International Journal of Environmental Research and Public Health

12 pages, 1184 KB

Open AccessArticle

Dietary Predictors of Paraben Exposure Among Adults in Northern Thailand

by Vivat Keawdounglek, Pussadee Laor and Warapon Paenkhokuard

Int. J. Environ. Res. Public Health 2026, 23(5), 686; https://doi.org/10.3390/ijerph23050686 - 21 May 2026

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Background: Parabens are frequently utilized as preservatives in processed foods; nevertheless, the primary dietary factors contributing to exposure in northern Thailand remain undetermined. Methods: A cross-sectional study was conducted among 130 adults in Northern Thailand. Dietary intake was assessed using self-reported [...] Read more.

Background: Parabens are frequently utilized as preservatives in processed foods; nevertheless, the primary dietary factors contributing to exposure in northern Thailand remain undetermined. Methods: A cross-sectional study was conducted among 130 adults in Northern Thailand. Dietary intake was assessed using self-reported food consumption data combined with previously measured paraben concentrations. Due to the skewed distribution of intake, participants were classified into lower and higher exposure groups. LASSO regression was applied for variable selection, followed by multivariable logistic regression to identify dietary predictors of exposure. Results: Several processed food items were significantly associated with higher paraben exposure, including soft drinks, potato chips, and canned fish. No demographic factors were significantly associated with exposure. The final model demonstrated good explanatory power and classification performance. Conclusions: These findings suggest that routine consumption of certain processed foods and beverages may play a larger role in exposure than individual characteristics, and they highlight practical targets, particularly soft drinks, potato chips, and canned fish, for community-based health-promotion strategies aimed at reducing unnecessary preservative intake. Full article

(This article belongs to the Section Environmental Health)

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15 pages, 841 KB

Open AccessArticle

Environmental Health Literacy and Climate Change Anxiety Among Teachers: The Mediating Role of Ecological Footprint Awareness

by Özge Açıkgöz and Pınar Soylar

Int. J. Environ. Res. Public Health 2026, 23(5), 685; https://doi.org/10.3390/ijerph23050685 - 21 May 2026

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Abstract

Background: Environmental health literacy plays an important role in helping individuals recognize environmental risks and adopt sustainable behaviors. Increasing environmental awareness may also influence emotional responses to environmental problems such as climate change. However, the mechanisms linking environmental health literacy to climate change [...] Read more.

Background: Environmental health literacy plays an important role in helping individuals recognize environmental risks and adopt sustainable behaviors. Increasing environmental awareness may also influence emotional responses to environmental problems such as climate change. However, the mechanisms linking environmental health literacy to climate change anxiety remain insufficiently explored. This study aimed to examine the relationship between environmental health literacy and climate change anxiety among teachers and to evaluate the mediating role of ecological footprint awareness in this relationship. Methods: This cross-sectional study was conducted with teachers working in public schools in the provinces of Elazığ and Erzincan, Türkiye. Data were collected using a personal information form, the Environmental Health Literacy Scale, the Ecological Footprint Awareness Scale, and the Climate Change Anxiety Scale. Descriptive statistics, group comparison tests, correlation analyses, and mediation analysis based on structural equation modeling were performed to examine the relationships among the study variables. Results: Participants’ mean scores were 35.98 ± 9.12 for the Climate Change Anxiety Scale, 95.37 ± 18.29 for the Environmental Health Literacy Scale, and 118.08 ± 25.92 for the Ecological Footprint Awareness Scale. Environmental health literacy was positively associated with ecological footprint awareness, and ecological footprint awareness was positively associated with climate change anxiety (p < 0.001). Mediation analysis indicated that ecological footprint awareness significantly mediated the relationship between environmental health literacy and climate change anxiety (β = 0.293, 95% CI: 0.112–0.496, p = 0.002). Conclusions: The findings suggest that ecological awareness can serve as a potential mechanism linking environmental knowledge with emotional responses to climate change. Strengthening ecological footprint awareness through environmental education programs for teachers may contribute to both environmental awareness and constructive engagement with climate-related issues. Full article

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23 pages, 685 KB

Open AccessArticle

Adaptation of Trajectory of Illness Framework to Assess the Experiences of Youths Living with Type 1 Diabetes Mellitus in the Rural Areas of Limpopo Province, South Africa

by Thembi Julia Motsepe, Gsakani Olivia Sumbane, Takalani Edith Mutshatshi and Leshata Winter Mokhwelepa

Int. J. Environ. Res. Public Health 2026, 23(5), 684; https://doi.org/10.3390/ijerph23050684 - 21 May 2026

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Abstract

Diabetes Mellitus is a chronic metabolic disorder characterized by elevated blood glucose due to defects in insulin secretion or action, or both, leading to serious short- and long-term complications if not effectively managed. However, there is limited qualitative evidence exploring how youths diagnosed [...] Read more.

Diabetes Mellitus is a chronic metabolic disorder characterized by elevated blood glucose due to defects in insulin secretion or action, or both, leading to serious short- and long-term complications if not effectively managed. However, there is limited qualitative evidence exploring how youths diagnosed with Type 1 Diabetes Mellitus (T1DM) experience disease onset, management, complications, emotional adaptation, and education within the South African public healthcare system. The study aims to investigate the lived experiences of youths living with T1DM in a selected public hospital in Limpopo province, South Africa. The objectives were to explore and describe the lived experiences of youths living with T1DM. A qualitative, explorative, descriptive, and contextual design was used to gain a thorough understanding of the experiences of youths living with T1DM. A non-probability sampling technique was used to select 12 participants using a pre-determined criterion. Data were collected through individual semi-structured interviews using an interview guide. The data were analyzed using Colaizzi’s method, where themes and sub-themes were developed with the inclusion of an independent coder. Measures to ensure trustworthiness and ethical considerations were adhered to throughout the study. The findings revealed that, despite the participants sharing the same diagnosis, they experience multiple interrelated barriers that significantly hindered effective self-care management, such as limited access to diabetic diet, glucometers and supplies, treatment and informational-related barriers, school-related challenges, transportation constraints and inadequate social support. Furthermore, the findings highlighted gaps in early recognition of symptoms, standardized diabetes education, psychosocial support, and continuity of care. The study recommends the need for holistic, patient-centred, and contextualized interventions that do not only address medical management but the socioeconomic, educational, and psychological needs of youths. Full article

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1 pages, 195 KB

Open AccessRetraction

RETRACTED: Castellano-Tejedor, C.; Cencerrado, A. Gamification for Mental Health and Health Psychology: Insights at the First Quarter Mark of the 21st Century. Int. J. Environ. Res. Public Health 2024, 21, 990

by Carmina Castellano-Tejedor and Andrés Cencerrado

Int. J. Environ. Res. Public Health 2026, 23(5), 683; https://doi.org/10.3390/ijerph23050683 - 21 May 2026

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Abstract

The journal retracts the article titled “Gamification for Mental Health and Health Psychology: Insights at the First Quarter Mark of the 21st Century” [...] Full article

17 pages, 304 KB

Open AccessArticle

Knowledge, Attitudes, and Management of Postpartum Depression Among Healthcare Professionals in Croatian Primary and Community Care: A Cross-Sectional Survey Study

by Ema Dejhalla, David Zahirović, Rafaela Jurman, Mate Rukavina, Sanja Smojver-Ažić and Tina Zavidić

Int. J. Environ. Res. Public Health 2026, 23(5), 682; https://doi.org/10.3390/ijerph23050682 - 21 May 2026

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Abstract

Background: Postpartum depression (PPD) is a common perinatal mental health disorder with important consequences for mothers and children. Early detection depends largely on primary and community healthcare professionals. This study assessed knowledge, recognition patterns, and screening practices related to PPD and examined factors [...] Read more.

Background: Postpartum depression (PPD) is a common perinatal mental health disorder with important consequences for mothers and children. Early detection depends largely on primary and community healthcare professionals. This study assessed knowledge, recognition patterns, and screening practices related to PPD and examined factors associated with screening implementation. Methods: An exploratory cross-sectional online survey using convenience sampling was conducted between December 2025 and March 2026 among 154 healthcare professionals (74 community nurses and 80 physicians). Structured questionnaires assessed PPD knowledge, while physicians additionally reported screening and treatment practices. Group differences, correlations, and predictors of screening implementation were analyzed statistically. Results: Community nurses achieved higher overall knowledge scores than physicians (66.1% vs. 58.4%; p = 0.0038). Physicians more frequently distinguished baby blues from PPD (60.0% vs. 27.0%; p < 0.001). Awareness of validated screening tools among physicians was low, with only 10.0% recognizing the EPDS. Although physician knowledge correlated with screening frequency before correction for multiple testing (ρ = 0.27; p = 0.015), the association was not statistically significant after BH–FDR correction (q = 0.075). In multivariable logistic regression analysis, guideline awareness was not significantly associated with screening implementation (OR = 3.81; 95% CI 0.98–14.82; p = 0.053). Conclusions: Gaps remain in knowledge of PPD screening tools and treatment, particularly among physicians. The findings support the need for improved education, dissemination of clinical guidelines, and implementation support for standardized screening practices. However, given the exploratory convenience-sampling design and the lack of statistically significant adjusted associations, further longitudinal and implementation-focused studies are needed. Full article

20 pages, 633 KB

Open AccessArticle

Using Life Cycle Assessments to Measure the Environmental Impact of Alternative Care Models in the Neonatal Intensive Care Unit

by Thomas Walsh, Samantha House, Emily Monroe, Will Clendenning, Chad Klaas, Samantha Melgar, Ismael Rosales-Albarran, Tyler Hartman and Kathryn Richards

Int. J. Environ. Res. Public Health 2026, 23(5), 681; https://doi.org/10.3390/ijerph23050681 - 20 May 2026

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Abstract

The healthcare sector is a major contributor to global greenhouse gas emissions. Little is known about the impact of individual clinical practices on overall emissions; more granular healthcare emissions data are needed to identify opportunities for resource stewardship. Our objective was to deploy [...] Read more.

The healthcare sector is a major contributor to global greenhouse gas emissions. Little is known about the impact of individual clinical practices on overall emissions; more granular healthcare emissions data are needed to identify opportunities for resource stewardship. Our objective was to deploy an interdisciplinary team to perform Life Cycle Assessments (LCAs) comparing carbon emissions attributable to a novel home-care program for premature infants to those attributable to routine care in the Neonatal Intensive Care Unit (NICU). We used LCA methodology to compare the carbon footprint of two weeks of traditional care of infants in our NICU to that of those enrolled in an institutional alternative care program known as “Hope Grows at Home,” which transitions eligible infants requiring nasogastric feeds to the home setting with ongoing NICU team support. Our analysis showed that in-home care produces 77 kg of CO₂ emissions (kgCO₂e) per infant over a 14-day period, as compared to in-hospital care, which produced 338 kgCO₂e. Transportation to a healthcare facility accounted for the majority of emissions in both groups (292 kgCO₂e for NICU care and 58 kgCO₂e for home care). This finding is likely impacted by our facility’s rural location. Home care reduced solid waste emissions by approximately 94% relative to NICU care (1.74 vs. 26.97 kgCO₂e per term), reflecting the home setting’s reuse of feeding syringes and bottles that are routinely single-use in the hospital. Prospective data collection strategies for infants enrolled in home care will further refine our results. Exploring additional interdisciplinary collaborations may facilitate similar analyses, offering more insight into environmental stewardship opportunities within healthcare. Full article

(This article belongs to the Section Health Care Sciences)

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40 pages, 2785 KB

Open AccessArticle

An Exploration of Machine Learning Methods in Human Biomonitoring

by Kavita Singh, Jiazhou Bi, Malo Musende, Sean P. Collins, Michael M. Borghese, Janice M.Y. Hu, Tyler Pollock, Annie St-Amand, Deirdre Hennessy and David L. Buckeridge

Int. J. Environ. Res. Public Health 2026, 23(5), 680; https://doi.org/10.3390/ijerph23050680 - 20 May 2026

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Abstract

Artificial intelligence (AI) is being broadly integrated into processes to manage and analyze large amounts of data accurately and efficiently. In this work, we explored how AI methods, in particular machine learning (ML), are being implemented in human biomonitoring using a mixed methodology [...] Read more.

Artificial intelligence (AI) is being broadly integrated into processes to manage and analyze large amounts of data accurately and efficiently. In this work, we explored how AI methods, in particular machine learning (ML), are being implemented in human biomonitoring using a mixed methodology approach that consisted of: (1) a scoping literature review and (2) an international scan of biomonitoring programs to contextualize current practices and perceptions from researchers in the field. We synthesized findings from the review according to the year of publication, biomonitoring study and location, study outcomes, and the most frequent ML methods. We additionally categorized all published ML methods from the review according to three dimensions (paradigm, type of task, and model structure), mapped studies to biomonitoring themes and other applications, and provided details for the more commonly applied ML methods. The international scan was administered through a 30-question online survey and gathered information on current uses, perspectives, and barriers related to AI. Scoping review: We found 286 studies that applied a ML method to human biomonitoring data. Eighty-two ML methods were identified, with the most common being supervised approaches. ML was predominantly applied to predict health-related outcomes based on chemical exposure. International scan: The survey yielded 30 responses from programs across 15 countries. Approximately 27% of respondents reported implementing AI-related methods in the collection and analysis of biomonitoring data, and the primary barrier to adopting these methods was a lack of technical expertise (80%). This exploratory work provides an integrated understanding of ML applications in the human biomonitoring field. ML clearly holds promise for furthering our understanding of chemical exposure in people and will likely undergo continued growth in applications. Full article

(This article belongs to the Section Environmental Health)

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11 pages, 506 KB

Open AccessArticle

Relationship Between Self-Efficacy and Burnout Syndrome in Resident Physicians in Metropolitan Lima

by Rafael Emiliano Sulca Quispe, Danny Vergel Moncada and Filomeno Teodoro Jauregui Francia

Int. J. Environ. Res. Public Health 2026, 23(5), 679; https://doi.org/10.3390/ijerph23050679 - 20 May 2026

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Abstract

Burnout syndrome is one of the main problems among healthcare personnel. In resident physicians, this syndrome can affect both their clinical performance and their personal well-being. Objective: To determine the relationship between self-efficacy and burnout syndrome in resident physicians at hospitals in Metropolitan [...] Read more.

Burnout syndrome is one of the main problems among healthcare personnel. In resident physicians, this syndrome can affect both their clinical performance and their personal well-being. Objective: To determine the relationship between self-efficacy and burnout syndrome in resident physicians at hospitals in Metropolitan Lima. Method: An observational, analytical, cross-sectional study was conducted. The sample consisted of 521 resident physicians from different specialties, selected using non-probability sampling. The General Self-Efficacy Scale and the Maslach Burnout Inventory were used. Results: Self-efficacy was inversely correlated with emotional exhaustion (rho = −0.387; p < 0.001), depersonalization (rho = −0.347; p < 0.001), and global burnout syndrome (rho = −0.453; p < 0.001), and directly correlated with personal accomplishment (rho = 0.530; p < 0.001). The structural equation model showed an excellent fit and confirmed a direct effect of self-efficacy on the dimensions of burnout. Conclusions: Higher levels of self-efficacy are associated with lower levels of emotional exhaustion, depersonalization, and overall burnout, as well as greater personal accomplishment in resident physicians. Full article

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14 pages, 2054 KB

Open AccessArticle

Voices in Images: Unveiling the Lived Realities of Adolescents with Disabilities in Ghana

by Josephine M. Kyei, Charles Ampong Adjei, Mary A. Asirifi, William Menkah, Prisca Ama Anima, Hellen Gateri, Reyna Parikh, Elizabeth Burgess-Pinto and Florence Naab

Int. J. Environ. Res. Public Health 2026, 23(5), 678; https://doi.org/10.3390/ijerph23050678 - 20 May 2026

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Abstract

Ghana has a substantial disability burden with approximately 8% of the population, including adolescents, living with one form of disability or another. Despite this, the everyday experiences and challenges of adolescents with disabilities remain insufficiently documented. This study employed a phenomenological qualitative approach [...] Read more.

Ghana has a substantial disability burden with approximately 8% of the population, including adolescents, living with one form of disability or another. Despite this, the everyday experiences and challenges of adolescents with disabilities remain insufficiently documented. This study employed a phenomenological qualitative approach using photovoice methodology to explore the inner lives and often unvoiced experiences of adolescents with disabilities within their socio-cultural contexts. A total of fifty-four (54) adolescents aged 10–19 years with hearing, visual, and physical disabilities participated in the study. Participants were purposively selected to ensure maximum variation by sex, age and locality. The data were analysed manually using the photovoice data analyses procedure as proposed by Tsang. Three overarching themes emerged from the data: adversity, resilience, and social support. Participants used a range of visual images to represent their challenges, including images symbolising darkness, a stick lying on a bare floor, a coconut tree, heaps of sand, and stacks of wood logs. Images of chapel and group gatherings were also used to illustrate coping strategies and social support respectively. These findings underscore the need for the development of age-appropriate, resilience-focused interventions tailored to adolescents with disabilities in Ghana. it also highlights the need for larger community support networks and empowerment groups that meet the needs of adolescents with disabilities in Ghana. Full article

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

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20 pages, 3724 KB

Open AccessArticle

Toxicological Assessment of 17β-Estradiol and 17α-Ethinylestradiol After Adsorption in a Biomass Filter Associated with the Nanomaterial δ-FeOOH

by Fernanda Junger Schaper, Isadora Amaral Ramos, Sthefany Burmann Soares, Alice Camilo Duarte, Edipaula Barbosa Franco, Camila de Sousa Queiroz Almeida, Cleide Aparecida Bomfeti, Jairo Lisboa Rodrigues and Márcia Cristina da Silva Faria

Int. J. Environ. Res. Public Health 2026, 23(5), 677; https://doi.org/10.3390/ijerph23050677 - 20 May 2026

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Abstract

Emerging contaminants pose significant risks to ecosystems yet are not routinely included in standard monitoring or regulatory frameworks. Among these substances, endocrine disruptors such as β-estradiol and 17α-ethinylestradiol threaten both human and environmental health by interfering with metabolism, reproduction, and development across multiple [...] Read more.

Emerging contaminants pose significant risks to ecosystems yet are not routinely included in standard monitoring or regulatory frameworks. Among these substances, endocrine disruptors such as β-estradiol and 17α-ethinylestradiol threaten both human and environmental health by interfering with metabolism, reproduction, and development across multiple species. These hormones are continuously released into the environment through excretion and improper disposal, and conventional water treatment processes are largely ineffective at removing them. As a result, they can accumulate in aquatic organisms and enter the human food chain. Recent studies have demonstrated that banana peel, Pleurotus ostreatus biomasses, and the nanomaterial δ-FeOOH are efficient, low-cost materials for the removal of toxic metals, suggesting their potential applicability for eliminating estrogenic compounds. Therefore, this study aimed to evaluate the removal of β-estradiol and 17α-ethinylestradiol using filters composed of banana peel and P. ostreatus biomass combined with δ-FeOOH. Hormone removal efficiency was assessed by LC-MS, and toxicity reduction was evaluated through bioassays. The results showed up to 100% removal of hormone concentrations and a significant decrease in sample toxicity, indicating that this filtration system represents a safe and effective alternative for removing organic contaminants from water. Full article

(This article belongs to the Section Environmental Health)

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5 pages, 216 KB

Open AccessCommentary

Designing Mentorship for Constrained Systems: Reframing Workforce Development in Rural and Remote Health

by Shanshan Lin, Leah Pascoe, Grace Ward, Lynn Sinclair, Marlene Payk, Amy Zheng, David Sibbritt and Wenbo Peng

Int. J. Environ. Res. Public Health 2026, 23(5), 676; https://doi.org/10.3390/ijerph23050676 - 20 May 2026

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Abstract

Rural and remote health systems continue to face persistent workforce challenges that affect the delivery of chronic disease care, including diabetes management. Mentorship is widely recognised as a valuable strategy for supporting health professionals, with demonstrated benefits for practice development and workforce sustainability. [...] Read more.

Rural and remote health systems continue to face persistent workforce challenges that affect the delivery of chronic disease care, including diabetes management. Mentorship is widely recognised as a valuable strategy for supporting health professionals, with demonstrated benefits for practice development and workforce sustainability. However, many mentorship approaches are developed in well-resourced settings and assume stable infrastructure, protected time, and workforce capacity. These assumptions may not align with the realities of rural and remote practice, where service pressures and resource constraints shape everyday care. This commentary examines how mentorship can be designed for constrained health systems. It proposes a systems-oriented perspective that positions mentorship as part of routine practice rather than as a separate professional development activity. Emphasis is placed on flexibility, co-design, and cultural safety, with attention to how mentorship can be integrated within workforce development pathways. This reframing has implications for strengthening rural health services by supporting continuous, context-responsive learning within routine practice. More broadly, this approach offers a scalable pathway to workforce strengthening in geographically dispersed and resource-variable health systems. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research—2nd Edition)

19 pages, 18869 KB

Open AccessArticle

Burden of Ischemic Heart Disease in Central Asia from 1990 to 2021: A Systematic Analysis of the Global Burden of Disease Study 2021

by Dimash Davletov, Mukhtar Kulimbet, Alisher Makhmutov, Dinmukhammed Osser, Marat Pashimov, Batyrbek Assembekov and Kairat Davletov

Int. J. Environ. Res. Public Health 2026, 23(5), 675; https://doi.org/10.3390/ijerph23050675 - 20 May 2026

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Abstract

Ischemic heart disease (IHD) remains a leading cause of death globally. This study aims to analyze the burden of IHD in Central Asia and in individual countries of the region from 1990 to 2021, through a comparison of trends in incidence, prevalence, mortality, [...] Read more.

Ischemic heart disease (IHD) remains a leading cause of death globally. This study aims to analyze the burden of IHD in Central Asia and in individual countries of the region from 1990 to 2021, through a comparison of trends in incidence, prevalence, mortality, and disability-adjusted life years. Using data from the Global Burden of Disease (GBD) 2021 study, we extracted annual estimates for the Central Asian region, Kazakhstan, Kyrgyzstan, Uzbekistan, Tajikistan, Turkmenistan, Georgia, Armenia, Azerbaijan, and Mongolia. Metrics were reported as age-standardized rates per 100,000 population. Temporal trends were quantified using Average Annual Percent Change based on joinpoint regression models. A stratification by sex and age groups was done. Central Asia consistently maintained a higher IHD burden than the global average. While global age-standardized incidence rates per 100,000 population fell, Central Asia’s rates per 100,000 population rose from 641.97 in 1990 to 801.56 in 2021. Age-standardized death rates per 100,000 population in the region peaked in the mid-1990s following the dissolution of the Soviet Union but decreased overall from 320.47 in 1990 to 265.51 in 2021. However, this remains significantly higher than the 2021 global rate per 100,000 population of 108.73. Uzbekistan exhibited the highest growth in prevalence and incidence rates per 100,000 population, while Georgia demonstrated the largest reduction in DALYs rates per 100,000 population. Men demonstrated a higher burden across most metrics, although the sex gap narrowed in older populations. Central Asia faces rising incidence rates of IHD and burden levels that far exceed global averages. The significant heterogeneity among countries suggests that region-wide generalizations are insufficient and highlights the critical need for targeted, country-specific prevention programs and health system interventions. Full article

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10 pages, 534 KB

Open AccessBrief Report

Teachable Moments: Development of an Environmental Health Behavior Change Tool for Pregnant Women and Parents

by Rebecca H. Ofrane and Stella Agolli

Int. J. Environ. Res. Public Health 2026, 23(5), 674; https://doi.org/10.3390/ijerph23050674 - 20 May 2026

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Abstract

The perinatal period is a critical window of susceptibility for fetal development and awareness for women’s health. Pregnant women are highly motivated to reduce environmental health risks, yet often lack personalized, actionable guidance on mitigating endocrine-disrupting chemicals and other household hazards. Grounded in [...] Read more.

The perinatal period is a critical window of susceptibility for fetal development and awareness for women’s health. Pregnant women are highly motivated to reduce environmental health risks, yet often lack personalized, actionable guidance on mitigating endocrine-disrupting chemicals and other household hazards. Grounded in Motivational Interviewing theory, a digital assessment was developed to empower parents to identify and reduce exposures. The tool screens for home-based and environmental risks across several domains: air quality, lead, tobacco, cleaning agents, pesticides, and plastics (BPA/phthalates). Based on user inputs, a defined algorithm generates a positive index score paired with prioritized, low-cost behavioral recommendations designed to shift users from risk awareness to active mitigation. Since its launch in Spring 2024, the tool has had over 1900 views. Preliminary analytics suggest promising engagement, and feedback more so suggests that the motivational-interview-based framing, which emphasizes empowerment over fear, facilitates immediate behavioral changes, such as switching to safer personal care products and improving indoor ventilation. Digital health interventions that translate complex environmental data into a single, manageable score can bridge the gap between clinical knowledge and household practice. This article details the score’s calculation methodology and underlying datasets, and reports usage analytics and user feedback, discussing how digital screening can scale environmental health literacy and improve maternal and child health outcomes. Full article

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

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21 pages, 759 KB

Open AccessArticle

Facilitators and Barriers for Participation in Physical Activity Among Norwegian Physically Active First-Year Students: A Qualitative Study

by Friedolin Steinhardt, Stine Pedersen Bøtun and Line Dverseth Tjærandsen

Int. J. Environ. Res. Public Health 2026, 23(5), 673; https://doi.org/10.3390/ijerph23050673 - 19 May 2026

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Abstract

Regular physical activity is essential for physical and mental health, yet participation among Norwegian university students remains below nationally recommended levels. This study explored facilitators and barriers for physical activity among first-year students, using the COM-B model as a conceptual framework. Fifteen physically [...] Read more.

Regular physical activity is essential for physical and mental health, yet participation among Norwegian university students remains below nationally recommended levels. This study explored facilitators and barriers for physical activity among first-year students, using the COM-B model as a conceptual framework. Fifteen physically active first-year students from two higher education campuses in Bodø were interviewed in spring 2025, and the data were analysed using inductive thematic analysis. Analysis showed that students’ activity behaviours were shaped by a dynamic interaction between physical and psychological capabilities, particularly in relation to technical competence, previous injuries, and self-regulation strategies. Opportunity-related factors—such as time constraints, financial limitations, commuting distance, and access to facilities—substantially influenced students’ ability to maintain regular activity, while social support from friends, family, and peers functioned as an important facilitator. Motivation emerged through a mixture of automatic processes—including stress reduction, enjoyment, and habits—and reflective processes such as goal-setting and health-oriented decision-making. For students in physically demanding study programmes, professional identity and body-related expectations also contributed to their engagement. Overall, this study highlights the need for institutional strategies that simultaneously address structural, social, and psychological factors to support sustainable physical activity habits during the transition to university life. Full article

(This article belongs to the Section Exercise and Health-Related Quality of Life)

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17 pages, 654 KB

Open AccessSystematic Review

Micro and Nanoplastics and Obstetric Outcomes in Humans and Animals: A Systematic Review

by Blanca Novillo-Del Álamo, Alicia Martínez-Varea, Imelda Ontoria-Oviedo, Alba Ruiz-Gaitán, Charlotte Cosemans, Michelle Plusquin and Beatriz Marcos-Puig

Int. J. Environ. Res. Public Health 2026, 23(5), 672; https://doi.org/10.3390/ijerph23050672 - 19 May 2026

Viewed by 290

Abstract

Background: Micro- and nano-plastics (MNPs) are pervasive environmental contaminants that accumulate in various tissues, including the placenta. Experimental and clinical studies suggest potential cytotoxic, oxidative, and inflammatory effects that may lead to placental dysfunction and adverse obstetric outcomes. However, high-quality evidence on [...] Read more.

Background: Micro- and nano-plastics (MNPs) are pervasive environmental contaminants that accumulate in various tissues, including the placenta. Experimental and clinical studies suggest potential cytotoxic, oxidative, and inflammatory effects that may lead to placental dysfunction and adverse obstetric outcomes. However, high-quality evidence on the clinical relevance of MNPs exposure during pregnancy remains scarce, underscoring the need for systematic evaluation of their impact on maternal and fetal health. Methods: The databases PubMed, ScienceDirect, CENTRAL, Embase, MDPI and Google Scholar were searched for studies published up to September 2025 investigating the relationship between MNPs and obstetric outcomes. Results: Twelve studies were included in this review, with half employing an observational design in human subjects and the other half using experimental studies in murine models. Although the available evidence is limited, there are studies reporting the association between MNPs exposure and premature birth, low birth weight, intrauterine growth restriction, and miscarriage. The most prevalent polymer detected was polyethylene, and the most commonly used MNPs detection techniques were Raman microspectroscopy, digital microscopy, Fourier Transform Infrared, and Pyrolysis gas chromatography-mass spectrometry. Conclusions: This systematic review summarizes current limited insights on the potential effects of MNPs on obstetric outcomes, highlighting possible associations with low gestational age, low birth weight, intrauterine growth restriction, and miscarriage. Findings do not allow causal inference due to heterogeneity in study design, exposure assessment, contamination control, and analytical methodologies. Full article

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18 pages, 894 KB

Open AccessArticle

Healthcare Professionals’ Experiences of Telemedicine Supporting Outpatient Endometriosis Care: A Qualitative Study of Tele-Patient-Reported Outcome Measures

by Maria M. Feenstra, Anne Sidenius, Charlotte Nielsen and Martin Rudnicki

Int. J. Environ. Res. Public Health 2026, 23(5), 671; https://doi.org/10.3390/ijerph23050671 - 19 May 2026

Viewed by 432

Abstract

Background: Telemedicine may advance endometriosis care, but few initiatives are integrated in outpatient follow-up. A novel telemedicine approach—tele-patient-reported outcome measures (telePROM)—includes an endometriosis-specific questionnaire and phone and video consultations combined with text messaging (chat) with a multidisciplinary endometriosis team. This study explores how [...] Read more.

Background: Telemedicine may advance endometriosis care, but few initiatives are integrated in outpatient follow-up. A novel telemedicine approach—tele-patient-reported outcome measures (telePROM)—includes an endometriosis-specific questionnaire and phone and video consultations combined with text messaging (chat) with a multidisciplinary endometriosis team. This study explores how healthcare professionals experience telePROM and its integration in clinical practice. Methods: A qualitative study guided by interpretive description methodology. Data were generated through observations and focus group interviews conducted between January 2023 and March 2024 at a referral centre for endometriosis within a university hospital. A purposive sample of ten healthcare professionals comprising physicians, nurses and a medical secretary participated in the focus group interviews. Inductive analysis was inspired by interpretive description and carried out through an iterative process involving four steps, leading to the development of final themes and interpretation. Results: Three themes were identified from analysis: (1) Balancing Personalised Care With Increased Clinical Complexity; (2) Changing Professional Boundaries in a Digitally Supported Care Model; and (3) System Friction and Flexibility when Integrating TelePROM. Conclusions: Telemedicine improved endometriosis care by supporting patient-initiated and personalised consultations. However, sustainable, effective, and safe integration of telemedicine appears to require clinical experience, interdisciplinary collaboration, and supervision. Text communication (chat) proved to be an important element to ensure collection of additional information to complement patient-reported outcomes and it is essential for patient triage; yet it is rarely described in the literature. Ensuring organisational resilience during the digital transformation of healthcare requires ongoing training of healthcare professionals’ communicative and digital competences and may necessitate restructured technical support, including designated telemedicine experts in clinical practice to eliminate technical disruptions. These initiatives may contribute to and support the future implementation of telemedicine in healthcare. Full article

(This article belongs to the Special Issue Advances in Gynecological Diseases (Second Edition))

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19 pages, 1104 KB

Open AccessArticle

Development and Preliminary Evaluation of iCanPlan: A Mobile Health Application for Intimate Partner Violence Prevention in Thailand

by Montakarn Chuemchit, Suttharuethai Chernkwanma, Thandar Phyo and Swarnamala Kantipudi

Int. J. Environ. Res. Public Health 2026, 23(5), 670; https://doi.org/10.3390/ijerph23050670 - 19 May 2026

Viewed by 282

Abstract

Intimate partner violence (IPV) is a significant global public health issue that requires accessible, scalable, and contextually appropriate interventions. Mobile health (mHealth) technologies provide a promising platform to deliver support, information, and safety planning tools for individuals at risk of IPV. This study [...] Read more.

Intimate partner violence (IPV) is a significant global public health issue that requires accessible, scalable, and contextually appropriate interventions. Mobile health (mHealth) technologies provide a promising platform to deliver support, information, and safety planning tools for individuals at risk of IPV. This study aimed to develop and pilot-test iCanPlan, a mobile application designed to support IPV prevention in Thailand. The application evaluates IPV risk, identifies indicators of danger, and provides a countrywide list of assistance sources. iCanPlan consists of four main components: (1) an IPV risk assessment tool, (2) a list of support resources, (3) educational materials presented in the form of infographics, and (4) encouraging quotes from well-known public figures. The app features a clean, user-friendly interface with intuitive navigation and color-coded components to enhance usability. In addition, a preliminary study was conducted with 30 experts from multidisciplinary fields, including gender-based violence research, social work, psychology, public health, and non-governmental organizations. Participants used the application for one month and subsequently evaluated it using a structured questionnaire based on heuristic evaluation principles. The questionnaire assessed usability, safety features, content quality, cultural appropriateness, language clarity, ethical considerations, and overall evaluation using a five-point Likert scale. Data was analyzed using descriptive statistics (mean and standard deviation) in SPSS. The findings demonstrated excellent performance across all domains, with high mean scores for usability (M = 4.93), safety features (M = 4.73), and content quality (M = 4.82), while cultural appropriateness, language clarity, ethical considerations, and overall evaluation achieved perfect scores (M = 5.00). These results indicate strong agreement among experts regarding the application’s usability, safety, and relevance. The study highlights the potential of iCanPlan as a culturally appropriate and user-friendly digital intervention for IPV prevention. Further research involving the target population is needed to evaluate its effectiveness and long-term impact on help-seeking behavior and IPV-related outcomes. Full article

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20 pages, 925 KB

Open AccessArticle

Building a Resilience Ecosystem to Improve Employee Mental Health and Wellbeing in Canadian High-Stress Low-Control Occupations

by Gregory S. Anderson, Yan Song, Rosemary Ricciardelli, Joy C. MacDermid, Heidi Cramm, Deborah Norris and R. Nicholas Carleton

Int. J. Environ. Res. Public Health 2026, 23(5), 669; https://doi.org/10.3390/ijerph23050669 - 19 May 2026

Viewed by 327

Abstract

In response to inherent occupational and operational stress in public safety personnel (PSP), multiple policies and interventions have been implemented, often with sparse or low-quality research. The National Standard of Canada for Psychological Health and Safety in the Workplace (the Standard) is a [...] Read more.

In response to inherent occupational and operational stress in public safety personnel (PSP), multiple policies and interventions have been implemented, often with sparse or low-quality research. The National Standard of Canada for Psychological Health and Safety in the Workplace (the Standard) is a comprehensive framework aimed at promoting mental health and preventing psychological harm in Canadian workplaces. This longitudinal multiple-cohort implementation science project describes mental health strategies implemented and associated organizational outcomes across five PSP organizations implementing change within the standard framework. Data were collected at two levels over a three-year span from the five public safety organizations that identified priority areas for improvement within the Standard based on local data and consultations. The organization selected and implemented a range of proactive mental health interventions, including resiliency training. Individual pre-post surveys assessed a variety of mental health disorders and work-related items. Annual organizational data included sick leave hours and extended health benefits for psychological services. Survey responses were aggregated at the organizational level. Rank-based correlation analyses (Kendall’s tau) described associations among occupational stress, work engagement, stigma, and organizational indicators. Organizations demonstrated multiple indicators of progress in meeting the Standard. Post-mental health symptom scores were positively correlated with extended health costs. Higher organizational stress scores were associated with higher extended health costs (psychological) (τ = 1.0 at pre-intervention; 0.67 post-intervention). Positive changes in organizational stress scores and higher engagement scores over the implementation process were both associated with lower average extended health costs (τ = 1.0/−1.0 respectively). Resilience scores were inversely related to health costs (τ = −0.67), consistent with the protective role of resilience. The Standard can serve as a framework for improving workplace health and safety when integrated with multi-modal action plans and structured resilience programs. Full article

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

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10 pages, 249 KB

Open AccessArticle

Building Capacity for Rigorous Health Research Through Grant Writing Coaching

by Yulia A. Levites Strekalova, Rachel Liu-Galvin, Stacey Gorniak, Hongmei Wang, Felicite Noubissi, Adriana Baez Bermejo, Jonathan Stiles, Mohamed Mubasher and Elizabeth Ofili

Int. J. Environ. Res. Public Health 2026, 23(5), 668; https://doi.org/10.3390/ijerph23050668 - 19 May 2026

Viewed by 218

Abstract

Background: The National Research Mentoring Network (NRMN) aims to enhance capacity in the biomedical research workforce through mentorship, professional development, and networking. This study focuses on the Strategic Empowerment Tailored for Health Equity Investigators (NRMN-SETH) program, which supports early-stage investigators (ESIs), including those [...] Read more.

Background: The National Research Mentoring Network (NRMN) aims to enhance capacity in the biomedical research workforce through mentorship, professional development, and networking. This study focuses on the Strategic Empowerment Tailored for Health Equity Investigators (NRMN-SETH) program, which supports early-stage investigators (ESIs), including those from underrepresented groups, in developing grant-writing skills. Using a realist evaluation framework, this study explores the contexts, mechanisms, and outcomes contributing to the program’s effectiveness. Methods: A directed content analysis approach was employed, guided by the realist evaluation framework. Data sources included speaker slides, moderator notes, and participant observations from the 2024 RCMI NRMN-SETH session. Context-mechanism-outcome configurations were analyzed to identify key stakeholders, enabling factors, and barriers to success. Results: Five key mechanisms emerged: social support, peer accountability, knowledge of grant-writing strategies, technical grant-writing knowledge, and access to mentoring. Critical contexts included protected time for grant writing, access to subject-matter experts, and participant readiness. Institutional leadership support and cross-institutional collaborations were identified as essential for sustainability. Conclusions: The NRMN-SETH program effectively supports ESIs through mentorship and technical guidance, fostering equitable participation in biomedical research. Future efforts should focus on institutional investment in mentorship, grant readiness, and expanded access to subject-matter experts to enhance the program’s scalability and long-term impact. Full article

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

23 pages, 373 KB

Open AccessArticle

Socioeconomic, Behavioural, and Environmental Determinants of Asthma Inequalities in Europe: A Cross-Sectional Study Using EHIS Data

by Anastase Tchicaya, Nathalie Lorentz and Laureen Vanni

Int. J. Environ. Res. Public Health 2026, 23(5), 667; https://doi.org/10.3390/ijerph23050667 - 19 May 2026

Viewed by 271

Abstract

Asthma is a chronic respiratory disease with uneven prevalence across population groups. This study investigated the associations between socioeconomic status, health behaviours, and environmental exposures and asthma prevalence across European countries. We conducted a cross-sectional analysis using data from the European Health Interview [...] Read more.

Asthma is a chronic respiratory disease with uneven prevalence across population groups. This study investigated the associations between socioeconomic status, health behaviours, and environmental exposures and asthma prevalence across European countries. We conducted a cross-sectional analysis using data from the European Health Interview Survey (EHIS) covering wave III (2019). The sample included 223,453 adults aged 20 or older from 26 European countries. Asthma prevalence was self-reported. Socioeconomic variables included education and employment status, while behavioural factors included smoking and overweight status. Environmental exposures encompassed urbanisation and air pollution. Multilevel logistic regression models examined associations between asthma prevalence and its socioeconomic, behavioural, and environmental factors. Asthma prevalence was higher among individuals with lower educational attainment (OR = 1.30; 95% CI: 1.20–1.40), those who were unable to work due to long-standing health problems (OR = 2.27; 95% CI: 2.04–2.52), and retired individuals (1.44; 95% CI: 1.31–1.57). Individuals with pre-obesity and obesity had increased odds of asthma (OR = 1.13; 95%CI: 1.07–1.19, and OR = 1.76; 95%CI: 1.66–1.86, respectively). Urbanisation (OR = 1.13; 95%CI: 1.07–1.19) and exposure to air pollution (CO₂ and PM_2.5) were both significantly associated with higher asthma prevalence. Six countries exhibited a significant deviation from the average asthma prevalence. Inequalities in asthma prevalence in Europe were linked to socioeconomic disadvantage, unhealthy behaviours, and adverse environmental conditions. Some variability in asthma prevalence was independent of individual characteristics. These findings highlight the need for integrated public health policies that address the structural, behavioural, and environmental determinants of respiratory health. Full article

16 pages, 370 KB

Open AccessArticle

Psychobiological Correlates of Perceived Physical Activity Barriers: Insomnia, Chronotype, and Caffeine Consumption

by Mehmet Emre Eryücel and Mustafa Akil

Int. J. Environ. Res. Public Health 2026, 23(5), 666; https://doi.org/10.3390/ijerph23050666 - 19 May 2026

Viewed by 255

Abstract

Physical activity participation in young adulthood is typically explained by motivational and environmental determinants; however, regulatory models of daily behaviour suggest that transient fluctuations in sleep quality, circadian preference, and stimulant use may also be associated with how individuals appraise effort-related demands. Within [...] Read more.

Physical activity participation in young adulthood is typically explained by motivational and environmental determinants; however, regulatory models of daily behaviour suggest that transient fluctuations in sleep quality, circadian preference, and stimulant use may also be associated with how individuals appraise effort-related demands. Within this behavioural–temporal regulatory perspective, perceived barriers to physical activity may be related to variations in functional energy, alertness, and temporal alignment rather than solely stable contextual constraints. The present cross-sectional study examined whether insomnia symptoms (sleep initiation and awakening problems), chronotype, and daily caffeine intake were concurrently related to perceived personal, social, and environmental physical activity barriers in 788 university students (18–27 years). Standardized self-report measures were administered under controlled assessment conditions. Pearson correlations and theory-informed hierarchical regression models were applied. Sleep initiation problems demonstrated very weak positive correlations with total and domain-specific barriers (r = 0.12–0.17), whereas awakening problems showed very weak inverse correlations (r = −0.10 to −0.14, p ≤ 0.005). Chronotype was weakly associated only with personal barriers (β ≈ −0.09, p = 0.013). Daily caffeine intake showed a weak negative association with environmental barriers (β ≈ −0.15, p < 0.001). Across models, explained variance remained limited (adjusted R² = 0.040–0.053), indicating that these variables explained only a very small proportion of variance in perceived physical activity barriers. These findings suggest that sleep-related and chronobiological characteristics are not meaningful independent predictors of perceived physical activity barriers in this population and demonstrate only weak, domain-specific, and non-directionally consistent associations. Accordingly, the findings should be interpreted cautiously as exploratory rather than practically predictive. Given the cross-sectional design and low explained variance, the results primarily highlight the limited explanatory utility of these psychobiological factors relative to broader unmeasured contextual determinants. Longitudinal and time-sensitive designs incorporating objective behavioural assessments are required to clarify temporal ordering and potential regulatory mechanisms. Full article

(This article belongs to the Special Issue Physical Activity and Its Association with Health in University Students)

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28 pages, 2492 KB

Open AccessSystematic Review

In-Utero Exposure to Electronic Waste Heavy Metals and Adverse Pregnancy and Neonatal Outcomes: A Systematic Review

by Jianna R. D. Sparrow, George Gray and Jordan Fischbach

Int. J. Environ. Res. Public Health 2026, 23(5), 665; https://doi.org/10.3390/ijerph23050665 - 18 May 2026

Viewed by 227

Abstract

Electronic waste (e-waste) recycling releases heavy metals into surrounding environments, creating potential health risks for nearby populations, particularly pregnant women and developing fetuses. This systematic review evaluated human evidence linking prenatal exposure to heavy metals originating from informal e-waste recycling with adverse pregnancy [...] Read more.

Electronic waste (e-waste) recycling releases heavy metals into surrounding environments, creating potential health risks for nearby populations, particularly pregnant women and developing fetuses. This systematic review evaluated human evidence linking prenatal exposure to heavy metals originating from informal e-waste recycling with adverse pregnancy and neonatal outcomes. Electronic databases, including PubMed and Scopus, were searched through 23 September 2025, for studies measuring heavy metal exposure among pregnant women or neonates living in e-waste–affected communities. Following the Navigation Guide methodology, eight observational studies met the inclusion criteria and were assessed for risk of bias and strength of evidence. Across studies, concentrations of heavy metals were higher in exposed populations and were detected in maternal blood, placenta, cord blood, urine, and meconium samples from exposed populations. Prenatal exposure was consistently associated with adverse outcomes, with many studies reporting statistically significant associations between heavy metal exposure and reduced birth weight, length, head circumference, gestational age, neonatal body mass index, lower Apgar scores, impaired neonatal neurobehavioral development, placental molecular alterations, endocrine disruption, and increased neonatal DNA damage. Overall, the evidence was rated as moderate quality with sufficient evidence linking prenatal heavy-metal exposure from e-waste to impaired fetal growth and neonatal development, and limited evidence for pregnancy complications. These findings highlight the need for improved regulation of e-waste recycling and strengthened public health protections for vulnerable populations. Full article

(This article belongs to the Special Issue Environmental Factors Impacting Reproductive and Perinatal Health)

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19 pages, 2564 KB

Open AccessArticle

Beyond the Take-Home Pathway: Community-Level Pesticide Exposure Among Children Living in an Intensively Cultivated Agricultural Landscape

by Humberto González

Int. J. Environ. Res. Public Health 2026, 23(5), 664; https://doi.org/10.3390/ijerph23050664 - 18 May 2026

Viewed by 259

Abstract

Children living in agricultural regions are exposed to pesticides through multiple environmental and occupational exposure processes; however, the relative contribution of these processes remains insufficiently characterised in many rural contexts of the Global South. This study assessed pesticide exposure among children residing in [...] Read more.

Children living in agricultural regions are exposed to pesticides through multiple environmental and occupational exposure processes; however, the relative contribution of these processes remains insufficiently characterised in many rural contexts of the Global South. This study assessed pesticide exposure among children residing in an agricultural community in western Mexico characterised by close spatial proximity between residential areas and intensively cultivated fields. Urine samples were collected from children at two points in the agricultural cycle (March and December 2018). Pesticide concentrations were determined using liquid chromatography coupled with tandem mass spectrometry (LC–MS/MS). Paired longitudinal analyses were conducted to evaluate intra-individual changes in detection frequencies and urinary concentrations across sampling periods. Multiple pesticides were detected, including compounds with near-universal presence across both sampling periods. Significant increases in urinary concentrations were observed between March and December for several pesticides, consistent with seasonal agricultural dynamics, while no systematic differences were identified between children from agricultural and non-agricultural households. These findings indicate that pesticide exposure in this setting operates as a community-level exposure regime that is both structurally produced and territorially embedded. Exposure patterns reflect the convergence of agricultural practices, environmental dispersion processes, and spatial configurations that extend beyond occupational boundaries. The results highlight the limitations of risk models focused exclusively on individual or occupational exposure and underscore the need for public health strategies that address pesticide exposure as a structurally produced and territorially embedded condition. Full article

(This article belongs to the Special Issue Agricultural Health and Sustainability: Addressing Occupational, Mental, and Environmental Challenges)

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19 pages, 336 KB

Open AccessArticle

Patient Perspectives on Quantified Self Technologies and Healthcare Costs Among Patients with Diabetes in Zimbabwe

by Belinda Mutunhu and Baldreck Chipangura

Int. J. Environ. Res. Public Health 2026, 23(5), 663; https://doi.org/10.3390/ijerph23050663 - 18 May 2026

Viewed by 368

Abstract

The growing use of quantified self-technologies (QST) in chronic disease management is linked to better self-monitoring and patient engagement. However, little is known about how patients in resource-constrained settings fund and sustain the use of QST in diabetes self-management. This study asked: “How [...] Read more.

The growing use of quantified self-technologies (QST) in chronic disease management is linked to better self-monitoring and patient engagement. However, little is known about how patients in resource-constrained settings fund and sustain the use of QST in diabetes self-management. This study asked: “How do patients with diabetes perceive and experience the economic burden of using QST in Zimbabwe?” Using a qualitative design, 20 patients with diabetes participated in semi-structured interviews. The reflexive thematic analysis of Braun and Clarke generated three interrelated themes: technology investment costs, conventional healthcare costs, and socio-economic constraints. The findings show that the economic experience of QST adoption is context-dependent and is shaped by the financial realities of patients with diabetes and their access to technology. By focusing on patient-level cost experiences, the study adds qualitative evidence to public health debates on digital health affordability and highlights the need to assess perceived financial implications within a third-world socio-economic context. It is concluded that, although QST is available in third-world countries, sustained use depends on the financial capacity of patients with diabetes. Full article

19 pages, 1150 KB

Open AccessArticle

Upper Arm to Upper Leg Length Ratio and Dyslipidemia: A Novel Application of a Fixed Skeletal Proportion Metric in a Nationally Representative U.S. Sample

by Tanvir Ahmed, Akhi Nath, Nusrat Jahan, Nargis Hoque, Mobashera Jahan, Mst Sabrina Kaniz, Shovit Dutta, Swapnil Saha, Md. Ashraful Haque and Rodney G. Bowden

Int. J. Environ. Res. Public Health 2026, 23(5), 662; https://doi.org/10.3390/ijerph23050662 - 16 May 2026

Viewed by 1095

Abstract

Conventional anthropometric measures used to predict dyslipidemia, such as body mass index and waist circumference, vary over time and may not fully capture early-life influences on metabolic risk. Fixed skeletal proportions, including limb length ratios, remain stable after physical maturity and may reflect [...] Read more.

Conventional anthropometric measures used to predict dyslipidemia, such as body mass index and waist circumference, vary over time and may not fully capture early-life influences on metabolic risk. Fixed skeletal proportions, including limb length ratios, remain stable after physical maturity and may reflect developmental exposures relevant to lipid metabolism. This study examined the association between the upper arm–to–upper leg length ratio (UA/UL), a fixed skeletal proportion metric with established links to diabetes risk and dyslipidemia; this represents an application not previously reported in a nationally representative U.S. population. We conducted a cross-sectional analysis of adults aged ≥20 years using data from the National Health and Nutrition Examination Survey (NHANES) 2017–March 2020 (n = 7569). The UA/UL ratio was calculated from standardized upper arm and upper leg length measurements and categorized into quartiles based on the weighted sample distribution. Dyslipidemia was defined according to National Cholesterol Education Program Adult Treatment Panel III criteria or current lipid-lowering medication use. Survey-weighted logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) across progressively adjusted models. Dyslipidemia prevalence increased across UA/UL quartiles (58.4% in Q1 to 81.3% in Q4; p < 0.001). In unadjusted analyses, individuals in the highest UA/UL quartile had greater odds of dyslipidemia compared with the lowest quartile (OR 3.10, 95% CI 2.49–3.86). Associations remained significant after adjustment for demographic factors and for anthropometric measures considered separately. However, the association was attenuated and no longer statistically significant in fully adjusted models that included demographics, adiposity measures, hypertension, and diabetes. In sex-stratified analyses, the association was attenuated and no longer statistically significant in either sex after full adjustment; formal interaction testing confirmed no significant effect modification by sex (p-for-interaction = 0.943). Full article

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12 pages, 624 KB

Open AccessArticle

From Willingness to Readiness: Caregiver Activation for Cancer Care in Singapore

by Safora Johansen, Melissa Gaik Ming Ooi and Alice F. S. Chua

Int. J. Environ. Res. Public Health 2026, 23(5), 661; https://doi.org/10.3390/ijerph23050661 - 15 May 2026

Viewed by 239

Abstract

Background: Family caregivers are essential partners in the outpatient care of older adults with cancer, yet the knowledge, skills, and confidence, collectively, of caregiver activation are not well characterized in Asian settings. Understanding activation can inform tailored support to sustain effective caregiving. Accordingly, [...] Read more.

Background: Family caregivers are essential partners in the outpatient care of older adults with cancer, yet the knowledge, skills, and confidence, collectively, of caregiver activation are not well characterized in Asian settings. Understanding activation can inform tailored support to sustain effective caregiving. Accordingly, this study assessed the overall activation levels among cancer caregivers in the three most common cancer diagnoses in Singapore by using the Caregiver-Patient Activation Measure (CG-PAM). Methods: A total of 103 informal caregivers of patients ≥60 years (lung, GI, or myeloma) at Singapore’s largest public cancer hospitals completed the 13-item CG-PAM, scored 0–100 and classified into four activation levels. Descriptive statistics summarized characteristics and CG-PAM responses, and logistic regression analyses assessed the degree of activation for individual demographic and other characteristics (p < 0.05). Results: Caregivers showed moderate–high activation (mean 65.9 ± 16.1) and the following levels: L1, 4.9%; L2, 23.3%; L3, 38.8%; L4, 31.1%. They strongly endorsed personal responsibility and active engagement, reporting confidence in key self-management tasks, but struggled to sustain behaviors under stress. Activation was not significantly associated with demographic factors or any other measured characteristics. Conclusions: Caregivers of older adults with cancer in Singapore included in this study showed moderate–high activation and strong self-management confidence but struggled to sustain behaviors under stress. Routine activation assessment and tailored support (education, coaching) could strengthen outpatient care. Longitudinal and interventional research, alongside follow-up interviews, is needed to identify unmet needs, existing support systems, and inform scalable, sustainable models. Full article

(This article belongs to the Section Health Care Sciences)

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17 pages, 2167 KB

Open AccessArticle

Bayesian Multivariate Modelling of Lone Star (Amblyomma americanum) Tick Life Stage Abundance and Temporal Trends to Inform Public Health Risk in Virginia

by Thabo Lephoto, Henry Mwambi, Oliver Bodhlyera and Holly Gaff

Int. J. Environ. Res. Public Health 2026, 23(5), 660; https://doi.org/10.3390/ijerph23050660 - 15 May 2026

Viewed by 363

Abstract

The increasing abundance of ticks poses a growing public health concern due to heightened human exposure to tick bites. The lone star tick (Amblyomma americanum: Ixodida: Ixodidae), a common human-biting species in the United States, has expanded its range in recent [...] Read more.

The increasing abundance of ticks poses a growing public health concern due to heightened human exposure to tick bites. The lone star tick (Amblyomma americanum: Ixodida: Ixodidae), a common human-biting species in the United States, has expanded its range in recent years. However, how its different life stages vary across time, habitats, and locations remains insufficiently understood. We analyzed tick abundance data collected in southeastern Virginia between 2009 and 2018, focusing on larval, nymphal, and adult life stages. A Bayesian multivariate modelling framework was used to examine seasonal patterns, habitat effects, spatial variation, and biological links between life stages. Two commonly used count models were compared to determine which best described the observed tick abundance patterns. Tick abundance showed strong and distinct seasonal patterns across life stages. Adult ticks were most abundant in late spring to early summer (May–June), nymphs peaked in early to mid-summer (June–July), and larvae peaked later in summer (August). Wooded habitats consistently supported higher tick abundance than grassy areas. Although both models captured these trends, the negative binomial model provided a more stable and biologically meaningful representation of tick dynamics. Several counties, including Chesapeake, York, Portsmouth, and Northampton, were identified as areas of elevated tick abundance, indicating increased tick bite exposure risk. This study highlights clear seasonal and habitat-specific windows of increased tick activity that are relevant for surveillance and control planning. By clarifying when and where different tick life stages are more abundant, the findings support targeted public health interventions aimed at reducing human exposure to tick bites in Virginia. The modelling approach is also applicable to other regions, including settings where ticks affect livestock health and food security. Full article

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13 pages, 584 KB

Open AccessArticle

Burden of Disease Due to Consumption of Alcohol and Other Drugs in Colombia, 2016–2022: A Subnational Regional Analysis

by Oscar Alexander Gutiérrez-Lesmes, Emilce Salamanca Ramos and Karen Julieth Quintero Díaz

Int. J. Environ. Res. Public Health 2026, 23(5), 659; https://doi.org/10.3390/ijerph23050659 - 15 May 2026

Viewed by 384

Abstract

Alcohol and psychoactive substance use represent a major burden for global public health, increasing the risk of non-communicable diseases, violence, road traffic injuries, dependence, and mental disorders, and generating impacts on productivity and social welfare. This study aimed to estimate the burden of [...] Read more.

Alcohol and psychoactive substance use represent a major burden for global public health, increasing the risk of non-communicable diseases, violence, road traffic injuries, dependence, and mental disorders, and generating impacts on productivity and social welfare. This study aimed to estimate the burden of disease attributable to alcohol and other psychoactive substances in the departments of Colombia from 2016 to 2022. A burden-of-disease study was conducted using the Disability-Adjusted Life Years (DALYs) indicator, following the methodology of the World Health Organization Global Health Estimates. Official morbidity and mortality databases were used. An estimated 236,154.42 DALYs were attributable to alcohol and psychoactive substance use in Colombia during the study period, increasing from 14,158.7 DALYs in 2016 to 40,190.7 DALYs in 2022. The burden was heterogeneous across departments, with values above 1000 DALYs in Quindío (1779.5), Nariño (1624.3), and Norte de Santander (1008.0) and below 132 DALYs in La Guajira, Casanare, and Vaupés. Men accounted for 73.5% of total DALYs. The mean age of morbidity records associated with alcohol and psychoactive substance use disorders was 30.67 years in men and 32.37 years in women. The burden associated with psychoactive substance use is increasing in Colombia, with differences by sex and department of residence. Full article

(This article belongs to the Section Global Health)

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16 pages, 325 KB

Open AccessArticle

Primary Care Career Perceptions: Comparing Temperament and Character Inventory Profiles of Medical Students with General Practitioners

by Anna Nánási, Viktor Rekenyi, Csongor István Szepesi, Eszter Kovács, Nóra Horváth, Armand Kun and László Róbert Kolozsvári

Int. J. Environ. Res. Public Health 2026, 23(5), 658; https://doi.org/10.3390/ijerph23050658 - 15 May 2026

Viewed by 245

Abstract

The structural integrity of the Hungarian healthcare system is threatened by a systemic shortage of General Practitioners (GPs), with 1021 districts remaining vacant as of March 2026. This study assessed demographic characteristics, perceived career attributes, and temperament and character traits of 144 medical [...] Read more.

The structural integrity of the Hungarian healthcare system is threatened by a systemic shortage of General Practitioners (GPs), with 1021 districts remaining vacant as of March 2026. This study assessed demographic characteristics, perceived career attributes, and temperament and character traits of 144 medical students and 72 practicing GPs, achieving an overall response rate of 91.5%, using the TCI-55 inventory to identify factors influencing professional pathways. Statistical analysis utilized Mann–Whitney U, Chi-square, and Fisher’s exact tests. Results showed only 6 students indicated family medicine as their first choice, compared to 49 GPs (p < 0.001). Students frequently perceived the field as “boring” (82 students vs. 1 GP, p < 0.001) and burdened by “trivial patient problems” (44 students vs. 7 GPs, p = 0.001), while GPs highlighted “stress” (15 GPs vs. 4 students, p < 0.001) as a primary disadvantage. Students scored significantly higher in the temperament dimensions of Novelty Seeking (p < 0.001) and Reward Dependence (p < 0.001). Addressing these educational misperceptions and urgently mitigating the structural drivers of occupational stress and workforce fatigue are critical public health priorities required to ensure the sustainability of primary care, maintain the continuity of preventive services, and safeguard equitable population health outcomes. Full article

24 pages, 339 KB

Open AccessArticle

Strategies to Raise Awareness About Screening and Vaccination for the Human Papillomavirus Among Women in Limpopo Province, South Africa

by Matodzi Pertunia Mushasha and Lebitsi Maud Modiba

Int. J. Environ. Res. Public Health 2026, 23(5), 657; https://doi.org/10.3390/ijerph23050657 - 15 May 2026

Viewed by 286

Abstract

Background: Human papillomavirus (HPV) is a serious infection which is primarily transmitted through sexual intercourse. Almost 100% of cervical cancers are caused by HPV. Limited awareness of HPV leads to delayed cancer diagnoses, significantly increasing mortality and morbidity rates. Aim: The purpose of [...] Read more.

Background: Human papillomavirus (HPV) is a serious infection which is primarily transmitted through sexual intercourse. Almost 100% of cervical cancers are caused by HPV. Limited awareness of HPV leads to delayed cancer diagnoses, significantly increasing mortality and morbidity rates. Aim: The purpose of this study was to develop strategies to increase awareness of human papillomavirus screening and vaccination among women in Limpopo Province, South Africa. Setting: This study was carried out in the Vhembe District of the Thulamela Municipality of Limpopo Province. Methods: The E-Delphi method was used, and the researcher used a quantitative approach. A total population of 15 nursing managers was part of the study. Questionnaires were used to collect data. Data were analysed using the statistical package for the social sciences version 26. Results: In Round 1, 8 (53.3%) of the 15 participants strongly supported the strategy of updating women with the most recently revised HPV screening guidelines. In Round 2, consensus was achieved, with 14 (93.3%) of the participants strongly agreeing that the development of teaching programmes in healthcare facilities is necessary. This indicates a strong convergence of expert opinion on the importance of structured educational interventions to support the implementation of the strategy. The consensus in this study was defined as ≥70% agreement between participants on each item. Conclusions: The lack of awareness of HPV is concerning because early detection and treatment can prevent serious health problems. The study used the E-Delphi method to assess the effectiveness of strategies to increase awareness of HPV screening and vaccination in women. Contribution: Health policy initiatives may improve public awareness of HPV and vaccination, especially by focusing on educating nurses, which could improve women’s awareness and encourage HPV screening and vaccination. Full article

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Int. J. Environ. Res. Public Health, Volume 23, Issue 5 (May 2026) – 146 articles

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