International Journal of Environmental Research and Public Health

22 pages, 3609 KB

Open AccessArticle

Drinking Water Quality and Health Risk Assessment in Rural Ghana: Evidence from North-East and North Gonja Districts in the Savannah Region

by Elvis Kichana, Solomon A. Minyila, Braimah Apambire, Collins Gbeti, Abukari Wumbei and Fati Alhassan

Int. J. Environ. Res. Public Health 2026, 23(6), 821; https://doi.org/10.3390/ijerph23060821 - 22 Jun 2026

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Abstract

Background: Access to safe drinking water remains a critical public health concern in rural Ghana, particularly in climatically vulnerable and underserved settings. This study assessed the microbiological and chemical quality of drinking water and evaluated nitrate-related health risks in the North Gonja and [...] Read more.

Background: Access to safe drinking water remains a critical public health concern in rural Ghana, particularly in climatically vulnerable and underserved settings. This study assessed the microbiological and chemical quality of drinking water and evaluated nitrate-related health risks in the North Gonja and North-East Gonja Districts of the Savannah Region. Methods: A cross-sectional study was conducted between January and March 2025. A total of 460 water samples were collected from groundwater sources and household storage containers. Microbial analyses targeted total coliforms and Escherichia coli. Physicochemical and chemical parameters included nitrate-nitrogen, pH, residual chlorine, major ions, and trace metals. Data was analyzed using descriptive statistics, chi-square tests, spatial interpolation, and non-carcinogenic health risk assessment based on the hazard quotient (HQ) approach. Results: Widespread microbial contamination was observed, with 91.5% of household water samples positive for total coliforms and 46.6% for E. coli. Contamination of source water was significantly higher in North Gonja than in North-East Gonja. Overall, 49.1% (n = 55) of groundwater sources exceeded the World Health Organization guideline value for nitrate-nitrogen, with exceedances predominantly occurring in North Gonja. Additionally, 67.0% (n = 75) of samples were outside the acceptable pH range (6.5–8.5), including 74 samples below 6.5 and one above 8.5. Residual chlorine was not detected in any of the samples. Health risk assessment indicated potential non-carcinogenic risks associated with nitrate exposure, particularly among infants and children. Conclusions: The study demonstrates significant microbial contamination and nitrate-related health risks in the study area, particularly in North Gonja. Interventions such as improved source protection, routine water quality monitoring, chlorination, household water treatment, and implementation of Water Safety Plans are recommended to enhance drinking water safety and reduce associated public health risks. Full article

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16 pages, 649 KB

Open AccessArticle

Physical Activity of University Students During COVID-19 Restrictions: Evidence from Poland

by Piotr Gabryjończyk, Anna Jęczmyk, Monika Wojcieszak-Zbierska, Jarosław Uglis and Jan Zawadka

Int. J. Environ. Res. Public Health 2026, 23(6), 820; https://doi.org/10.3390/ijerph23060820 - 20 Jun 2026

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Abstract

This study aims to empirically analyze the patterns, intensity, and perceived barriers to physical activity among Polish university students during the COVID-19 pandemic. The research utilized a diagnostic survey method, employing a questionnaire. The online survey was conducted from December 2020 to May [...] Read more.

This study aims to empirically analyze the patterns, intensity, and perceived barriers to physical activity among Polish university students during the COVID-19 pandemic. The research utilized a diagnostic survey method, employing a questionnaire. The online survey was conducted from December 2020 to May 2022 via the Webankieta.pl platform. The minimum sample size, calculated using the standard formula for estimating a proportion in a large population, was set at 1100 participants and was exceeded, with 1260 students providing valid responses. The results show that over half (55.8%, mainly women) of the respondents did not participate in regular physical activity during the pandemic. Participants cited lack of desire, fatigue, and low motivation—not pandemic restrictions—as primary reasons. Conversely, 44.2% of respondents, mostly men, reported engaging in regular physical activity. Most engaged in moderate-intensity activities two to five times a week, with vigorous activities performed slightly less often. Women were more likely to do both types, while men favored strength training. The most common activities included walking (61.6%), simple gymnastic exercises (43.1%), strength training with equipment (35.0%), cycling (34.5%), and calisthenics (30.2%). The majority (81.3%) exercised at home or nearby (33.4%). Reported barriers, especially among those who exercised regularly, were pandemic-related, such as limited or closed access to gyms, fitness centers, and pools (59.1%), along with time constraints (44.7%) and low motivation or determination (32.0%). The findings emphasize the importance of targeted interventions to boost physical activity among university students, particularly women and those with fewer financial resources. Universities should consider implementing programs that promote accessible, regular activity and initiatives to enhance motivation and foster long-term, health-promoting habits. Full article

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

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16 pages, 312 KB

Open AccessArticle

Assessment of Occupational Health and Safety Hazards in Mosquito Control Personnel in North Carolina and Virginia, USA

by Naina Sharma Bastakoti, Stephanie L. Richards, Avian White and Jo Anne Balanay

Int. J. Environ. Res. Public Health 2026, 23(6), 819; https://doi.org/10.3390/ijerph23060819 - 19 Jun 2026

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Abstract

Mosquito control personnel work within health departments, public works, private companies, and other agencies. These essential outdoor workers have highly specialized training and are faced with a variety of potential health and safety hazards (e.g., arthropod bites and stings, exposure to insecticides and [...] Read more.

Mosquito control personnel work within health departments, public works, private companies, and other agencies. These essential outdoor workers have highly specialized training and are faced with a variety of potential health and safety hazards (e.g., arthropod bites and stings, exposure to insecticides and other chemicals, working with heavy equipment, noise, heat, solar ultraviolet radiation, slips, trips, and/or falls). Mosquito control personnel undergo employer-provided and other types of training on a variety of topics from regulatory updates to new surveillance and control techniques that are required for safety purposes and to maintain their applicator license. Here, an exploratory baseline survey was conducted among members of the North Carolina Mosquito and Vector Control Association (NCMVCA) and the Virginia Mosquito Control Association (VMCA). There was a 28% response rate so results should be interpreted with caution in this pilot study. Most respondents reported utilizing ultra-low volume insecticide application equipment for controlling adult mosquitoes. Backpack sprayers were utilized by less than half of respondents. Those who reported using respirators showed higher concern about insecticide-related health effects than those who did not use respirators. Outdoor workers encounter various potential hazards and utilize several forms of personal protective equipment to reduce risks. This baseline work can be considered a starting point for implementing and strengthening occupational safety and health awareness and preventive measures for mosquito control workers. Knowledge of health and safety hazards can reduce workplace risk. Full article

16 pages, 339 KB

Open AccessArticle

Association Between Dysfunctional Parenting Practices and Suspected Gaming Disorder Among Japanese Male Junior High School Students: A Cross-Sectional Study of Parental Assessment

by Daisuke Takahara, Misuzu Takahara, Noudéhouénou Credo Adelphe Ahissou and Daisuke Nonaka

Int. J. Environ. Res. Public Health 2026, 23(6), 818; https://doi.org/10.3390/ijerph23060818 - 19 Jun 2026

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Abstract

The growing prevalence of gaming disorder (GD) in adolescents is a global concern. Despite parents’ critical role in addressing GD, how dysfunctional parenting practices are associated with adolescent GD remains understudied. This study assessed the association between dysfunctional parenting practices and adolescent GD [...] Read more.

The growing prevalence of gaming disorder (GD) in adolescents is a global concern. Despite parents’ critical role in addressing GD, how dysfunctional parenting practices are associated with adolescent GD remains understudied. This study assessed the association between dysfunctional parenting practices and adolescent GD among Japanese male junior high school students. Data were collected in 2024 via web-based, self-administered questionnaires from 300 parents (183 fathers and 117 mothers), each reporting on one male junior high school student. Suspected GD was assessed using a validated parent report measure (i.e., the Gaming Disorder Scale for Parents). Dysfunctional parenting practices were measured using the Parenting Scale, comprising two dimensions: Overreactivity and Laxness. Mean factor scores of Overreactivity and Laxness were compared between the suspected and non-suspected GD groups using a t-test. Logistic regression models assessed the association of Overreactivity and Laxness with suspected GD, controlling for covariates. The mean score of Overreactivity was significantly higher in the suspected GD group than in the non-suspected group, whereas that of Laxness was not. After adjustment, overreactive parenting was significantly associated with suspected GD (adjusted odds ratio: 1.89, 95% CI [1.31, 2.74]). This study showed that overreactive parenting was independently and significantly associated with increased odds of suspected GD. Full article

(This article belongs to the Special Issue Psychological Wellbeing, Mental Health and Problematic Internet Use Among Adolescents)

17 pages, 988 KB

Open AccessProject Report

A National Virtual Peer Support Group for Women Veterans Living with Breast Cancer: Lessons from the Field

by Jenny K. Cohen, Kara Zamora-Rogoski, Caitlin L. McLean, Mariam E. Jacob, Evana Mack, Haley Moss and Aimee Kroll-Desrosiers

Int. J. Environ. Res. Public Health 2026, 23(6), 817; https://doi.org/10.3390/ijerph23060817 - 19 Jun 2026

Viewed by 478

Abstract

Within the Veteran’s Health Administration (VHA), peer support specialists (PSSs) have traditionally worked in mental health and behavioral health settings. PSS-facilitated cancer support groups are less common and underused in this setting. The purpose of this study was to understand the acceptability, feasibility, [...] Read more.

Within the Veteran’s Health Administration (VHA), peer support specialists (PSSs) have traditionally worked in mental health and behavioral health settings. PSS-facilitated cancer support groups are less common and underused in this setting. The purpose of this study was to understand the acceptability, feasibility, and perceived benefits of a PSS-facilitated peer support group for women veterans with breast cancer. Semi-structured interviews were conducted among veteran participants and health system leaders (HSLs) and were recorded, transcribed, and analyzed using rapid qualitative analysis. Key findings from interviews with veterans and HSLs emerged across several domains: The value of shared experiences, peer status and “matching”, virtual aspect, group structure, beneficial topics, and desired outcomes. Veteran participants greatly valued the ability to share experiences and connect with other women veterans with breast cancer and shared a desire for the facilitator to be a peer with an overlapping shared lived experience as they described benefits from peer interactions including supportive coping and instrumental coping. Veterans also reflected on the acceptability of the group being virtual, and uncovered attitudes and preferences regarding group structure, beneficial topics, and desired outcomes. HSLs noted that target outcomes might be linked to feeling connected with community and having an increased feeling of support. Findings suggest that cancer support groups, unlike more traditional mental health support groups at the VHA, may require greater specificity regarding programmatic content and PSS-cancer-experience-matching for group experience to feel authentic and meaningful. Full article

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

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16 pages, 951 KB

Open AccessArticle

Faecal Pathogen Survival and Risks of Use of Ecological Sanitation By-Products in Burera District, Rwanda: A Quantitative Microbial Risks Assessment

by Celestin Banamwana, David Musoke, Theoneste Ntakirutimana, Esther Buregyeya, John Ssempebwa, Gakenia Wamuyu Maina, Charles Drago Kato, Lordrick Alinaitwe, Patrick Albert Ipola and Nazarius Mbona Tumwesigye

Int. J. Environ. Res. Public Health 2026, 23(6), 816; https://doi.org/10.3390/ijerph23060816 - 19 Jun 2026

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Abstract

Reuse of human excreta and derivatives is becoming a common practice in areas with agricultural predominance. While in situ treated faeces through ecological sanitation (Ecosan), known as “faecal by-products” are being used to sustain soil nutrients and improve on-site sanitation, the concern remains [...] Read more.

Reuse of human excreta and derivatives is becoming a common practice in areas with agricultural predominance. While in situ treated faeces through ecological sanitation (Ecosan), known as “faecal by-products” are being used to sustain soil nutrients and improve on-site sanitation, the concern remains about the health risks related to the survival of pathogens in these by-products in the community of farmers. This study assessed the survival of faecal pathogens and estimated microbial risks associated with the use of Ecosan faecal by-products in agriculture. The quantitative microbial risks assessment (QMRA) framework was used to estimate the risks posed by each faecal pathogen in solid and semi-solid faecal by-products under the probabilistic model of Monte Carlo simulation. Ascaris lumbricoides (6.5 eggs/gr), Taenia species (0.3 egg/gr), Schistosoma species (9.3 cercariae/gr), Entamoeba species (4.4 cysts/gr), and Escherichia coli (451 Cfu/gr) were detected in semi-solid faecal products. Exposure scenarios were observed throughout four critical points: vault faecal by-products removal/unloading, transport, collection, and application of faecal by-products in the gardens. Due to the presence of eggs and cysts, an estimated annual risk of infections was found in semi-solid faecal by-products with Schistosoma species (88%) and Ascaris lumbricoides (90%). Both concentrations were above World Health organisation (WHO) standards of associated infective risks of 0–10% of helminths in faecal sludge applied in the gardens. The users of faecal by-products, particularly farmers are exposed not only to high concentrations of helminth eggs but also to protozoa and bacteria with infective risks of Entamoeba species (99%) and E. coli species (62%). A stepwise implementation of faecal pathogens die-off during treatment of faecal by-products in compliance with the WHO’s 2018 guidelines can prevent the use of unsanitary faecal by-products. According to these findings, the proper control of intestinal protozoa and soil-transmitted helminths (STHs) should be enforced through personal protective measures in Burera district, Rwanda. Full article

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19 pages, 427 KB

Open AccessArticle

Association Between Nutritional Biomarkers and Low Muscle Mass, Obesity, and Low Muscle Mass with Obesity Across Physical Activity Levels Among U.S. Adults: Finding from the National Health and Nutrition Examination Survey 2015–2018

by Uraiporn Booranasuksakul, Mario Siervo, Alongkote Singhato, Narisa Rueangsri, Tepparit Samrit, Wichukorn Suriyawongpaisal and Piyapong Prasertsri

Int. J. Environ. Res. Public Health 2026, 23(6), 815; https://doi.org/10.3390/ijerph23060815 - 19 Jun 2026

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Abstract

Background: Nutritional biomarkers are linked to body composition changes, but limited evidence has studied how nutritional biomarkers relate to low muscle mass, excess adiposity, and both coexisting conditions across different physical activity levels. This study aims to investigate associations between low muscle mass, [...] Read more.

Background: Nutritional biomarkers are linked to body composition changes, but limited evidence has studied how nutritional biomarkers relate to low muscle mass, excess adiposity, and both coexisting conditions across different physical activity levels. This study aims to investigate associations between low muscle mass, obesity, and low muscle mass with obesity and nutritional biomarkers across physical activity levels among U.S. adults across physical activity levels. Methods: This cross-sectional study analyzed data from adults aged 20–59 years from the 2015–2018 cycles of the National Health and Nutrition Examination Survey (NHANES) 2015–2018. Low muscle mass was defined by low appendicular lean mass relative to body weight (LALM/W). Obesity was classified using body mass index (BMI¹), waist circumference (WC²), and body fat percentage (FM%³), and low muscle mass with obesity was defined using three coexisting phenotypes (LALM/W-O1, LALM/W-O2, LALM/W-O3). Nutritional biomarkers included serum albumin, vitamin D, triglyceride, cholesterol, LDL cholesterol, iron, insulin resistance (HOMA IR), and high-sensitivity C-reactive protein (hs-CRP). Physical activity was categorized as inactive, insufficiently active, or sufficiently active based on MET minutes per week. Multivariable regression models accounted for the complex survey design and relevant covariates. Results: After adjustment, LALM/W was significantly associated with low serum albumin, low vitamin D, high triglyceride, high HOMA-IR, and high CRP. Obesity was significantly associated with low serum albumin, low vitamin D, high triglyceride, high LDL cholesterol, high HOMA-IR, and high CRP. LALM/W-O in all phenotypes were significantly associated with low serum albumin, low vitamin D, high triglyceride, high LDL cholesterol, high HOMA-IR, and high CRP. LALM/W-O phenotypes demonstrated the strongest associations, particularly with high HOMA-IR and hs-CRP. Although the associations varied by physical activity level, sufficiently active group was associated with lower odds of adverse nutritional biomarkers compared with insufficient activity. Conclusions: Nutritional biomarkers are associated with LALM/W and obesity. Sufficient physical activity was associated with fewer adverse outcomes. This suggests that adequate physical activity may be associated with better nutritional status and body composition. Full article

(This article belongs to the Special Issue Exercise and Active Living in Diverse Environments for Health Promotion)

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15 pages, 998 KB

Open AccessArticle

Perceived Exertion Is Associated with Cardiovascular Strain but Not Glycemic Response to Gym-Based Exercise in Adults with Type 1 Diabetes: An Exploratory Randomized Crossover Trial

by José Adevalton Feitosa Gomes, Anthony Rodrigues de Vasconcelos, José Roberto Andrade do Nascimento Júnior, Ysadora Verena Ribeiro de Souza, Fabiana Oliveira dos Santos Camatari, Bruno Bavaresco Gambassi, Manoel da Cunha Costa, Paulo Adriano Schwingel and Jorge Luiz de Brito Gomes

Int. J. Environ. Res. Public Health 2026, 23(6), 814; https://doi.org/10.3390/ijerph23060814 - 19 Jun 2026

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Abstract

Adults with type 1 diabetes mellitus (T1DM) face elevated cardiovascular risk, and regular exercise is a key non-pharmacological mitigation strategy. However, safe prescription requires cardiovascular and glycemic monitoring, often unfeasible in real-world gyms. Low-cost psychophysiological tools (ratings of perceived exertion—RPE and enjoyment) may [...] Read more.

Adults with type 1 diabetes mellitus (T1DM) face elevated cardiovascular risk, and regular exercise is a key non-pharmacological mitigation strategy. However, safe prescription requires cardiovascular and glycemic monitoring, often unfeasible in real-world gyms. Low-cost psychophysiological tools (ratings of perceived exertion—RPE and enjoyment) may offer practical alternatives. This exploratory randomized crossover trial examined whether post-session RPE and enjoyment are associated with acute heart rate (HR) and capillary blood glucose (BG) responses to gym-based aerobic and resistance training. Twelve adults with T1DM (29.8 ± 7.8 years; HbA1c 7.7 ± 1.6%; LDL-c 119.5 ± 24.4 mg/dL) completed three ~30 min sessions: aerobic interval training (AE) and two resistance protocols (STA, STB). HR and BG were measured pre-, immediately post-, and 20 min post-exercise; RPE and enjoyment, post-session. Multiple linear regression, controlling for exercise session type, examined associations of RPE and enjoyment with resting HR, BG, and percentage of heart rate reserve (%HR). RPE was higher after STA and STB than AE (p < 0.001; η²p = 0.529), while enjoyment and %HR were similar across sessions. Neither variable was associated with resting HR or BG (all adjusted R² < 0; all p > 0.05). Controlling for exercise session type, RPE was a significant positive predictor of %HR (β = 0.44, p = 0.044), whereas enjoyment was not (β = −0.06, p = 0.719); however, the overall %HR model did not reach statistical significance (adjusted R² =0.119; F(4,31) = 2.183; p = 0.094). These exploratory findings suggest that RPE, but not enjoyment, may serve as a low-cost adjunct intensity marker to inform exercise prescription in adults with T1DM at elevated cardiovascular risk; however, replication in larger samples is needed before clinical recommendations can be drawn. Direct BG monitoring remains essential for safety. Full article

(This article belongs to the Special Issue Health Effects of Physical Activity and Exercise in People at Risk for Cardiovascular Diseases)

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20 pages, 553 KB

Open AccessArticle

A Qualitative Phenomenological Study of Treatment Options for Patients with SCD and Chronic Pain: Buprenorphine–Naloxone or Full-Agonist Therapy

by Najibah Galadanci, Calia Torres, Terrika Johnson and Julie Kanter

Int. J. Environ. Res. Public Health 2026, 23(6), 813; https://doi.org/10.3390/ijerph23060813 - 18 Jun 2026

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Abstract

Data in sickle cell disease (SCD) shows that 30–50% of adults have chronic pain. Chronic pain is a life-shaping condition that is often inadequately managed with chronic opioid therapy (COT). Buprenorphine–naloxone (bup-nal) is an alternative (to COT), yet patient perspectives on its use [...] Read more.

Data in sickle cell disease (SCD) shows that 30–50% of adults have chronic pain. Chronic pain is a life-shaping condition that is often inadequately managed with chronic opioid therapy (COT). Buprenorphine–naloxone (bup-nal) is an alternative (to COT), yet patient perspectives on its use remain limited. This is a phenomenological qualitative study exploring how adults with SCD experience chronic pain and consider treatment options including COT and bup-nal. Semi-structured interviews were conducted with 26 adults with SCD and chronic pain who were offered pain management with bup-nal, including individuals who declined or discontinued treatment. Participants described pain as a constant, embodied experience around which they structured their daily functioning, relationships, well-being, and treatment. Those receiving bup-nal consistently reported improved daily functioning, greater independence, enhanced mood, and reduced healthcare utilization. In contrast, participants not receiving bup-nal described ongoing pain interference, reduced daily functioning, and continued reliance on acute care services. Importantly, participants emphasized functional improvement and stability, rather than pain elimination, as the most meaningful outcomes. These findings suggest that buprenorphine–naloxone may shift pain from a dominant, disabling experience to a more manageable condition that improves participation in work, relationships, and daily activities. To optimize management of chronic pain in SCD, it is necessary to align treatment with patient priorities. Full article

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14 pages, 600 KB

Open AccessArticle

Changes in Bone Parameters and Serum Zinc Levels Following Oral Zinc Supplementation in Duchenne Muscular Dystrophy: A Quasi-Experimental Study

by Thaís Borges, Evellyn Grilo, Thais Alves Cunha, Luana Lima, Karina Vermeulen-Serpa, Mário Dourado-Júnior, Marília Lopes, Núbia Torres, Breno Bezerra, José Brandão-Neto and Sancha Vale

Int. J. Environ. Res. Public Health 2026, 23(6), 812; https://doi.org/10.3390/ijerph23060812 - 18 Jun 2026

Viewed by 693

Abstract

Individuals with Duchenne muscular dystrophy (DMD) are prone to nutritional imbalances, and zinc deficiency may contribute to impaired bone health. This study evaluated serum zinc status and the effects of oral supplementation on bone parameters in DMD. In this quasi-experimental before-and-after study, 34 [...] Read more.

Individuals with Duchenne muscular dystrophy (DMD) are prone to nutritional imbalances, and zinc deficiency may contribute to impaired bone health. This study evaluated serum zinc status and the effects of oral supplementation on bone parameters in DMD. In this quasi-experimental before-and-after study, 34 patients were assessed at three time points over eight months. Eligible participants who met the inclusion criteria and agreed to participate received the proposed interventions during routine follow-up at the Neurology outpatient clinic. Anthropometry, dietary intake, bone mineral density (BMD), bone mineral content (BMC), and serum zinc were measured; supplementation (5–15 mg/day) was provided for four months. Baseline zinc deficiency was observed in 36.7% of participants. No significant overall changes were detected. Stratified analyses revealed a modest increase in total body BMD among individuals with adequate baseline BMD (p = 0.02). As this finding emerged from a subgroup analysis, it should be interpreted cautiously, and the potential contribution of physiological growth to the observed change cannot be excluded. In addition, zinc-deficient participants showed a significant rise in serum zinc levels (p = 0.008). These findings suggest that the response to zinc supplementation may vary according to baseline nutritional and skeletal status and underscore the relevance of micronutrient monitoring in individuals with DMD. Trial registration: The trial was also registered in the Brazilian Registry of Clinical Trials under the code RBR-7cfdxm, approved on 14 June 2018. Full article

(This article belongs to the Special Issue Healthcare Delivery and Nutritional Support in Rare Diseases)

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18 pages, 1481 KB

Open AccessArticle

Risk of Diabetes Mellitus and Its Association with Cardiorespiratory Endurance in Zenú Indigenous People in Momil, Córdoba, Colombia

by Leily Montoya-Alvarez, Edgar Rodriguez-Sepúlveda, Claudia Galeano-Páez, Osnamir Elias Bru-Cordero and Noelba Alcala-Tafur

Int. J. Environ. Res. Public Health 2026, 23(6), 811; https://doi.org/10.3390/ijerph23060811 - 18 Jun 2026

Viewed by 664

Abstract

Type 2 diabetes mellitus (T2DM) represents a growing public health concern in Indigenous populations, where early risk identification remains limited. This study aimed to analyze the association between estimated T2DM risk and cardiorespiratory endurance in a Zenú Indigenous community in northern Colombia. A [...] Read more.

Type 2 diabetes mellitus (T2DM) represents a growing public health concern in Indigenous populations, where early risk identification remains limited. This study aimed to analyze the association between estimated T2DM risk and cardiorespiratory endurance in a Zenú Indigenous community in northern Colombia. A cross-sectional study was conducted among adults aged 18–70 years belonging to the Momil Urban Minor Indigenous Cabildo (Córdoba, Colombia). T2DM risk was assessed using the Finnish Diabetes Risk Score (FINDRISC), and cardiorespiratory endurance was evaluated through the Ruffier index. Associations were examined using a multivariable ordinal logistic regression model, and discriminative performance was evaluated using receiver operating characteristic (ROC) curve analysis. A total of 95 participants were included, most of whom were classified as low risk according to FINDRISC, while cardiorespiratory endurance assessed by the Ruffier index was predominantly classified as moderate to good. Age was significantly associated with higher risk categories in the adjusted model, whereas cardiorespiratory endurance was not significantly associated with estimated T2DM risk. The model demonstrated excellent discriminative capacity (AUC = 0.912; 95% CI: 0.850–0.973). In this population, age and family history were key determinants of estimated T2DM risk. Findings regarding cardiorespiratory endurance should be interpreted cautiously given sample size limitations. Full article

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

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22 pages, 1710 KB

Open AccessArticle

First-Mile Walking to Transit and Physical Activity: A Cross-Sectional Study of the MRT Pink Line Corridor in Bangkok, Thailand

by Sigit D. Arifwidodo, Nattanon Ubontip, Natsiporn Sangyuan, Orana Chandrasiri, Panitat Ratanawichit and Putthipanya Rueangsom

Int. J. Environ. Res. Public Health 2026, 23(6), 810; https://doi.org/10.3390/ijerph23060810 - 18 Jun 2026

Viewed by 456

Abstract

Background. First-mile walking to mass rapid transit (MRT) has two methodological problems. Composite walkability scores blur which features drive walking. And because walking to transit is itself transport physical activity (PA), linking it to total PA is circular. Both issues are sharper in [...] Read more.

Background. First-mile walking to mass rapid transit (MRT) has two methodological problems. Composite walkability scores blur which features drive walking. And because walking to transit is itself transport physical activity (PA), linking it to total PA is circular. Both issues are sharper in tropical Asian cities. Methods. We surveyed 378 adults within a 1 km network distance of 20 stations on Bangkok’s Pink Line MRT. Walkability was measured with NEWS-A (aggregate and eight subscales); PA with the GPAQ. Binary logistic regression with station-cluster-robust standard errors tested which NEWS-A subscales predict first-mile walking and whether walkers meet the WHO PA guideline (≥150 min/week MVPA). A tautology sensitivity test removed transport PA from the outcome. Results. Walkers were 71.7% of the sample. Disaggregating NEWS-A improved fit; two subscales were the dominant predictors: pedestrian infrastructure and traffic safety. Walkers were 30.6 percentage points more likely to meet the overall PA guideline; with transport PA removed, the gap was 17.5 points and still significant. The pedestrian infrastructure effect was strongest 201–1000 m from a station, not at the immediate frontage. Conclusions. Perceived pedestrian infrastructure quality and perceived traffic safety drive first-mile walking in suburban Bangkok. The walking–PA link is not entirely a measurement artefact. The 201–1000 m ring is a plausible priority for pedestrian investment. Full article

(This article belongs to the Special Issue Building Healthy Cities: Influences of the Urban Environment on Active Mobility and Human Health)

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11 pages, 578 KB

Open AccessBrief Report

Comparison of Heart Rate Variability Between Sexes: Impact of a Physically Active Lifestyle

by Reberth Magalhães Da Silva, Ariane Viana, Fernanda Monma, Fernando Alves Santa Rosa, José Robertto Zaffalon, Jr. and Kátia De Angelis

Int. J. Environ. Res. Public Health 2026, 23(6), 809; https://doi.org/10.3390/ijerph23060809 - 18 Jun 2026

Viewed by 545

Abstract

Sex differences and lifestyle factors such as physical activity play an important role in cardiovascular autonomic regulation. Heart rate variability (HRV) is a widely used marker of cardiac autonomic modulation and cardiovascular health. However, the combined influence of sex and physical activity levels [...] Read more.

Sex differences and lifestyle factors such as physical activity play an important role in cardiovascular autonomic regulation. Heart rate variability (HRV) is a widely used marker of cardiac autonomic modulation and cardiovascular health. However, the combined influence of sex and physical activity levels on HRV in young, healthy adults has not been sufficiently explored. Therefore, this study investigated the effects of sex and a physically active lifestyle on HRV in men and women. A cross-sectional study was conducted on a cohort of young, healthy adults aged 18–30 and categorized into four groups based on: physically active men (AM; n = 37), sedentary men (SM; n = 44), and physically active women (AW; n = 31) and sedentary women (SW; n = 40). Regarding the impact of lifestyle, the AM group exhibited 41% higher total variance (VAR-RR) and 34% higher RMSSD (a parasympathetic index) than the SM group. The AW exhibited 74% and 78% higher VAR-RR and RMSSD, respectively, compared to the SW. Furthermore, the physically active groups (AM and AW) displayed a 75% and 50% lower LF/HF ratio, respectively, compared to their sedentary counterparts. Interestingly, the LF/HF ratio was 66% higher, and the RMSSD was 20% lower in the AM group than in the AW group. HRV indices demonstrated large to very large effect sizes. In conclusion, these findings demonstrate significantly advantage in cardiac autonomic modulation among physically active individuals and women. Together, these results reinforce the roles of female sex and an active lifestyle as important protective factors for cardiovascular health. Full article

(This article belongs to the Special Issue Health Effects of Physical Activity and Exercise in People at Risk for Cardiovascular Diseases)

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20 pages, 1212 KB

Open AccessArticle

Knowledge, Attitudes, and Perceptions Towards Male Circumcision Among Men Aged 20–40 Years in Otjiwarongo, Otjozondjupa Region, Namibia

by Masilu Daniel Masekameni, Joinet Sitapata, Phoka Caphus Rathebe and Themba Titus Sigudu

Int. J. Environ. Res. Public Health 2026, 23(6), 808; https://doi.org/10.3390/ijerph23060808 - 18 Jun 2026

Viewed by 705

Abstract

Male circumcision (MC) has been shown in studies from South Africa, Kenya, and Uganda to reduce heterosexual Human Immunodeficiency Virus (HIV) transmission among men by approximately 50–60%. Despite Namibia’s adoption of voluntary medical male circumcision (VMMC) as part of national HIV prevention strategies, [...] Read more.

Male circumcision (MC) has been shown in studies from South Africa, Kenya, and Uganda to reduce heterosexual Human Immunodeficiency Virus (HIV) transmission among men by approximately 50–60%. Despite Namibia’s adoption of voluntary medical male circumcision (VMMC) as part of national HIV prevention strategies, uptake remains suboptimal in some communities. This study assessed the knowledge, attitudes, and perceptions (KAP) of male circumcision among men aged 20–40 years in Otjiwarongo, Namibia, and examined socio-demographic factors associated with these outcomes. A community-based cross-sectional survey was conducted between March and May 2024, involving 359 participants selected through multistage sampling. Data were collected using structured, pre-tested questionnaires and analysed using STATA version 19. Descriptive statistics, chi-square tests, and binary logistic regression were used to summarise data and identify predictors of favourable KAP outcomes. Overall, 69.1% of respondents demonstrated good knowledge of male circumcision, 72.7% had positive attitudes, and 69.9% reported positive perceptions. Awareness of male circumcision was high (91.9%); however, only 69.4% of participants recognised its role in reducing HIV infection risk, and notable misconceptions persisted regarding its protective effects and procedural aspects. Multivariable analysis showed that urban residence (AOR = 1.58; 95% CI: 1.03–2.42; p = 0.035) and higher education (AOR = 4.12; 95% CI: 1.21–14.02; p = 0.024) were significant predictors of favourable KAP outcomes. In addition, good knowledge was strongly associated with positive attitudes (AOR = 3.25; 95% CI: 2.01–5.26; p < 0.001) and perceptions (AOR = 2.87; 95% CI: 1.79–4.60; p < 0.001). In conclusion, while knowledge, attitudes, and perceptions towards male circumcision were generally favourable, important gaps and misconceptions remain. Targeted, culturally appropriate health education interventions are needed, particularly among rural and less-educated populations, to improve understanding and acceptance of VMMC as part of comprehensive HIV prevention strategies. Full article

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

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11 pages, 478 KB

Open AccessArticle

A National Overview of Nutritional Care in Diet-Treated Inborn Errors of Metabolism in Brazil

by Soraia Poloni, Laura de Azevedo Pesce, Viviane de Cássia Kanufre, Lilia Ramos Farret, Camila Pugliese, José Araújo de Oliveira Silva, Monique Poubel, Maria Efigênia de Queiroz Leite and Renata Bernardes de Oliveira

Int. J. Environ. Res. Public Health 2026, 23(6), 807; https://doi.org/10.3390/ijerph23060807 - 17 Jun 2026

Viewed by 630

Abstract

Aim: To evaluate the status of the nutritional management of diet-treated IEM in Brazil from the perspectives of healthcare professionals, patients, and families. Methods: Data were collected through two nationwide digital questionnaires administered to healthcare professionals involved in dietary management (n = [...] Read more.

Aim: To evaluate the status of the nutritional management of diet-treated IEM in Brazil from the perspectives of healthcare professionals, patients, and families. Methods: Data were collected through two nationwide digital questionnaires administered to healthcare professionals involved in dietary management (n = 37) and to patients and caregivers (n = 278), addressing professional training, workload, access to resources, treatment adherence, and socioeconomic factors. Results: Healthcare professionals from 20 out of the 26 Brazilian states participated, most of them female (81%) and dietitians (81%). Although more than half had over 10 years of experience, 59% considered their training insufficient to work with IEM. Only 19% reported exclusive dedication to the field, and 54% were the sole professional responsible for dietary prescriptions at their center. Weekly workload dedicated to IEM varied widely. Among the patients and families, phenylketonuria (60.4%) and glycogen storage disease (25.9%) were the most frequent conditions. Higher educational level and longer time since diagnosis were associated with a better understanding of dietary management (p < 0.05). Among patients on protein-restricted diets, most reported regular use of protein substitutes, although 92% reported poor palatability and 36% reported supply problems. Access to special low-protein foods was limited, and over half of the families reported some level of food insecurity. Conclusions: Significant systemic, logistical, and socioeconomic barriers to optimal dietary management of IEM persist in Brazil, highlighting the need for strengthened public policies, professional training, and equitable access to dietary resources. Full article

(This article belongs to the Special Issue Healthcare Delivery and Nutritional Support in Rare Diseases)

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13 pages, 627 KB

Open AccessArticle

Association Between Physical Activity, Body Mass Index, and Aerobic Capacity in Periurban Adolescents

by Fabian Sepúlveda, Ana Peñata-Taborda, Osnamir Bru-Cordero, Leily Montoya-Álvarez and Alicia Humanez-Álvarez

Int. J. Environ. Res. Public Health 2026, 23(6), 806; https://doi.org/10.3390/ijerph23060806 - 17 Jun 2026

Viewed by 419

Abstract

Adolescence is a critical window for health behavior consolidation, yet the combined influence of physical activity level (PAL) and the body mass index (BMI) on aerobic capacity remains understudied, especially in transitioning periurban environments. This study examined the association between PAL, BMI, and [...] Read more.

Adolescence is a critical window for health behavior consolidation, yet the combined influence of physical activity level (PAL) and the body mass index (BMI) on aerobic capacity remains understudied, especially in transitioning periurban environments. This study examined the association between PAL, BMI, and aerobic capacity in adolescents from Montería, Colombia. A cross-sectional study was conducted among 112 adolescents (aged 12–17 years). Aerobic capacity was assessed using the 20 m shuttle run test (Course Navette), and PAL was measured via the validated Assessment of Physical Activity Levels Questionnaire (APALQ), following standard fitness assessment protocols. Multivariable linear regression models were utilized to estimate independent associations, adjusting for age and sex. The multivariable model was significant (F = 8.45; p < 0.001), explaining 21% of the variance in aerobic capacity (adjusted R² = 0.21). PAL was positively and independently associated with aerobic capacity (B = 0.22; 95% CI: 0.05–0.38; p = 0.010), regardless of BMI. While age showed a positive association (B = 0.09; p = 0.032) and sex was inversely associated (B = −0.39; p < 0.001), BMI did not emerge as an independent predictor in the adjusted model (B = −0.04; p = 0.080). Aerobic capacity in adolescents is more consistently explained by behavioral factors (what they “do”) than by anthropometric status (what they “weigh”). These findings support a paradigm shift in pediatric public health, prioritizing high-intensity movement overweight control to improve cardiorespiratory fitness in transitioning urban territories. Full article

(This article belongs to the Special Issue Healthy Child, Healthy Adult—Children’s Nutrition and Physical Activity as a Public Health Concern)

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18 pages, 945 KB

Open AccessArticle

Occupational Exposure Profiles and Respiratory Health Outcomes Among Surface and Underground Miners: A Comparative Epidemiological Analysis

by Masilu Daniel Masekameni, Thokozane Patrick Mbonane, Khathutshelo Vincent Mphaga, Themba Titus Sigudu and Phoka Caiphus Rathebe

Int. J. Environ. Res. Public Health 2026, 23(6), 805; https://doi.org/10.3390/ijerph23060805 - 17 Jun 2026

Viewed by 509

Abstract

Occupational lung diseases remain a significant public health concern in mining populations, particularly in high-exposure environments. This study examined occupational exposure profiles and respiratory health outcomes among surface and underground miners in Mpumalanga Province. A cross-sectional analytical design was employed among 239 mine [...] Read more.

Occupational lung diseases remain a significant public health concern in mining populations, particularly in high-exposure environments. This study examined occupational exposure profiles and respiratory health outcomes among surface and underground miners in Mpumalanga Province. A cross-sectional analytical design was employed among 239 mine workers. Data on socio-demographic characteristics, occupational exposures, behavioural factors, and respiratory outcomes were analysed using descriptive statistics, chi-square tests, and logistic regression models. Underground miners were significantly more likely to report high dust exposure (44.9% vs. 24.1%), poor ventilation (60.6% vs. 39.3%), and longer working hours (>8 h: 68.5% vs. 50.0%) compared to surface miners. They also reported a higher prevalence of respiratory symptoms, including chronic cough (45.7% vs. 25.9%), shortness of breath (41.7% vs. 23.2%), wheezing (34.6% vs. 18.8%), and diagnosed lung disease (23.6% vs. 9.8%). Multivariable analysis showed that underground mining (AOR = 1.92; 95% CI: 1.08–3.41), smoking (AOR = 1.78; 95% CI: 1.02–3.11), and high dust exposure (AOR = 2.89; 95% CI: 1.45–5.76) were independent predictors of chronic cough. A significant interaction between smoking and underground mining (AOR = 2.74; 95% CI: 1.32–5.68) further amplified respiratory risk. Additionally, underground miners demonstrated lower levels of knowledge (48.8% vs. 66.1%) and poorer preventive practices (44.1% vs. 64.3%). These findings highlight the combined influence of occupational and behavioural factors on respiratory health and highlight the need for integrated interventions to reduce the burden of occupational lung diseases. Full article

(This article belongs to the Special Issue Modern Epidemiology of Occupational Lung Diseases)

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16 pages, 1075 KB

Open AccessSystematic Review

Preoperative Treatment Expectations and Their Association with Postoperative Quality of Life and Patient Satisfaction in Non-Orthopedic Surgery: A Systematic Review

by Nanna W. Christiansen, Thora G. Thomsen, Elizabeth E. Rosted, Marianne Krogsgaard, Marian C. Petersen and Anja Geisler

Int. J. Environ. Res. Public Health 2026, 23(6), 804; https://doi.org/10.3390/ijerph23060804 - 16 Jun 2026

Viewed by 547

Abstract

Background: Patients’ preoperative expectations may influence postoperative quality of life and satisfaction. Aim: To provide an overview of the evidence regarding the association between patients’ preoperative expectations and postoperative quality of life as the primary outcome, with postoperative satisfaction included as a secondary [...] Read more.

Background: Patients’ preoperative expectations may influence postoperative quality of life and satisfaction. Aim: To provide an overview of the evidence regarding the association between patients’ preoperative expectations and postoperative quality of life as the primary outcome, with postoperative satisfaction included as a secondary outcome. Methods: A systematic review was conducted in accordance with the PRISMA guidelines and Cochrane Handbook of Systematic Reviews guidelines. A comprehensive search was conducted across five databases for all study types. Results: Ten cohort studies met the inclusion criteria, encompassing 1013 patients undergoing various surgical procedures. Most studies exhibited a high risk of bias, and several employed unvalidated instruments to assess preoperative expectations. Only one study found a significant association between preoperative expectations and quality of life. One study reported significantly better perceived health among patients with high preoperative expectations, and four studies identified a significant relationship between preoperative expectations and post-operative satisfaction. Overall, the findings were inconsistent, and the included studies demonstrated substantial methodological heterogeneity. Conclusions: Only individual studies identified significant associations with quality of life, perceived health, or postoperative satisfaction; overall, the findings were inconsistent. The evidence is limited by high risk of bias, heterogeneous methodologies, and use of non-validated measurement tools. Further research is needed to clarify the role preoperative expectations have in postoperative outcomes. Full article

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1 pages, 177 KB

Open AccessCorrection

Correction: Grewal et al. Diversity and Representation in Cardiovascular Research: Evidence Gaps, Emerging Models, and Policy Implications. Int. J. Environ. Res. Public Health 2026, 23, 241

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

Int. J. Environ. Res. Public Health 2026, 23(6), 803; https://doi.org/10.3390/ijerph23060803 - 16 Jun 2026

Viewed by 412

Abstract

Missing Conflict of Interest [...] Full article

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

14 pages, 1229 KB

Open AccessArticle

Persistence of Asbestos-Containing Friction Materials in the Hungarian Waste Stream Twenty Years After the European Union Ban

by Áron Szandi, Zsombor Balog, Krisztián Sándor Zaka and Gergely Zoltán Macher

Int. J. Environ. Res. Public Health 2026, 23(6), 802; https://doi.org/10.3390/ijerph23060802 - 16 Jun 2026

Cited by 1 | Viewed by 697

Abstract

Although asbestos has been banned in the European Union since 2005, asbestos-containing materials, such as brake pads and clutch linings, may still occur in waste streams due to the long service life of vehicles, legacy equipment, and international trade in spare parts. The [...] Read more.

Although asbestos has been banned in the European Union since 2005, asbestos-containing materials, such as brake pads and clutch linings, may still occur in waste streams due to the long service life of vehicles, legacy equipment, and international trade in spare parts. The persistence of these materials raises environmental and occupational health concerns, particularly in waste management systems. This study aims to assess the presence, temporal trends, and sectoral distribution of asbestos-containing friction materials in the Hungarian waste management system two decades after the EU ban, and to evaluate the associated regulatory and occupational risk implications. The analysis is based on national hazardous waste datasets classified under EWC code 16 01 11* (asbestos-containing brake pads), with a specific focus on this waste category rather than on the full range of asbestos-related waste streams recorded in the national database. The results indicate that asbestos-containing friction materials are still present in the waste stream, with measurable quantities recorded annually. Despite regulatory control, identification challenges and potential misclassification may contribute to underreporting. The continued occurrence of asbestos-containing materials highlights the persistence of legacy hazardous materials within circular economy systems. Strengthened monitoring, improved identification protocols, and enhanced occupational safety measures are necessary to mitigate residual exposure risks. The findings underline that asbestos is not merely a historical issue but remains a contemporary environmental and public health challenge. Full article

(This article belongs to the Section Environmental Health)

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15 pages, 448 KB

Open AccessArticle

Association Between Food Environment Characteristics and Overweight and Anemia in Socially Vulnerable Children Living in Favelas

by Luiz Gonzaga Ribeiro Silva-Neto, Risia Cristina Egito de Menezes, Vanessa Sá Leal, Thays Lane Ferreira dos Santos and Telma Maria de Menezes Toledo Florêncio

Int. J. Environ. Res. Public Health 2026, 23(6), 801; https://doi.org/10.3390/ijerph23060801 - 15 Jun 2026

Viewed by 490

Abstract

Background: The food environment plays a significant role in determining children’s nutritional status, especially in socially vulnerable settings, where the high availability of ultra-processed beverages can contribute to both overweight and nutritional deficiencies, such as anemia. Thus, this study aimed to assess the [...] Read more.

Background: The food environment plays a significant role in determining children’s nutritional status, especially in socially vulnerable settings, where the high availability of ultra-processed beverages can contribute to both overweight and nutritional deficiencies, such as anemia. Thus, this study aimed to assess the association between the availability of fruits, vegetables, and ultra-processed beverages in the food environment and the occurrence of overweight and anemia in children living in socially vulnerable areas. Methods: This is a cross-sectional study with an ecological component, conducted between 2020 and 2021, involving 665 children residing in 40 favelas and urban communities in Maceió, Alagoas, Brazil. Socioeconomic, anthropometric, and hematological data were collected, along with a characterization of the food environment in 624 establishments using the AUDITNOVA tool, focusing on the availability of fruits, vegetables, and ultra-processed beverages. The outcomes investigated were overweight (BMI-for-age z-score > +2) and anemia (hemoglobin < 11 g/dL). Multilevel models were used to assess the associations between the food environment and the outcomes of interest. Results: The prevalence of overweight was 19.7%, while anemia affected 50.4% of the children assessed. Greater availability of fruits and vegetables was associated with a lower chance of being overweight (OR: 0.82; 95% CI: 0.79–0.98). In contrast, high availability of ultra-processed beverages was associated with a higher chance of being overweight (OR: 1.35; 95% CI: 1.07–1.84) and anemia (OR: 1.53; 95% CI: 1.04–2.29). Conclusion: Food environments characterized by widespread availability of ultra-processed beverages were associated with a higher prevalence of overweight and anemia among children. In comparison, greater availability of fresh or minimally processed foods was associated with a lower prevalence of overweight. These findings highlight the importance of public policies that promote healthier food environments in socially vulnerable areas. Full article

(This article belongs to the Special Issue The Role of the Food Environment in the Health of Children and Adolescents)

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15 pages, 2446 KB

Open AccessArticle

Characterization of Carcinogenic and Non-Carcinogenic Metal(loid)s in Water Within a Uranium-Mining-Impacted Region in Northwestern New Mexico, USA

by Christine Samuel-Nakamura and Abdul-Mehdi S. Ali

Int. J. Environ. Res. Public Health 2026, 23(6), 800; https://doi.org/10.3390/ijerph23060800 - 15 Jun 2026

Viewed by 535

Abstract

More than 500 unreclaimed mines and about 1100 associated waste sites remain on the Navajo Nation as a result of uranium (U) mining. This study evaluated the impact of U-mining water contamination in a region of Northwestern New Mexico. The goal of this [...] Read more.

More than 500 unreclaimed mines and about 1100 associated waste sites remain on the Navajo Nation as a result of uranium (U) mining. This study evaluated the impact of U-mining water contamination in a region of Northwestern New Mexico. The goal of this study was to determine historical baseline concentrations of selected metal(loid)s: those found to be highly associated with cancer (arsenic (As), cadmium (Cd), lead (Pb)) and other associated metals: cesium (Cs), molybdenum (Mo), selenium (Se), thorium (Th), U, and vanadium (V), using inductively coupled plasma-mass spectrometry. Cadmium drinking water concentrations (10.64 μg/L) exceeded the United States Environmental Protection Agency Maximum Contaminant Levels (MCLs) of 5 μg/L. Overall, water mean concentration levels were 11.04 μg/L of Pb, 4.21 μg/L of As, 3.53 μg/L of U, 278.67 μg/L for Mo, 21.70 μg/L for V, 2.39 μg/L for Cs, and 7.75 μg/L for Se. These findings underscore the importance of improving access to safer water sources and highlight the need for continued environmental monitoring and research on exposure pathways associated with carcinogenicity and other negative health outcomes. Full article

(This article belongs to the Special Issue Socioeconomic–Environmental Factors in Cancer Epidemiology and Prevention)

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30 pages, 1935 KB

Open AccessArticle

Factors Influencing Water and Sweet Beverage Purchasing Decisions and Behaviours Among Low-Income Households in Four Peri-Urban Communities in Accra: An Exploratory Study

by Christopher Delali Amegah, Gloria Adobea Odei Obeng-Amoako, Shu Wen Ng, Monica Lambon-Quayefio and Seth Adu-Afarwuah

Int. J. Environ. Res. Public Health 2026, 23(6), 799; https://doi.org/10.3390/ijerph23060799 - 15 Jun 2026

Viewed by 778

Abstract

Background: In May 2023, Ghana implemented a 20% ad valorem tax on bottled water and sweet beverages (SBs), replacing a 17.5% tax; sachet water remained untaxed. The effect on low-income consumers’ purchasing decisions and consumption patterns remains poorly understood. Objective: We aimed to [...] Read more.

Background: In May 2023, Ghana implemented a 20% ad valorem tax on bottled water and sweet beverages (SBs), replacing a 17.5% tax; sachet water remained untaxed. The effect on low-income consumers’ purchasing decisions and consumption patterns remains poorly understood. Objective: We aimed to explore factors influencing water and SB purchasing behaviours among low-income households in four peri-urban Accra communities. Methods: This study employed a convergent parallel mixed-methods design. Four focus group discussions (n = 36) and a cross-sectional survey (n = 43) were conducted among purposively sampled household primary shoppers in early 2025 across Oyarifa, Teiman, Kweiman, and Danfa. Data were analysed thematically and descriptively. Results: Of 43 participants, 67% were female and 65% had junior high school education. Water insecurity was common (60%), and sachet water was the main drinking source (77%). SB purchasing was driven by taste and convenience, while sachet water choices were linked to perceived safety, price, and availability. Tax awareness was moderate (56%); many perceived bottled water taxation as unfair and reported intentions to switch to cheaper local alternatives. Conclusions: Limited tax awareness and perceived inequities suggest the need for policy refinements to better align fiscal measures with public health objectives. Full article

(This article belongs to the Special Issue Beyond Hunger: Food Insecurity, Unhealthy Diets, and the Public Health Challenge of Malnutrition)

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19 pages, 594 KB

Open AccessArticle

Reliability and Validation of the Vietnamese Utian Quality-of-Life Scale in Postmenopausal Women

by Nguyen Dinh Phuong Thao, Le Thi Thanh Tuyen, Dao Trong Quan and Duong Thi Kim Hoa

Int. J. Environ. Res. Public Health 2026, 23(6), 798; https://doi.org/10.3390/ijerph23060798 - 15 Jun 2026

Viewed by 788

Abstract

The absence of a culturally adapted instrument to assess menopause-specific quality of life in Vietnamese women limits both clinical practice and research in this population. This study aimed to translate, culturally adapt, and psychometrically validate the Vietnamese version of the Utian Quality of [...] Read more.

The absence of a culturally adapted instrument to assess menopause-specific quality of life in Vietnamese women limits both clinical practice and research in this population. This study aimed to translate, culturally adapt, and psychometrically validate the Vietnamese version of the Utian Quality of Life (VN-UQOL) Scale. A cross-sectional design was employed with 384 community-dwelling postmenopausal women aged 46–65 years. The UQOL was translated and adapted following established guidelines, including forward-back translation, expert review, and pilot testing. Internal consistency was evaluated using Cronbach’s alpha, construct validity through confirmatory factor analysis (CFA), and concurrent validity via Pearson correlations with the Vietnamese Menopause Rating Scale (VN-MRS). The VN-UQOL demonstrated excellent internal consistency, with a total scale Cronbach’s alpha of 0.87 and sub-scale alphas ranging from 0.81 to 0.93. Content validity indices (I-CVI, S-CVI) were 1.0. CFA confirmed the original four-factor structure, with all factor loadings exceeding 0.50 and good model fit indices (CFI = 0.921, RMSEA = 0.072). Concurrent validity was supported by significant negative correlations between the VN-UQOL sub-scales and corresponding VN-MRS domains (p < 0.01). The VN-UQOL is a reliable and valid instrument for assessing menopause-specific quality of life in Vietnamese women, providing a valuable tool for clinical practice and research in this underserved population. Full article

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15 pages, 320 KB

Open AccessArticle

Dental Treatment Needs and Cost Burden Among Older Adults: A K-Means Cluster Analysis to Inform Oral Health Policies

by Burcu Aksoy, Şükrü Can Akmansoy, Yasemin Özkan and Gonca Mumcu

Int. J. Environ. Res. Public Health 2026, 23(6), 797; https://doi.org/10.3390/ijerph23060797 - 14 Jun 2026

Viewed by 486

Abstract

Oral health problems among older adults represent a growing public health concern due to increasing life expectancy and treatment needs. This study aimed to assess dental treatment needs and cost burden within the context of oral health policies. This retrospective study included anonymized [...] Read more.

Oral health problems among older adults represent a growing public health concern due to increasing life expectancy and treatment needs. This study aimed to assess dental treatment needs and cost burden within the context of oral health policies. This retrospective study included anonymized data from 250 patients aged ≥65 years (F/M: 121/129; 65–89 years). Sociodemographic characteristics, treatment needs, and costs were obtained from the Hospital Information Management System (HIMS). Costs were adjusted to 2025 Turkish lira values using the Consumer Price Index and converted to international dollars using purchasing power parity (PPP). Patients were classified by total treatment costs using K-means cluster analysis. Periodontal (61.2%), restorative (36.0%), and endodontic (41.2%) treatment needs, which are largely preventable through oral hygiene practices, were more frequent among patients with a lower mean age, whereas tooth loss and prosthodontic treatment needs (89.6%) increased with mean age. Cluster analysis identified two groups: a low-cost group (67.6%) and a high-cost group (32.4%). The high-cost group had a lower mean age (68.84 ± 4.27 years) compared to the low-cost group (70.73 ± 5.18 years), indicating that relatively younger patients needed more complex and costly treatments. Out-of-pocket payments were notable for prosthodontic and surgical treatments, although Social Security Institution (SSI) payments constituted most of the costs. Preventive and early dental care strategies are essential to reduce treatment complexity and cost burden among older adults within the framework of oral health policy. Full article

(This article belongs to the Special Issue Improving Oral Health for Older Adults)

12 pages, 623 KB

Open AccessArticle

Sociodemographic and Structural Risk Factors for Dengue in a Rapidly Developing Indonesian District

by Inke Nadia Diniyanti Lubis, Nelli Khalilah Sari Siregar, Gema Nazri Yanni, Isti Ilmiati Fujiati and Lenni Evalina Sihotang

Int. J. Environ. Res. Public Health 2026, 23(6), 796; https://doi.org/10.3390/ijerph23060796 - 14 Jun 2026

Viewed by 383

Abstract

Background: Dengue infection is an expanding public health threat in Indonesia, increasingly reported in semi-urban areas undergoing rapid demographic and environmental change, where household-level determinants remain poorly characterised. Methods: We conducted a case–control study in the Deli Serdang district, North Sumatra, evaluating sociodemographic [...] Read more.

Background: Dengue infection is an expanding public health threat in Indonesia, increasingly reported in semi-urban areas undergoing rapid demographic and environmental change, where household-level determinants remain poorly characterised. Methods: We conducted a case–control study in the Deli Serdang district, North Sumatra, evaluating sociodemographic and environmental risk factors for dengue. Patients admitted to the district referral hospital (July–September 2024) were screened via medical records. Laboratory-confirmed dengue cases were compared with non-dengue febrile controls. Housing conditions and sociodemographic characteristics were assessed using a validated electronic questionnaire with photographic documentation. Multivariable logistic regression identified independent risk factors. Results: Of 238 individuals screened, 39 dengue cases and 78 controls were enrolled. Male sex (aOR 6.7, 95% CI 1.3–33.7), student status (aOR 7.8, 95% CI 1.1–56.5), absence of window screens (aOR 12.9, 95% CI 3.1–53.8), and surrounding vegetation (aOR 7.3, 95% CI 1.7–31.9) were independently associated with dengue infection. Rural residence was overrepresented among cases, suggesting expansion beyond traditional urban boundaries. Conclusions: Dengue risk in a transitional setting is shaped by demographic exposure and modifiable structural vulnerabilities. Integrated prevention strategies, including window screening, covered water storage, environmental management, and school-based vector control, are needed in rapidly urbanising districts. Full article

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25 pages, 1199 KB

Open AccessArticle

Decomposing Wealth-Based Inequalities in Neonatal Mortality in India: Evidence from National Family Health Survey (2019–2021)

by Diksha Gautam, Anuj Kumar Pandey, Benson Thomas M and Sutapa Bandyopadhyay Neogi

Int. J. Environ. Res. Public Health 2026, 23(6), 795; https://doi.org/10.3390/ijerph23060795 - 12 Jun 2026

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Abstract

India exhibits substantial variation in neonatal mortality across regions and socioeconomic groups. This study used nationally representative survey data (2019–2021) to examine wealth-based inequalities in neonatal mortality. Socioeconomic disparities were assessed using Erreygers’ Normalized Concentration Index (ECI) and concentration curves, with subgroup analyses [...] Read more.

India exhibits substantial variation in neonatal mortality across regions and socioeconomic groups. This study used nationally representative survey data (2019–2021) to examine wealth-based inequalities in neonatal mortality. Socioeconomic disparities were assessed using Erreygers’ Normalized Concentration Index (ECI) and concentration curves, with subgroup analyses by residence, state development status (Empowered Action Group (EAG) vs. non-EAG), district typology, and region. Inequality was further decomposed using the Wagstaff method. Analysis of 176,843 most recent live births revealed marked rural–urban disparities, with neonatal mortality in rural areas (18.3 per 1000 live births) 1.6 times higher than in urban areas (11.5). Neonatal mortality was significantly concentrated among poorer households (ECI: −0.0123; p < 0.001), with greater inequality in urban areas, EAG states, and non-aspirational districts. Regional variation was evident, with the highest inequality in the Western and Central regions. Decomposition analysis showed that inequality was primarily driven by adverse household conditions and maternal risk factors concentrated among poorer populations. Key contributors included unclean cooking fuel, higher parity, large family size, normal delivery and inadequate antenatal care. These findings highlight the need for equality-focused strategies addressing both social determinants and gaps in access to quality maternal and newborn care. Full article

(This article belongs to the Special Issue Addressing Disparities in Health and Healthcare Globally)

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23 pages, 328 KB

Open AccessArticle

What Characterizes Employees with Emotional Exhaustion and Employees with Work Overload?

by Celine-Chantal Elster-Kann and Beate Muschalla

Int. J. Environ. Res. Public Health 2026, 23(6), 794; https://doi.org/10.3390/ijerph23060794 - 12 Jun 2026

Viewed by 439

Abstract

Emotional exhaustion has been discussed as a major contributor to work ability problems, with substantial economic, individual, and social consequences. Research largely focuses on specific professions and sometimes overlooks that exhaustion and work overload problems are partly distinct. This study uses a differential [...] Read more.

Emotional exhaustion has been discussed as a major contributor to work ability problems, with substantial economic, individual, and social consequences. Research largely focuses on specific professions and sometimes overlooks that exhaustion and work overload problems are partly distinct. This study uses a differential analysis to explore working conditions and individual characteristics in employees with emotional exhaustion or perceived work overload, aiming to identify potential common risk factors. A representative German cross-sectional sample of 2289 employees aged 15–67, working at least 10 h per week, was analyzed. Employees with and without treatment for exhaustion, and with and without perceived work overload, were compared using variance analysis. Overloaded employees reported more work demands, while exhausted employees appear to be more often female and not in their preferred occupation. Several psychosocial work factors (e.g., responsibility) were more consistently associated with the overload and exhaustion groups than many of the physical work conditions. Employee characteristics such as openness and internal locus of control appeared to be similarly distributed across groups. Overload without exhaustion can be distinguished from combined exhaustion and overload, suggesting that work overload may occur with or without exhaustion, in relation to individual psychosocial resources. Preventive interventions for work ability may benefit from addressing overload as a distinct risk factor, besides illness-related exhaustion. Full article

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

15 pages, 8122 KB

Open AccessArticle

Influence of the GSTP1 rs1695 Polymorphism on Mercury Levels and Memory Performance in the Suruí Indigenous from the Brazilian Amazon

by Mayara Calixto da Silva, Paulo Cesar Basta, Bruna Duarte Pinto, Daniel Escorsim Machado, Felipe Oliveira Pessoa-Silva, Rogério Adas Ayres de Oliveira, Ana Claudia Santiago de Vasconcellos and Jamila Alessandra Perini

Int. J. Environ. Res. Public Health 2026, 23(6), 793; https://doi.org/10.3390/ijerph23060793 - 12 Jun 2026

Viewed by 683

Abstract

Mercury (Hg) is a major neurotoxicant and public health concern and gold mining is a significant source of Hg contamination in the Amazon. There, Indigenous peoples are vulnerable to this exposure. Individual susceptibility influences both internal mercury levels and related clinical outcomes. In [...] Read more.

Mercury (Hg) is a major neurotoxicant and public health concern and gold mining is a significant source of Hg contamination in the Amazon. There, Indigenous peoples are vulnerable to this exposure. Individual susceptibility influences both internal mercury levels and related clinical outcomes. In this context, the GSTP1 gene stands out due to its role in detoxification of xenobiotics. The objectives were to assess the associations between: (1) Hg levels and neurotoxicity signs; (2) the GSTP1 rs1695 polymorphism and Hg levels; and (3) whether the GSTP1 rs1695 polymorphism modifies the effect of mercury on neurotoxicity signs. A cross-sectional study was conducted between April and May 2023, with 113 Paiter-Suruí Indigenous people. Sociodemographic and clinical data were collected using a validated methodology. Hair and oral mucosa cells were collected to assess Hg levels and the GSTP1 rs1695 polymorphism. Hg levels ranged from 0.1 μg/g to 6.5 μg/g (median = 1 μg/g, IQR = 1.43). Individuals with impaired memory and muscle strength had significantly higher mercury levels (β = 4.39 and β = 1.24). Carriers of the GSTP1AA genotype showed a 0.46-point reduction for each 1 μg/g increase in mean Hg levels, compared to individuals with the GSTP1GG genotype (β = −0.46). These results may support public policies by identifying priority groups for intervention based on genetic profiles. Full article

(This article belongs to the Section Environmental Health)

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Open AccessArticle

Examine Facilitators and Barriers to Return to Work (RTW) for Employees with Common Mental Disorder (CMD) Symptoms: A Multi-Stakeholder Qualitative Study

by Nandini Khatter, Sapna Chotai and Giouliana Kadra-Scalzo

Int. J. Environ. Res. Public Health 2026, 23(6), 792; https://doi.org/10.3390/ijerph23060792 - 12 Jun 2026

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Abstract

Returning to work (RTW) following sickness absence due to common mental disorder (CMD) symptoms, such as anxiety, depression and stress, is increasingly recognised as a critical yet complex phase of recovery. Despite this, individuals do not always experience the process as supportive or [...] Read more.

Returning to work (RTW) following sickness absence due to common mental disorder (CMD) symptoms, such as anxiety, depression and stress, is increasingly recognised as a critical yet complex phase of recovery. Despite this, individuals do not always experience the process as supportive or straightforward. This study explored the factors shaping RTW by examining the perspectives of service users, employment advisors (EAs) and human resource (HR) professionals. In a qualitative study, using purposive sampling, we recruited 17 participants across the three stakeholder groups. Data were collected through semi-structured interviews and analysed using thematic analysis. The findings suggest that RTW is shaped by a dynamic interplay between individual experiences, workplace relationships and organisational structures. Participants described returning to work as an ongoing and often uncertain process, influenced by shifts in confidence, expectations of support and the extent to which workplaces were able to respond flexibly to individual needs. While some accounts reflected collaborative and supportive environments, others highlighted disconnection, misalignment and unmet expectations across stakeholders. Overall, the findings point to RTW as a negotiated process, requiring alignment between employees, managers and organisational systems. The study highlights the importance of consistent, flexible and context-sensitive approaches to support sustainable RTW following CMD-related absence. Full article

(This article belongs to the Special Issue Mental Health Promotion in the Workplace)

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Int. J. Environ. Res. Public Health, Volume 23, Issue 6 (June 2026) – 135 articles

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