCS70). Analyses of Covariance and Logistic Regressions were performed to: (i) compare carers’ and non-carers’ PA and SB, (ii) examine the impact of caring hours on PA and SB, and (iii) identify predictors of adherence to the UK Chief Medical Officers’ PA guidelines. After adjusting for covariates, (i) no differences were observed in PA or SB outcomes between carers and non-carers (p > 0.05) (e.g., mean daily step count 9316.06 vs. 9554.11 and mean sitting time 1.09 h/day vs. 1.19 h/day, respectively). (ii) Caring hours were not associated with differences in PA or SB (p > 0.05). (iii) Logistic regressions revealed very low adherence to PA guidelines among carers: 2% met the moderate-to-vigorous PA guideline, 26% met the muscle-strengthening guideline, and only 1% met the combined recommendations. Demographic and health variables did not explain adherence to these guidelines. This study found no significant differences in objectively measured PA and SB between informal carers and non-carers or caring hours. However, adherence to the UK CMOs’ PA guidelines among carers was extremely low. These findings provide the first objective benchmark of carers’ PA and SB patterns in Great Britain and highlight guideline adherence as a key area for future interventions. Future research should consider the wider context of caring in order to develop flexible, tailored interventions that can support carers in achieving an active lifestyle whilst managing responsibilities. Full article

(This article belongs to the Special Issue Family Caregiving, Nursing and Health Promotion)

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20 pages, 1139 KB

Open AccessReview

Diversity and Representation in Cardiovascular Research: Evidence Gaps, Emerging Models, and Policy Implications

by Simran Grewal, James Wildish, Catherine Chalmers, Christine Dedding, Jeanine Suurmond, Charles Agyemang and Nimrat Grewal

Int. J. Environ. Res. Public Health 2026, 23(2), 241; https://doi.org/10.3390/ijerph23020241 - 14 Feb 2026

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Abstract

Although cardiovascular disease (CVD) is the leading cause of mortality globally, it remains insufficiently understood in large parts of the world. The scientific foundations underpinning CVD risk prediction, diagnostics, and treatment are extensively derived from homogenous datasets, primarily including White, male participants from [...] Read more.

Although cardiovascular disease (CVD) is the leading cause of mortality globally, it remains insufficiently understood in large parts of the world. The scientific foundations underpinning CVD risk prediction, diagnostics, and treatment are extensively derived from homogenous datasets, primarily including White, male participants from high-income countries. This lack of diversity and inclusion can lead to biased evidence, which in turn contributes to reduced diagnostic accuracy and the under-representation of key populations, and ultimately limits the generalizability of trial results and guidelines. In this paper, we discuss that diversity in cardiovascular data is a scientific necessity for valid and globally applicable knowledge and not just a matter of fairness. Drawing from emerging initiatives in genomics, digital health, and participatory research, we propose a global roadmap to reshape how cardiovascular research is conducted. This includes strategies such as data donation frameworks, inclusive biobanking, equitable AI development, and international policy change. Only by integrating diversity into scientific methodologies can we ensure that cardiovascular guidelines are effective, inclusive, and just. Full article

(This article belongs to the Special Issue Inequities in Health and Well-Being)

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16 pages, 882 KB

Open AccessArticle

Factors Associated with Nutritional Status in Grassroots Recyclers in Ecuador: A Machine Learning Approach

by Jenny Albarracín-Méndez, Diana Morales-Avilez, Francisco Arias-Pallaroso, Gabriele Davide Bigoni-Ordoñez and Andrea Gómez-Ayora

Int. J. Environ. Res. Public Health 2026, 23(2), 240; https://doi.org/10.3390/ijerph23020240 - 14 Feb 2026

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Abstract

Grassroots recyclers play a fundamental role in solid waste management in Ecuador; however, they often work under precarious conditions that may compromise their health. This study aimed to identify factors associated with nutritional status, operationalized as the presence or absence of nutritional alterations, [...] Read more.

Grassroots recyclers play a fundamental role in solid waste management in Ecuador; however, they often work under precarious conditions that may compromise their health. This study aimed to identify factors associated with nutritional status, operationalized as the presence or absence of nutritional alterations, among grassroots recyclers through supervised machine learning approaches. Data from 303 recyclers from three Ecuadorian cities (Cuenca, Macas, and La Libertad) were analyzed, incorporating sociodemographic, occupational, and health-related variables. Nutritional alterations were defined based on anthropometric and biochemical indicators, specifically, excess body weight and/or elevated total lipid levels. The results showed that 71% presented nutritional alterations, evidencing an important public health problem in this vulnerable population. Significant associations were observed with sex, age, canton of residence, ability to ride a bicycle, bicycle use for work, and attendance at medical check-ups. Among the evaluated models, CatBoost trained with SMOTE achieved the highest ROC-AUC value and the most balanced performance between classes, although sensitivity for individuals without nutritional alterations remained limited. Feature importance analysis highlighted sociodemographic, occupational, economic, and healthcare access factors, underscoring the multidimensional nature of nutritional risk and supporting the use of machine learning as a support tool for public health planning and targeted interventions. Full article

(This article belongs to the Section Global Health)

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13 pages, 357 KB

Open AccessArticle

Domestic Medical Waste Management: An Assessment of Knowledge and Disposal Practices in the City of Tshwane Metropolitan Municipality

by Reneilwe Prudence Mariba, Matodzi Michael Mokoena, Thabiso John Morodi and Gomotsegang Fred Molelekwa

Int. J. Environ. Res. Public Health 2026, 23(2), 239; https://doi.org/10.3390/ijerph23020239 - 14 Feb 2026

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Abstract

The improper disposal of domestic medical waste (DMW) constitutes a significant public health and environmental concern; however, limited studies exist concerning DMW disposal practices in South Africa. This study evaluated the knowledge and practices involving the disposal of domestic medical waste (DMW) in [...] Read more.

The improper disposal of domestic medical waste (DMW) constitutes a significant public health and environmental concern; however, limited studies exist concerning DMW disposal practices in South Africa. This study evaluated the knowledge and practices involving the disposal of domestic medical waste (DMW) in the City of Tshwane Metropolitan Municipality. The study investigated common disposal methods, levels of awareness of appropriate techniques, and associated health risks. Data were collected using structured questionnaires (Annexure A) with closed-ended questions, administered both physically at shopping complexes and electronically via LinkedIn, WhatsApp, and email to eligible participants. Data analysis was conducted using the Statistical Package for the Social Sciences (SPSS) Version 29 and Microsoft Excel, with results presented in graphical form. Findings revealed that 78.3% of residents disposed of DMW in general waste bins, while 85.8% reported discarding medicine bottles in the same manner, and only 5.2% returned unused medications to pharmacies. The findings highlight gaps in awareness, infrastructure, and policy, necessitating comprehensive education programs, improved waste management services, and policy revisions to include DMW. A proposed model emphasizes education, community involvement, infrastructure enhancement, and ongoing policy evaluation to address these challenges. These efforts aim to reduce health risks, mitigate environmental impacts, and promote safe DMW disposal practices, safeguarding public health and creating a sustainable environment. Full article

(This article belongs to the Section Environmental Health)

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24 pages, 872 KB

Open AccessArticle

Towards Caring Technologies in Older Adult Care Through the Co-Creation of an Ethical Process Guide

by Elisabeth Honinx, Cato van Schyndel, Arend Roos, Emily Paulding, Toni Wright, Kathleen Galvin, Theofanis Fotis, Jorg Huber, Erik Laes and Nathalie Lambrechts

Int. J. Environ. Res. Public Health 2026, 23(2), 238; https://doi.org/10.3390/ijerph23020238 - 13 Feb 2026

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Abstract

As populations age, the gap between care needs and available support systems is widening, leading to critical vulnerabilities in staffing, infrastructure, and funding. The need for accessible, human-centred, and ethically grounded care technologies is growing. However, the development of digital health tools often [...] Read more.

As populations age, the gap between care needs and available support systems is widening, leading to critical vulnerabilities in staffing, infrastructure, and funding. The need for accessible, human-centred, and ethically grounded care technologies is growing. However, the development of digital health tools often lacks inclusivity and practical guidance. Existing ethical frameworks tend to remain abstract, which limits their real-world application. This study examines how such frameworks support the responsible development and implementation of caring technologies in older adult care. To achieve this, in-depth interviews were conducted with care providers, technology developers, and policymakers from partner organisations of the EMPOWERCARE project in the four participating countries: the UK, the Netherlands, Belgium and France. A core challenge was the limited applicability of abstract ethical principles in daily care settings. While existing initiatives often define ethical domains, few offer a structured, actionable process to guide implementation in practice. The proposed guide responds with a step-by-step structure, practical examples, and participatory tools to support inclusive, value-driven technology adoption. It is envisioned both as an implementation aid and a quality label to align stakeholders. Future research should validate the guide’s usability, explore its role across care contexts, and examine how ethics can be more firmly embedded in innovation governance. Full article

(This article belongs to the Special Issue Public Mental Health Promotion for Vulnerable Populations: Opportunities in the Digital Era)

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12 pages, 582 KB

Open AccessArticle

Preliminary Findings of a Chronic Disease Management Program in Medicare Advantage Enrollees with Mild to Moderate Kidney Disease

by Trevon Morales, Rubette Harford, Dulcie Kermah, Jose Flaque, Michelle Camacho, Damaris Vasquez, Vanessa Schmidt, Inés Hernández-Roses, James P. O’Drobinak and Keith C. Norris

Int. J. Environ. Res. Public Health 2026, 23(2), 237; https://doi.org/10.3390/ijerph23020237 - 13 Feb 2026

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Abstract

Background: Chronic kidney disease (CKD) is traditionally viewed as a condition marked by a progressive reduction in kidney function leading to the need for kidney dialysis or transplantation. The estimated prevalence of CKD in adults in Puerto Rico is ~20% higher than that [...] Read more.

Background: Chronic kidney disease (CKD) is traditionally viewed as a condition marked by a progressive reduction in kidney function leading to the need for kidney dialysis or transplantation. The estimated prevalence of CKD in adults in Puerto Rico is ~20% higher than that of the overall United States (US). To address the disproportionately high rate of CKD in Puerto Rico, we created a multidisciplinary chronic disease management (CDM) program targeting CKD and diabetes mellitus (DM), the leading CKD risk factor. Methods: Over 7200 eligible enrollees in a Puerto Rico-Managed Medicare Program participated in a CDM program targeting individuals with CKD or DM as determined by administrative review. Evaluations were conducted on 4068 program participants with baseline glomerular filtration rate (eGFR) and codifying CKD stage by eGFR. A dietitian/nurse team provided dietary and lifestyle recommendations to the patient/family and a nephrologist/endocrinologist made diabetes and CKD recommendations to the primary care provider. Findings on 2095 participants with Stages 1–3 CKD with follow-up eGFR at least 6 months but less than 2 years after baseline are presented. Results: At baseline, the mean age was 74 years (range 30–101), 59% of patients were female and mean duration of follow-up from initial evaluation to second evaluation was 407 days (±159 days SD). Most participants had Stage 2 CKD (34.8%), followed by CKD Stage 1 and 3 (33.5 and 31.7%). During the follow-up period, 55.9% of participants with Stage 1 CKD remained in Stage 1, 84.9% of patients with Stage 2 remained in Stage 2 or regressed to Stage 1, while 96.1% of patients with Stage 3 remained in Stage 3 or regressed to Stage 2. Only 15.1% of patients in Stage 2 progressed to Stage 3 and 3.9% of patients in Stage 3 progressed to Stage 4 or 5. A secondary analysis comparing all 665 CDM Stage 3 participants to 117,249 historical controls found CDM participants demonstrated a higher rate of regression (20.3% vs. 15.2%; absolute difference +5.1 percentage points; p = <0.01) and a lower rate of progression (3.9% vs. 15.3%; absolute difference −11.4 percentage points; p < 0.001). Conclusions: Early findings of a multidisciplinary CDM intervention indicate that 79% of participants with CKD Stages 1–3 by eGFR had stabilized or improved CKD status. Comparison to a randomized control group to better assess for causality and longer-term CDM program follow-up on CKD status and clinical outcomes is warranted. Full article

(This article belongs to the Special Issue Exploring and Addressing Healthcare Inequalities in Marginalized Communities)

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11 pages, 1395 KB

Open AccessBrief Report

Prevalence of Multiple Chemical Sensitivity in Canada Between 2000 and 2020

by Stephanie Robins, John Molot and Rohini Peris

Int. J. Environ. Res. Public Health 2026, 23(2), 236; https://doi.org/10.3390/ijerph23020236 - 13 Feb 2026

Viewed by 186

Abstract

Multiple chemical sensitivity (MCS) describes an acquired condition characterized by recurrent, non-specific symptoms attributed to previously tolerated chemical exposure. Although Canada collects national data on MCS through population health surveys, the condition remains poorly understood and under-studied. This study analyzes data from the [...] Read more.

Multiple chemical sensitivity (MCS) describes an acquired condition characterized by recurrent, non-specific symptoms attributed to previously tolerated chemical exposure. Although Canada collects national data on MCS through population health surveys, the condition remains poorly understood and under-studied. This study analyzes data from the Canadian Community Health Survey (2000–2020) to examine trends in MCS prevalence across demographic characteristics, including province of residence, sex, and age. Descriptive analyses were used to assess temporal changes and differences between regions and population subgroups. Between 2000 and 2020, the proportion of Canadians reporting an MCS diagnosis increased from 1.9% to 3.5%. Prevalence varied geographically, with higher rates consistently observed in the Atlantic provinces compared with the Prairie provinces. MCS prevalence increased with age in both sexes; however, rates were higher among young males than females, with this pattern reversing in mid-life as prevalence became higher among females. These findings provide a national overview of MCS prevalence over two decades and offer relevant information for public health authorities, healthcare professionals, and researchers. The observed prevalence aligns with international estimates, underscoring MCS as an emerging public health concern in Canada. Full article

(This article belongs to the Special Issue Understanding Multiple Chemical Sensitivity (MCS): Interdisciplinary Insights into Science, Policy, and Lived Experience)

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14 pages, 1164 KB

Open AccessSystematic Review

Epidemiological Characteristics of Dengue Infection in Bangladesh: A Systematic Review

by Md Moustafa Kamal, Tsheten Tsheten, Rashidul Haque and Syeda Zakia Hossain

Int. J. Environ. Res. Public Health 2026, 23(2), 235; https://doi.org/10.3390/ijerph23020235 - 13 Feb 2026

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Abstract

Background: Dengue infection (DI) is a mosquito-borne arboviral disease primarily transmitted by infected female Aedes mosquitoes. In Bangladesh, DI poses a substantial public health challenge with recurrent outbreaks and rising incidence rates. This systematic review assesses the epidemiological characteristics of dengue infection in [...] Read more.

Background: Dengue infection (DI) is a mosquito-borne arboviral disease primarily transmitted by infected female Aedes mosquitoes. In Bangladesh, DI poses a substantial public health challenge with recurrent outbreaks and rising incidence rates. This systematic review assesses the epidemiological characteristics of dengue infection in Bangladesh, focusing on demographic, clinical, and geographic trends. Objectives: To analyze dengue prevalence, demographic distribution, clinical symptoms, and serotype patterns in Bangladesh, with an emphasis on urban–rural disparities, gender differences, and serotype evolution. Methods: A systematic search was conducted across PubMed, Scopus, Web of Science, and Global Health (Ovid) databases, reviewing studies published from 2000 to 2024. Following PRISMA guidelines, 25 studies meeting eligibility criteria were selected. Data extraction and quality assessment were independently performed by three reviewers, ensuring methodological rigor. Results: Dengue incidence was higher in urban areas, mainly affecting males aged 20–34, with dengue virus serotype 3 (DENV-3) as the dominant serotype. Fever, headache, and joint pain were the most common symptoms, while severe cases often presented with respiratory and hemorrhagic complications. Acute symptoms like dyspnea and dehydration spread rapidly in densely populated areas. In rural areas, dengue showed a more endemic pattern, with persistent symptoms such as gastroenteritis and muscle pain. Conclusion: Dengue is now firmly endemic in Bangladesh, with clear geographic, demographic, and clinical differences. The dominance of DENV-3 and its association with more severe illness highlight the need for targeted and context specific interventions. Control efforts should prioritize vector management, public education, and continuous surveillance in urban areas, while strengthening community surveillance and primary healthcare in rural settings. Further research on rural transmission and the clinical impact of DENV-3 is essential to guide effective and tailored dengue control strategies. Full article

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16 pages, 316 KB

Open AccessCommentary

Genomic Medicine and Individual Autonomy: Reflections on Knowledge Societies and Governmentality

by Richard H. Parrish II

Int. J. Environ. Res. Public Health 2026, 23(2), 234; https://doi.org/10.3390/ijerph23020234 - 13 Feb 2026

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Abstract

This paper offers a comprehensive analysis of the multifaceted implications of genomic medicine’s evolving regulatory frameworks on individual autonomy. As genomic technologies increasingly permeate healthcare and society, they fundamentally reshape the boundaries of health and disease, profoundly impacting personal identity and self-understanding. The [...] Read more.

This paper offers a comprehensive analysis of the multifaceted implications of genomic medicine’s evolving regulatory frameworks on individual autonomy. As genomic technologies increasingly permeate healthcare and society, they fundamentally reshape the boundaries of health and disease, profoundly impacting personal identity and self-understanding. The expansion of genomic surveillance and risk classification introduces new forms of scrutiny and vigilance, as individuals are redefined according to probabilistic genetic markers rather than traditional clinical symptoms. Regulatory developments facilitate compulsory interventions and challenge established notions of informed consent, as genetic risk factors in otherwise healthy individuals prompt preemptive medicalization and intervention. These changes heighten the risk of genetic discrimination and reinforce social stratifications, as access to care, insurance, and employment may become contingent upon genomic profiles. Furthermore, the commodification of genetic information raises significant concerns about privacy, ownership, and the potential misuse of personal data by commercial and governmental entities. The increasingly blurred lines between medical necessity and social control highlight constitutional and ethical dilemmas, particularly regarding the balance of public health priorities and the preservation of individual freedoms. Drawing on theoretical frameworks such as Stehr’s knowledge society and governmentality, the paper critically examines how regulatory responses both reflect and shape broader societal values, often introducing persistent uncertainty and vulnerability into the core of personal and collective identity. Ultimately, the analysis underscores the urgent need for innovative governance models that can effectively balance the promise of scientific and technological advances with the protection of personal autonomy, democratic knowledge control, and social justice in the genomic era. Lay statement: This paper explores how new rules and regulations around genetic medicine can impact people’s personal freedoms and sense of identity. It highlights concerns about privacy, discrimination, and the ways in which our understanding of health and disease is changing, calling for better protections and fairer policies as genetic technologies become more common. Full article

(This article belongs to the Special Issue The Effects of Public Policies on Health)

18 pages, 942 KB

Open AccessArticle

A Heavy Metal and Trace Element Biomonitoring Study in a Young Cohort (Aged 18–24) in Istanbul, Turkey

by Nilay Topal, Meltem Pak Demir, Aydanur Kulaç, Bulut Yurtsever, Demet Dinç and Fehime Aksungar

Int. J. Environ. Res. Public Health 2026, 23(2), 233; https://doi.org/10.3390/ijerph23020233 - 12 Feb 2026

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Abstract

This study aimed to determine the exposure levels of young individuals living in Istanbul, a region in Turkey with a high population density and significant environmental pollution, by measuring the levels of heavy metals and trace elements in blood, serum, and urine. A [...] Read more.

This study aimed to determine the exposure levels of young individuals living in Istanbul, a region in Turkey with a high population density and significant environmental pollution, by measuring the levels of heavy metals and trace elements in blood, serum, and urine. A total of 95 young people aged 18–24 participated in the study. Toxic heavy metals (Pb, As, Hg, Cd, and Cr) and physiological trace elements (Cu, Zn, Se, Mo, Mn, and Co) were measured in participants’ whole blood, serum, and urine samples using the ICP-MS technique. Participants were stratified by gender, as differences in body surface area may affect the absorption and metabolism of trace elements, and by smoking status, since smoking is a recognized source of heavy metal exposure. Gender differences revealed that blood lead levels were higher in males (p < 0.05), while manganese levels were higher in females (p < 0.05). When serum samples were analyzed, males had significantly higher zinc (p < 0.05) and selenium (p < 0.05) levels compared to females, whereas females had significantly higher levels of copper (p < 0.05) and cobalt (p < 0.05). Similar differences for copper (p < 0.05) and cobalt (p < 0.05) were observed in urine samples, with higher levels found in females. Blood cadmium levels were found to be significantly higher in smokers (p < 0.05). This biomonitoring study is one of the rare studies conducted in this region to assess heavy metal exposure among young adults. Full article

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32 pages, 1893 KB

Open AccessArticle

Psychological and Mental Health Support for Vietnamese University Students in Economics Majors: Approaches and Needs Assessment

by Ngoc Bich Luu, Hà Thanh Nguyễn, Ngoc Bao Nguyen, Son Hong Dang and Hoa Quynh Nguyen

Int. J. Environ. Res. Public Health 2026, 23(2), 232; https://doi.org/10.3390/ijerph23020232 - 11 Feb 2026

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Abstract

The mental health of students in university has become an increasingly pressing concern due to rising academic pressure, career uncertainty, and major life transitions. Identifying students’ psychological support needs requires an understanding of the challenges they face, as well as their expectations regarding [...] Read more.

The mental health of students in university has become an increasingly pressing concern due to rising academic pressure, career uncertainty, and major life transitions. Identifying students’ psychological support needs requires an understanding of the challenges they face, as well as their expectations regarding support forms, intervention methods, and service providers. This study employed a mixed-methods cross-sectional design, combining large-scale questionnaire surveys (701 respondents) with qualitative interviews to assess the mental health status and psychological support needs of students at economics universities in Vietnam. The findings reveal that students commonly experience negative emotional states, particularly anxiety related to academic workload, financial instability, personal health, and future career orientation. A proportion of students reported depressive symptoms such as persistent sadness, prolonged stress, and physiological disturbances including insomnia and disordered eating. While severe behavioral disorders are uncommon, signs of declining academic motivation, social withdrawal, and weakened interactions with lecturers are evident. Students express a strong demand for mental health support, especially in career guidance, learning strategies, emotional regulation, and interpersonal problem-solving. Individual, professional, confidential counseling services are the most preferred forms of support, highlighting the need for a comprehensive mental health and psychological support system tailored to the context of Vietnamese universities. Full article

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9 pages, 934 KB

Open AccessArticle

Socioeconomic and Clinical Risk Factors for Meconium-Stained Amniotic Fluid and Associated Maternal–Neonatal Morbidity in Ethiopia: A Prospective Case–Control Study

by Loris Marin, Guido Ambrosini, Elisabetta Valentini, Jordyn Conley and Alessandra Andrisani

Int. J. Environ. Res. Public Health 2026, 23(2), 231; https://doi.org/10.3390/ijerph23020231 - 11 Feb 2026

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Abstract

Meconium-stained amniotic fluid (MSAF) results from premature release of meconium by the fetus under stressful conditions and is associated with increased risk of maternal and neonatal morbidity and mortality. Risk factors for stressful conditions may differ between women living in highly developed countries [...] Read more.

Meconium-stained amniotic fluid (MSAF) results from premature release of meconium by the fetus under stressful conditions and is associated with increased risk of maternal and neonatal morbidity and mortality. Risk factors for stressful conditions may differ between women living in highly developed countries and those in low-income countries. This study aimed to evaluate known and potential risk factors for MSAF and to assess the association between MSAF and maternal and neonatal morbidity. This prospective case–control study was conducted at a tertiary care hospital in Wolisso, Ethiopia. A total of 165 women were enrolled and divided into two groups: group A (65 women with MSAF) and group B (100 women with clear amniotic fluid). Data were collected through medical records (pregnancy, maternal and fetal outcomes) and questionnaires (socioeconomic factors). Women with MSAF had statistically significant differences in distance traveled, means of transportation, travel time to reach the hospital, weekly workload, and family income compared to controls. Higher rates of intrapartum monitoring abnormalities and operative deliveries were also observed among women with MSAF. The socioeconomic situation of pregnant women referred to the hospital in Wolisso appears to be related to the occurrence of MSAF. Recognizing these risk factors is crucial to improving quality of care and maternal–fetal health. Full article

(This article belongs to the Section Global Health)

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Int. J. Environ. Res. Public Health, Volume 23, Issue 2 (February 2026) – 121 articles

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