International Journal of Environmental Research and Public Health

16 pages, 851 KiB

Open AccessArticle

Impact of Combined Hypertension and Diabetes on the Prevalence of Disability in Brazilian Older People—Evidence from Population Studies in 2013 and 2019

by Rafaela Gonçalves Ribeiro-Lucas, Barbara Niegia Garcia de Goulart and Patricia Klarmann Ziegelmann

Int. J. Environ. Res. Public Health 2025, 22(7), 1157; https://doi.org/10.3390/ijerph22071157 - 21 Jul 2025

Abstract

Disability in basic and instrumental activities of daily living (BADL and IADL) reflects functional decline in older adults and can be associated with chronic conditions like type 2 diabetes (T2DM) and hypertension (SAH). This cross-sectional study utilized data from the 2013 and 2019 [...] Read more.

Disability in basic and instrumental activities of daily living (BADL and IADL) reflects functional decline in older adults and can be associated with chronic conditions like type 2 diabetes (T2DM) and hypertension (SAH). This cross-sectional study utilized data from the 2013 and 2019 Brazilian National Health Surveys to investigate the associations between T2DM, SAH, and disability levels. Exposures were self-reported diagnoses and outcomes were classified as independent, moderate, or severe. Multivariable Poisson regression models, with robust variance estimates, estimated adjusted prevalence ratios (PRa), accounting for sociodemographic variables and the survey design. In 2013, the absence of diabetes and hypertension was associated with a lower prevalence (PRa = 0.70; 95% CI: 0.58–0.85) of moderate disability in BADL when compared with the presence of only one of the conditions. On the other hand, the coexistence of T2DM and SAH was associated with a higher prevalence (PRa = 1.39; 95% CI: 1.01–1.91). A similar result was found in 2019 with the addition that coexistence was also associated with a higher prevalence of severe disability in BADLs (PRa = 1.82; 95% CI: 1.59–2.07). For IADL, the absence of T2DM and SAH was associated with a lower prevalence of severe disability in 2013 and 2019 and a lower prevalence of moderate disability only in 2019. However, coexistence showed a higher prevalence in both degrees of disability and both years of the survey. These findings highlight the impact of T2DM and SAH on disability in older people. Therefore, it is crucial to develop targeted strategies for vulnerable subgroups to enhance functional independence in aging populations. Full article

(This article belongs to the Special Issue Access to Public Health Services and Challenges to Healthcare Management)

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16 pages, 420 KiB

Open AccessArticle

Supervision, Moral Distress and Moral Injury Within Palliative Care—A Qualitative Study

by Pia Geuenich, Lena Schlömer, Sonja Owusu-Boakye and Henrikje Stanze

Int. J. Environ. Res. Public Health 2025, 22(7), 1156; https://doi.org/10.3390/ijerph22071156 - 21 Jul 2025

Abstract

The number of people requiring palliative care is increasing. This can result in moral and ethical conflicts that may lead to psychological distress and moral injury. (MI). Solutions are needed to counteract career abandonment—supervision (SV) could be one solution. This study examines the [...] Read more.

The number of people requiring palliative care is increasing. This can result in moral and ethical conflicts that may lead to psychological distress and moral injury. (MI). Solutions are needed to counteract career abandonment—supervision (SV) could be one solution. This study examines the extent to which palliative care nurses link MI to their everyday experiences and whether SV can contribute to the identification and prevention of moral distress and MI. In addition, factors that influence the implementation of, participation in, and perception of SV are analyzed. A qualitative study design was chosen for the investigation, consisting of guided interviews, narrative-generating questions with seven participants working in palliative care, and participant observation with audio recording during two supervisions of two palliative care teams with 16 participants in total. The data was analyzed using qualitative content analysis according to Mayring. The results show differences in workload between acute and palliative care wards. Time pressure and hierarchical structures promote distress and MI and are particularly evident on acute wards. The interviewees described specific experiences of MI. In addition, factors were identified that influence participation in SV. The analysis of SV showed that workload is a key cause of moral distress and can have an impact on health. SV can be used for sensitization and exchange. Implementation and acceptance of SV depend on individual and structural factors. In palliative care, signs of moral distress are present and are specifically addressed in SV, which means that SV can be a tool for dealing with stressful situations. Full article

(This article belongs to the Special Issue End-of-Life Care and Nursing)

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11 pages, 578 KiB

Open AccessProtocol

Climate Change and Its Health Impact in South Africa: A Scoping Review Protocol

by Olubunmi Margaret Ogbodu, Ayodeji Oluwabunmi Oriola and Busisiwe Mrara

Int. J. Environ. Res. Public Health 2025, 22(7), 1155; https://doi.org/10.3390/ijerph22071155 - 21 Jul 2025

Abstract

Climate change is profoundly impacting human health in South Africa, aggravating existing health challenges and creating new threats, particularly in vulnerable populations. This scoping review aims to comprehensively map existing evidence of climate change and diverse human health impacts to assist in the [...] Read more.

Climate change is profoundly impacting human health in South Africa, aggravating existing health challenges and creating new threats, particularly in vulnerable populations. This scoping review aims to comprehensively map existing evidence of climate change and diverse human health impacts to assist in the equipping of health systems to address evolving challenges of climate change. The scoping review will inform the development of evidence-based policy, improve public health preparedness, and ensure that adaptation strategies are effectively tailored to South Africa’s socio-economic and environmental conditions. This scoping review protocol will be conducted using the Joanna Briggs Institute (JBI) methodology, following five steps: (1) defining the research question, (2) search strategy, (3) setting inclusion criteria, (4) extracting data, (5) assessing, summarizing, and presenting findings. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) tool will be used. A comprehensive peer-reviewed literature search, including PubMed, Scopus, ScienceDirect, and Google Scholar, will be conducted by two independent reviewers. The review will be conducted over eight weeks, focusing on English studies published between 2015 and 2025, and conducted within South Africa. A two-stage screening process will determine article eligibility. Disagreements will be resolved through consensus and consultation of a third reviewer. The results of this review will be presented as tables, including a narrative synthesis of the findings. Full article

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10 pages, 468 KiB

Open AccessArticle

Sociodemographic and Clinical Predictors of Tuberculosis and Unsuccessful Treatment Outcomes in Davao City, Philippines: A Retrospective Cohort Study

by Alfredo A. Hinay, Jr., Marielle A. Mamalintaw, Joulei Mei L. Damasin, Bai Jana Shamera A. Dilangalen, Brent Adrian S. Montinola, Cristine Joy S. Napinas, Lester Evan Rey L. Valiente, Nathasia Lyn C. Insular, April Joy D. Parilla, Nelyn Mae T. Cadotdot, Nikka Mae R. Elipio, Jennifer Ashley H. Reyes and Avee Joy B. Dayaganon

Int. J. Environ. Res. Public Health 2025, 22(7), 1154; https://doi.org/10.3390/ijerph22071154 - 21 Jul 2025

Abstract

Background/Objectives: Tuberculosis (TB) remains a major public health challenge in Davao City, Philippines, with persistent issues in both disease burden and treatment outcomes. Understanding the risk factors for TB and its unsuccessful treatment is essential for guiding effective interventions. This study aimed to [...] Read more.

Background/Objectives: Tuberculosis (TB) remains a major public health challenge in Davao City, Philippines, with persistent issues in both disease burden and treatment outcomes. Understanding the risk factors for TB and its unsuccessful treatment is essential for guiding effective interventions. This study aimed to evaluate the association of sociodemographic and clinical factors with TB occurrence and to identify predictors of unsuccessful TB treatment outcomes among patients in Davao City. Methods: A retrospective cohort study was conducted using data from 521 patients diagnosed with drug-susceptible TB at Davao Chest Center between January 2021 and May 2024. The sociodemographic and clinical profiles of the patients were described using descriptive statistics. Chi-square tests were used to assess the associations between sociodemographic and clinical variables with TB risk and treatment outcomes. Results: The patient cohort was predominantly aged 31–50 years (n = 201, 38.58%), male (n = 284, 54.51%), and married (n = 285, 54.70%), with most residing in Districts I and II (n = 98, 38% each), and had no previous TB treatment (n = 344, 66.03%). Among the 456 patients assessed for comorbidities, 56.14% (n = 256) had at least one comorbidity. Evaluation of the risk factors for TB occurrence among the study population revealed that comorbidity status was not significantly associated with an increased risk of TB diagnosis (p = 0.682). However, among patients diagnosed with TB, the presence of comorbidities was significantly associated with unsuccessful treatment outcomes (p = 0.003). Conclusions: Although sociodemographic factors did not significantly influence TB risk or treatment outcomes, the presence of comorbidities was a significant predictor of unsuccessful TB treatment. These findings highlight the importance of integrating comorbidity management with TB care to improve treatment success in high-burden urban settings. Full article

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17 pages, 321 KiB

Open AccessArticle

Black Men and Health Literacy: Strategies for Improvement in a Digital Age Through the Adaptation of a Chronic Disease Self-Management Program

by Evelina Weidman Sterling, Laura Stevens, Vanessa Robinson-Dooley and Tyler Collette

Int. J. Environ. Res. Public Health 2025, 22(7), 1153; https://doi.org/10.3390/ijerph22071153 - 21 Jul 2025

Abstract

Health literacy is a critical determinant of health outcomes, yet it is often overlooked, particularly among marginalized groups. This paper explores the significance of health literacy, with a particular focus on low-income African American and Black (AA/B) men, a population that faces unique [...] Read more.

Health literacy is a critical determinant of health outcomes, yet it is often overlooked, particularly among marginalized groups. This paper explores the significance of health literacy, with a particular focus on low-income African American and Black (AA/B) men, a population that faces unique challenges due to intersecting factors such as race, gender, socioeconomic status, and educational disparities. We examine how these factors contribute to health literacy gaps, highlighting adverse effects on health outcomes for AA/B men compared to the general population. Additionally, we stress the growing importance of digital literacy in an increasingly technology-driven world. Not actively addressing digital health literacy, especially within chronic disease self-management programs (CDSMPs), further exacerbates health disparities within this group. Recommendations are provided for improving health literacy, with specific strategies to also enhance general literacy and digital literacy, among low-income AA/B men. The paper also advocates for a systematic review of the existing literature on health literacy among this group, emphasizing the need for tailored interventions that account for the unique challenges faced by low-income AA/B men. In conclusion, the paper underscores the critical need for targeted research and practical approaches to improve health literacy and ultimately health outcomes for AA/B men in the digital age, particularly through CDSMPs. Full article

(This article belongs to the Special Issue Men’s Health Care and Health Literacy)

27 pages, 3707 KiB

Open AccessSystematic Review

Mobile and Web Apps for Weight Management in Overweight and Obese Adults: An Updated Umbrella Review and Meta-Analysis

by Felipe da Fonseca Silva Couto and Carlos Podalirio Borges de Almeida

Int. J. Environ. Res. Public Health 2025, 22(7), 1152; https://doi.org/10.3390/ijerph22071152 - 21 Jul 2025

Abstract

Obesity is a global epidemic with substantial health and economic impacts, making scalable weight management strategies essential. A comprehensive synthesis of eHealth interventions for weight management is needed to guide clinical practice. This umbrella review evaluated mobile and web-based interventions for weight loss [...] Read more.

Obesity is a global epidemic with substantial health and economic impacts, making scalable weight management strategies essential. A comprehensive synthesis of eHealth interventions for weight management is needed to guide clinical practice. This umbrella review evaluated mobile and web-based interventions for weight loss in adults with overweight or obesity, compared to conventional or non-intervention controls. Systematic reviews were identified across five electronic databases from inception to February 2025. Two reviewers independently selected studies and assessed methodological quality using AMSTAR 2. Pooled estimates were calculated using random-effects models. Eleven systematic reviews (261 primary studies, 62,407 participants) were included. Mobile app interventions yielded a significant reduction in body weight (MD = −1.32 kg; I² = 82%), as did long-term eHealth interventions (MD = −1.13 kg; I² = 76%). Most meta-analyses showed high heterogeneity. Web-based interventions showed no significant effect. In conclusion, mobile apps and long-term eHealth interventions resulted in modest but statistically significant reductions in body weight, body mass index, and waist circumference. The evidence for web-based approaches remains inconclusive. Further research should focus on low-resource settings, primary care, and the integration of emerging technologies such as artificial intelligence. (PROSPERO CRD42025644218). Full article

(This article belongs to the Section Global Health)

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13 pages, 369 KiB

Open AccessPerspective

Early Warning Signs for Monitoring Airborne Respiratory Virus Transmission

by Qingyang Liu

Int. J. Environ. Res. Public Health 2025, 22(7), 1151; https://doi.org/10.3390/ijerph22071151 - 20 Jul 2025

Abstract

Airborne respiratory viruses (e.g., influenza, respiratory syncytial virus (RSV), and SARS-CoV-2) continue to pose a serious threat to global public health due to their ability to spread through multiple transmission pathways. Among these, aerosol transmission stands out as a key route, particularly in [...] Read more.

Airborne respiratory viruses (e.g., influenza, respiratory syncytial virus (RSV), and SARS-CoV-2) continue to pose a serious threat to global public health due to their ability to spread through multiple transmission pathways. Among these, aerosol transmission stands out as a key route, particularly in enclosed environments. However, current monitoring systems have major limitations in sensitivity, standardization, and high time resolution. This study provides a summary of the latest information on the monitoring technologies for respiratory virus aerosols. It discusses the technical and ethical challenges in real-world applications. In addition, this study proposes practical solutions and future development pathways. The aim of this study is to provide theoretical support for building a dynamic, precise, and effective early warning system for monitoring variants of airborne respiratory viruses Full article

(This article belongs to the Section Environmental Health)

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27 pages, 1004 KiB

Open AccessArticle

A Conceptual Model for Strengthening Family Capabilities Through a Process of Care

by James Reid, Chanté Johannes, Shenaaz Wareley, Collen M. Ngadhi, Avukonke Nginase and Nicolette V. Roman

Int. J. Environ. Res. Public Health 2025, 22(7), 1150; https://doi.org/10.3390/ijerph22071150 - 20 Jul 2025

Abstract

Family capabilities shape the well-being of individuals and families, particularly in diverse sociocultural contexts. However, existing frameworks often fail to capture the complexities of family dynamics, particularly in South Africa. This limitation is addressed in this study by developing a new conceptual model, [...] Read more.

Family capabilities shape the well-being of individuals and families, particularly in diverse sociocultural contexts. However, existing frameworks often fail to capture the complexities of family dynamics, particularly in South Africa. This limitation is addressed in this study by developing a new conceptual model, through an ethic of care lens, to understand family. A Human-Centered Design strategy is employed, utilizing workshops to gather and deductively interpret data. A sample of 53 participants is recruited from two communities in South Africa. The Listening Guide approach is used to analyze the data, alongside thematic analysis, to identify overarching themes. The findings reveal tangible needs (material and physical requirements), as well as intangible needs (emotional and psychological support). The relation between these needs and harms highlights how care is shaped in families. While families endeavor to meet intangible needs, many fail to communicate these intangible needs, which also leads to harm. This is exacerbated when the primary caregiver within the family, the ‘glue’, has needs for care that are not met. In addition, the findings reveal the interrelatedness of care in family dynamics among family members, and help to explore the boundaries, capacities, and capabilities of what families do and how they care. Full article

(This article belongs to the Special Issue The Impact of Family Capabilities on the Wellbeing and Mental Health of Family Members)

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17 pages, 1038 KiB

Open AccessArticle

Pet Flea and Tick Control Exposure During Pregnancy and Early Life Associated with Decreased Cognitive and Adaptive Behaviors in Children with Developmental Delay and Autism Spectrum Disorder

by Amanda J. Goodrich, Daniel J. Tancredi, Yunin J. Ludeña, Ekaterina Roudneva, Rebecca J. Schmidt, Irva Hertz-Picciotto and Deborah H. Bennett

Int. J. Environ. Res. Public Health 2025, 22(7), 1149; https://doi.org/10.3390/ijerph22071149 - 19 Jul 2025

Abstract

Approximately 18% of U.S. children experience cognitive and behavioral challenges, with both genetic and environmental contributors. We examined if household insecticides, particularly those used in and around the home and on pets, are associated with neurodevelopmental changes. Data were from children aged 24–60 [...] Read more.

Approximately 18% of U.S. children experience cognitive and behavioral challenges, with both genetic and environmental contributors. We examined if household insecticides, particularly those used in and around the home and on pets, are associated with neurodevelopmental changes. Data were from children aged 24–60 months in the CHARGE study with the following classifications: autism spectrum disorder (ASD, n = 810), developmental delay (DD, n = 192), and typical development (TD, n = 531). Exposure to indoor, outdoor, and pet insecticides was reported for the period from three months pre-conception to the second birthday. Cognitive and adaptive functioning were assessed using the Mullen Scales of Early Learning and Vineland Adaptive Behavior Scales. Linear regression was used to evaluate associations by diagnostic group, adjusting for confounders. Flea/tick soaps, shampoos, and powders used during year two were significantly associated with lower cognitive and adaptive scores in children with ASD after FDR correction. Flea/tick skin treatments in early pregnancy were associated with reduced scores in the DD group, though not significant after correction, especially when used with high frequency. No associations were observed in TD children. These findings underscore the need to examine early-life exposure to non-agricultural insecticides as modifiable risk factors for neurodevelopment. Full article

(This article belongs to the Section Environmental Health)

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12 pages, 1120 KiB

Open AccessArticle

A Temporal Comparison of 50 Years of Australian Scuba Diving Fatalities

by John M. Lippmann

Int. J. Environ. Res. Public Health 2025, 22(7), 1148; https://doi.org/10.3390/ijerph22071148 - 19 Jul 2025

Abstract

Australian scuba fatalities over 50 years were examined to determine temporal changes over two consecutive periods, 1972–1999 and 2000–2021. The Australasian Diving Safety Foundation database and National Coronial Information System were searched to identify scuba deaths from 1972 to 2021. Historical data, police [...] Read more.

Australian scuba fatalities over 50 years were examined to determine temporal changes over two consecutive periods, 1972–1999 and 2000–2021. The Australasian Diving Safety Foundation database and National Coronial Information System were searched to identify scuba deaths from 1972 to 2021. Historical data, police and witness reports, and autopsies were recorded and comparisons made between the two periods. Of 430 total deaths, 236 occurred during 1972–1999 and 194 during 2000–2021, with average annual fatalities of 8.4 and 8.8, respectively. The proportion of males reduced (83% to 76%) and median ages rose (33 to 47 years) with a large rise in the percentage of casualties among people aged 45 years or older (24% to 57%). There were increases in certified divers (64% to 81%) and in the proportion of divers who were with a buddy at the time of their incident (17% to 27%), as well as a decrease in out-of-gas incidents (30% to 25%). A reduction in primary drowning (47% to 36%) was accompanied by more than a doubling of cardiac-related disabling conditions (12% to 26%). The substantial increase in casualties’ ages and of the proportions of casualties aged 45 or more and of females between the periods indicate the inclusion of a broader cohort of participants and ageing of longtime divers. The reduction in primary drowning was likely due to increased training and improvements in equipment, particularly BCDs and pressure gauges. The rise in cardiac-related deaths was due to an older and more obese cohort. Improved health education and surveillance and improved dive planning are essential to reduce such deaths. Full article

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16 pages, 315 KiB

Open AccessArticle

Development and Validation of the Intimate Partner Violence Workplace Disruptions Assessment (IPV-WDA)

by Kathryn Showalter, Laneshia Conner, Rebecca Bosetti, William Burrows and Rujeko Machinga-Asaolu

Int. J. Environ. Res. Public Health 2025, 22(7), 1147; https://doi.org/10.3390/ijerph22071147 - 19 Jul 2025

Abstract

A vast majority of survivors of intimate partner violence (IPV) experience economic abuse, including but not limited to, employment sabotage. The purpose of this study is to further understand IPV by testing a technology-inclusive abuser-initiated workplace disruption measurement in an exploratory factor analysis [...] Read more.

A vast majority of survivors of intimate partner violence (IPV) experience economic abuse, including but not limited to, employment sabotage. The purpose of this study is to further understand IPV by testing a technology-inclusive abuser-initiated workplace disruption measurement in an exploratory factor analysis (EFA) so that future researchers can better examine and address economic abuse. Using a sample of survivors (N = 312) employed in the nursing profession in the United States, who may be uniquely impacted by technology, we used complete data to examine experiences of abuser-initiated workplace disruptions, including those that utilized cellphones (e.g., excessive texting, harassment of coworkers, preventing educational advancement). The results revealed a two-factor structure: one containing a variety of direct and indirect workplace disruptions relevant to the nursing profession (73% of variance) and a second containing only cell-phone related harassment (9% of variance). Implications for healthcare employers seeking to protect employees from IPV, as well as policymakers, are included. Full article

(This article belongs to the Special Issue Models and Approaches to Workplace Health Promotion and Well-Being with Diverse Population Groups)

12 pages, 910 KiB

Open AccessArticle

Sexual Harassment of Cisgender Women University Students: How the Gender Composition of Colleges Relates to Differential Prevalence

by Natalie Q. Poole, Christopher J. Cannon, Amy L. Gabriel, Emma J. Briles and Matt J. Gray

Int. J. Environ. Res. Public Health 2025, 22(7), 1146; https://doi.org/10.3390/ijerph22071146 - 19 Jul 2025

Abstract

Gender harassment is the most common variant of sexual harassment and is often seen in male-dominated workplaces. Importantly, persistent gender harassment produces pronounced impairment in psychological and occupational domains. The current study aimed to examine the degree to which male dominated academic degree [...] Read more.

Gender harassment is the most common variant of sexual harassment and is often seen in male-dominated workplaces. Importantly, persistent gender harassment produces pronounced impairment in psychological and occupational domains. The current study aimed to examine the degree to which male dominated academic degree programs are associated with higher rates of sexual harassment compared to female dominated programs. Four academic fields were chosen for their gender disparity—business, engineering, health sciences, and education. Consistent with hypotheses, cisgender women students in the college of engineering were most likely to experience gender harassment by peers and faculty. Implications and future directions are discussed. Full article

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18 pages, 683 KiB

Open AccessArticle

The Global COVID-19 Pandemic Experience: Innovation Through Environmental Assessment and Seropositivity Surveillance

by Robert M. Park

Int. J. Environ. Res. Public Health 2025, 22(7), 1145; https://doi.org/10.3390/ijerph22071145 - 18 Jul 2025

Abstract

Objectives: To confirm a conjecture from year 2020 of the SARS-CoV-2 (COVID-19) pandemic suggesting policy alternatives to substantially reduce mortality burden. Methods: Data from a global COVID-19 database comparing different countries on cumulative mortality and vaccination were analyzed in conjunction with surveys of [...] Read more.

Objectives: To confirm a conjecture from year 2020 of the SARS-CoV-2 (COVID-19) pandemic suggesting policy alternatives to substantially reduce mortality burden. Methods: Data from a global COVID-19 database comparing different countries on cumulative mortality and vaccination were analyzed in conjunction with surveys of seropositivity. Predictions of final mortality burden under an alternate policy scenario for Japan were calculated and the COVID-19 outcomes for China were assessed. Results: By 2025, Western countries (US, UK, Brazil and Italy) had cumulative mortality rates in the range of 3339–3548 deaths per million, about 6-fold higher than East Asian and New Zealand ‘zero-COVID’ countries. Moderate virus suppression in Japan produced the lowest cumulative mortality of the countries analyzed; if earlier policies had been maintained, the predicted cumulative mortality rate by 2025 would be one-tenth that of the US, UK, Brazil and Italy and one-half to one-third that of other zero-COVID countries. For China, transitioning from a zero-COVID policy in 2022–2023, the estimated 2025 cumulative mortality was 1607/million, half that of Western countries. Conclusions: To minimize COVID-19 mortality would require: (1) Innovation on systematic sampling of ambient airborne virus exposure to sustain low but non-zero virus levels across entire populations, and (2) seropositivity assessment (instead of mass PCR testing for new cases) for calibrating exposure management, and tracking and protecting high-risk populations. Full article

(This article belongs to the Section Environmental Health)

29 pages, 1411 KiB

Open AccessArticle

Adapting a Participatory Group Programme for Caregivers of Children with Complex Neurodisability from Low-, Middle-Income Countries to a High-Income Setting: Moving from “Baby Ubuntu” to “Encompass”

by Kirsten Prest, Kirsten Barnicot, Catherine Hurt, Frances Badenhorst, Aleksandra Borek, Melanie Whyte, Phillip Harniess, Alea Jannath, Rachel Lassman, Christopher Morris, Rachel Osbourne, Tracey Smythe, Cally J. Tann, Keely Thomas, Emma Wilson, Angela Harden and Michelle Heys

Int. J. Environ. Res. Public Health 2025, 22(7), 1144; https://doi.org/10.3390/ijerph22071144 - 18 Jul 2025

Abstract

The “Baby Ubuntu” programme is a well-established, low-cost, community-based intervention to support caregivers of children with complex neurodisability, like cerebral palsy, in low- and middle-income country (LMIC) contexts. This process-focused paper describes our utilisation of the ADAPT guidance to adapt “Baby Ubuntu” for [...] Read more.

The “Baby Ubuntu” programme is a well-established, low-cost, community-based intervention to support caregivers of children with complex neurodisability, like cerebral palsy, in low- and middle-income country (LMIC) contexts. This process-focused paper describes our utilisation of the ADAPT guidance to adapt “Baby Ubuntu” for use in ethnically and linguistically diverse, and economically deprived urban boroughs in the United Kingdom (UK). The process was guided by an adaptation team, including parents with lived experience, who explored the rationale for the intervention from local perspectives and its fit for this UK community. Through qualitative interviews and co-creation strategies, the perspectives of caregivers and healthcare professionals substantially contributed to the “Encompass” programme theory, drafting the content, and planning the delivery. Ten modules were co-produced with various topics, based on the “Baby Ubuntu” modules, to be co-facilitated by a parent with lived experience and a healthcare professional. The programme is participatory, allowing caregivers to share information, problem solve, and form supportive peer networks. The “Encompass” programme is an example of a “decolonised healthcare innovation”, as it aims to transfer knowledge and solutions developed in low- and middle-income countries to a high-income context like the UK. Piloting of the new programme is underway. Full article

(This article belongs to the Special Issue Health Intervention for Young Children with or at Risk for Disabilities)

12 pages, 641 KiB

Open AccessArticle

Do Patients with Complaints Attributed to Chemicals in the Environment Trust in Biomonitoring as a Valid Diagnostic Tool? A Prospective, Observational Study from a German University Outpatient Clinic

by Claudia Schultz, Catharina Sadaghiani, Stefan Schmidt, Roman Huber and Vanessa M. Eichel

Int. J. Environ. Res. Public Health 2025, 22(7), 1143; https://doi.org/10.3390/ijerph22071143 - 18 Jul 2025

Abstract

Biomonitoring often yields normal results in patients who report environmental sensitivities, such as in multiple chemical sensitivity. This study examined whether biomonitoring results influence disease attribution and perception. Patients over 18 presenting for the first time to the University Environmental Medicine Outpatient Clinic [...] Read more.

Biomonitoring often yields normal results in patients who report environmental sensitivities, such as in multiple chemical sensitivity. This study examined whether biomonitoring results influence disease attribution and perception. Patients over 18 presenting for the first time to the University Environmental Medicine Outpatient Clinic in Freiburg with suspected complaints linked to heavy metals, wood preservatives, pesticides, solvents, or mold spores were included. Illness perceptions were assessed before and after biomonitoring using the Illness Perception Questionnaire (IPQ-R). Of 358 patients, 51 met inclusion criteria; 3 showed relevant findings, and 15 did not attribute their symptoms to environmental causes at baseline. The remaining 33 patients were analyzed. After receiving a normal biomonitoring result, only seven patients (21%) altered their illness attribution. These individuals also reported milder perceived consequences, less personal control over the illness, and showed lower levels of somatization and compulsiveness than those who maintained their original attribution. Most patients remained convinced of an environmental cause despite unremarkable findings. This suggests that a substantial subset of patients is strongly attached to an environmental explanation for their symptoms, with stable attribution linked to higher psychological symptom burden and a belief in personal control over the illness. Full article

(This article belongs to the Section Environmental Health)

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16 pages, 500 KiB

Open AccessArticle

Periodontal Health Knowledge of Schoolteachers: A Cross-Sectional Study

by Khansa Taha Ababneh, Fathima Fazrina Farook, Lama Alosail, Maram Ali Alqahtani, Norah Gharawi and Afrah Alossimi

Int. J. Environ. Res. Public Health 2025, 22(7), 1142; https://doi.org/10.3390/ijerph22071142 - 18 Jul 2025

Abstract

Background/Objectives: Schoolteachers play a central role in shaping their students’ beliefs and attitudes towards oral health. Our aim was to investigate the oral and periodontal health knowledge of schoolteachers in Riyadh and factors affecting this knowledge. Methods: Government schoolteachers from representative [...] Read more.

Background/Objectives: Schoolteachers play a central role in shaping their students’ beliefs and attitudes towards oral health. Our aim was to investigate the oral and periodontal health knowledge of schoolteachers in Riyadh and factors affecting this knowledge. Methods: Government schoolteachers from representative areas of Riyadh (n = 895) responded to a structured questionnaire. Descriptive statistics, t-tests, one-way analysis of variance, and multiple linear regression (p ≤ 0.05). Results: Teachers demonstrated good basic oral/periodontal health knowledge (mean score = 60.21 ± 10.68). Most knew that toothbrushing is necessary to preserve dental (78.66%) and periodontal (57.88%) health; that gingival bleeding (74.41%), swelling (64.25%), and abscess formation (52.96%) are signs of periodontal disease; about 63% identified dental biofilm as an etiologic factor, and 58% knew that periodontitis may cause gingival recession and influence systemic health (74.07%). However, only 38% knew that dental flossing is necessary to preserve periodontal health, and 66.03% believed that gingival health can be restored with a special toothpaste. Teachers who were female, older in age, worked in north Riyadh, and taught the intermediate stage demonstrated statistically significantly better knowledge than the other categories. Conclusions: The studied sample of schoolteachers possesses acceptable basic oral health knowledge but has inadequate knowledge of periodontal health. Factors influencing teachers’ knowledge were age, gender, region of work, and teaching stage. Full article

(This article belongs to the Section Health Care Sciences)

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25 pages, 324 KiB

Open AccessArticle

Psychological Flexibility and Inflexibility of University Students: An In-Depth Qualitative Study

by Wendy Cervantes-Perea, Jone Martínez-Bacaicoa and Manuel Gámez-Guadix

Int. J. Environ. Res. Public Health 2025, 22(7), 1141; https://doi.org/10.3390/ijerph22071141 - 18 Jul 2025

Abstract

In the Hexaflex model of Acceptance and Commitment Therapy (ACT), psychological flexibility refers to the ability to openly embrace difficult thoughts and emotions while acting in alignment with personal values. In contrast, psychological inflexibility involves rigid avoidance and control strategies that hinder adaptive [...] Read more.

In the Hexaflex model of Acceptance and Commitment Therapy (ACT), psychological flexibility refers to the ability to openly embrace difficult thoughts and emotions while acting in alignment with personal values. In contrast, psychological inflexibility involves rigid avoidance and control strategies that hinder adaptive functioning. Although previously studied, more culturally relevant evidence is needed to inform interventions that promote well-being and mental health among Latin American students. This study explored manifestations of psychological flexibility and inflexibility in 15 undergraduate students from the University of Magdalena in Colombia (mean age = 20.13 years; 53.33% female) through semi-structured, face-to-face interviews (~45 min each). Data were analyzed using Interpretative Phenomenological Analysis (IPA), focusing on how participants described and made sense of their experiences. A total of 25 emergent themes were identified and grouped into 12 subordinate themes, mapped onto the 6 core ACT processes. The participants reported efforts to control or avoid distressing internal experiences, often resulting in difficulty acting in accordance with their values. The findings highlight a recurring ambivalence between avoidance and acceptance, and barriers to committed action, underscoring the dynamic interplay between flexibility and inflexibility. These results support the relevance of ACT-based interventions, such as structured group sessions that foster acceptance, mindfulness, and values-based behavior. Integrating this training into counseling and academic support services could enhance students’ well-being and performance. Future research should examine these dynamics longitudinally and across diverse contexts. Full article

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

14 pages, 1435 KiB

Open AccessArticle

Association Between Diet, Sociodemographic Factors, and Body Composition in Students of a Public University in Ecuador

by Angélica María Solís Manzano, María Victoria Padilla Samaniego, Verónica Patricia Sandoval Tamayo, Edgar Rolando Morales Caluña, Katherine Denisse Suarez Gonzalez, Tannia Valeria Carpio-Arias and Patricio Ramos-Padilla

Int. J. Environ. Res. Public Health 2025, 22(7), 1140; https://doi.org/10.3390/ijerph22071140 - 18 Jul 2025

Abstract

Body composition is associated with multiple factors. The main objective of this study is to determine the association between diet and sociodemographic factors on the body structure and composition of university students at a public university in Ecuador. This cross-sectional study allowed for [...] Read more.

Body composition is associated with multiple factors. The main objective of this study is to determine the association between diet and sociodemographic factors on the body structure and composition of university students at a public university in Ecuador. This cross-sectional study allowed for the collection of detailed body composition and dietary data from 204 students (41.7% men and 58.3% women, with an average age of 23.3 ± 4.4 years). The study was conducted using validated questionnaires and bioimpedance techniques. Statistical analysis included ANOVA tests, complemented by a PCA-Biplot, to examine the relationships between study variables. Statistical analysis revealed that men’s birthplace had a significant impact on several body measurements, such as hip circumference and weight, but no significant differences were observed in body structure and composition based on nutrient intake. Furthermore, larger upper-arm circumference in women was correlated with higher fat intake. The results of the multivariate analysis indicated a differential influence of dietary components on body composition. The study highlights the need for nutritional intervention strategies and educational programs that consider the diversity of students’ backgrounds to promote healthy habits and mitigate the negative effects of eating habits and irregular physical activity patterns on their health and body composition. Full article

(This article belongs to the Section Health Care Sciences)

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21 pages, 2570 KiB

Open AccessArticle

Exploration of Providers’ Perceptions and Attitudes Toward Phage Therapy and Intentions for Future Adoption as an Alternative to Traditional Antibiotics in the US—A Cross-Sectional Study

by Subi Gandhi, Dustin Edwards, Keith Emmert and Bonnie Large

Int. J. Environ. Res. Public Health 2025, 22(7), 1139; https://doi.org/10.3390/ijerph22071139 - 18 Jul 2025

Abstract

Antibiotic resistance presents a global threat, making the swift development of alternative treatments essential. Phage therapy, which employs bacterial viruses that specifically target bacteria, shows promise. Although this method has been utilized for over a century, primarily in Eastern Europe, its use in [...] Read more.

Antibiotic resistance presents a global threat, making the swift development of alternative treatments essential. Phage therapy, which employs bacterial viruses that specifically target bacteria, shows promise. Although this method has been utilized for over a century, primarily in Eastern Europe, its use in the US remains limited. This study aimed to assess the awareness and willingness of US healthcare providers to adopt phage therapy in response to the growing issue of antibiotic resistance. A survey of 196 healthcare providers, primarily MDs and DOs, found that while 99% were aware of antimicrobial resistance, only 49% were knowledgeable about phage therapy as a treatment for resistant bacterial infections. Nonetheless, 56% were open to considering phage therapy, and this willingness was associated with prior knowledge, concerns about antibiotic resistance, previous training, and confidence in recommending it (p < 0.05). Our study of U.S. healthcare providers revealed key findings about their views on phage therapy as a potential alternative for treating bacterial infections. Credible information is essential to promoting phage therapy use among U.S. providers via educational initiatives, clinical guidance, and research dissemination to promote phage therapy use among U.S. providers. Evidence-based education and clinical guidance help providers make sound decisions on the appropriate and safe use of phage therapy. Full article

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International Journal of Environmental Research and Public Health

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