International Journal of Environmental Research and Public Health

26 pages, 1044 KB

Open AccessArticle

Resilience, Quality of Life, and Minor Mental Disorders in Nursing Professionals: A Study in Challenging Work Environments

by Emerson Roberto dos Santos, Marco Antonio Ribeiro Filho, Weslley dos Santos Borges, William Donegá Martinez, João Daniel de Souza Menezes, Matheus Querino da Silva, André Bavaresco Gonçalves Cristóvão, Renato Mendonça Ribeiro, Flávia Cristina Custódio, Geovanna Mohieddine Felix Pereira, Jéssica Gisleine de Oliveira, Alex Bertolazzo Quitério, Rauer Ferreira Franco, Amanda Oliva Spaziani, Ana Paula Bernardes da Rosa, Rodrigo Soares Ribeiro, Nayara Tedeschi Fernandes Furtile, Daniele Nunes Longhi Aleixo, Tânia Cassiano Garcia Gonçalves, João Júnior Gomes, Adriana Pelegrini dos Santos Pereira, Fernando Nestor Facio Júnior, Marli de Carvalho Jerico, Josimerci Ittavo Lamana Faria, Maysa Alahmar Bianchin, Luís Cesar Fava Spessoto, Maria Helena Pinto, Rita de Cássia Helú Mendonça Ribeiro, Daniele Alcalá Pompeo, Antônio Hélio Oliani, Denise Cristina Móz Vaz Oliani, Júlio César André and Daniela Comelis Bertolin Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2025, 22(9), 1375; https://doi.org/10.3390/ijerph22091375 - 31 Aug 2025

Abstract

Introduction: The mental health of nursing professionals is an escalating global concern, particularly due to the inherently challenging work conditions they frequently encounter. This study aimed to investigate the prevalence of Minor Mental Disorders (MMD) and resilience levels among nursing professionals, analyzing the [...] Read more.

Introduction: The mental health of nursing professionals is an escalating global concern, particularly due to the inherently challenging work conditions they frequently encounter. This study aimed to investigate the prevalence of Minor Mental Disorders (MMD) and resilience levels among nursing professionals, analyzing the relationship between these constructs and identifying resilience’s potential protective role. Methods: This was a quantitative, descriptive, correlational, and cross-sectional study. The sample consisted of 203 nursing professionals (including nursing assistants, technicians, and nurses) from two healthcare institutions in the interior of São Paulo, Brazil. Data were collected between August and October 2019. Instruments utilized included a sociodemographic and professional questionnaire, the Self-Report Questionnaire (SRQ-20) for MMD screening, and the Wagnild & Young Resilience Scale. Results: The overall prevalence of MMD in the studied sample was 31.0%. Mean scores for the SRQ-20 domains were observed as follows: Depressive/Anxious Mood (1.33), Somatic Symptoms (1.63), Reduced Vital Energy (1.77), and Depressive Thoughts (0.39). A key finding indicated that resilience did not demonstrate a significant direct predictive role on MMDs when the effect of quality of life was controlled. However, resilience showed a significant positive correlation with Quality of Life (QoL) (coef. = 0.515; p < 0.001). Furthermore, QoL emerged as a robust and statistically significant negative association with all dimensions of MMD. Discussion: These findings suggest that resilience may function as an indirect moderator or precursor to QoL, with QoL, in turn, exerting a more direct and substantial influence on the reduction of MMDs. This integrated perspective aligns with the understanding that resilience contributes to a more adaptive assessment of stressors and, consequently, to better QoL, thereby minimizing the detrimental effects of stress on mental health. Conclusion: This study reaffirms the high prevalence of Minor Mental Disorders among nursing professionals, highlighting Quality of Life as a primary target for interventions aimed at promoting mental well-being. It also emphasizes resilience as a valuable individual resource that indirectly supports mental health by enhancing QoL. A holistic understanding of occupational stressors, psychosocial, and biological mechanisms is crucial for developing effective and targeted support strategies for these essential professionals. Full article

(This article belongs to the Special Issue Psychological Health and Wellness Among Healthcare Professionals)

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14 pages, 444 KB

Open AccessArticle

Determinants of Caregiving Subgroups for Mexican American Caregivers Assisting Older Adults at Home and Their Influence on Perceived Stress

by Karen E. Schlag, Xiaoying Yu, Soham Al Snih and Monique R. Pappadis

Int. J. Environ. Res. Public Health 2025, 22(9), 1374; https://doi.org/10.3390/ijerph22091374 - 31 Aug 2025

Abstract

Patterns of family caregiving of older adults have been identified based on aspects such as care-related tasks and intensity and are associated with caregiver well-being. A gap remains, however, in understanding how individual-, relational-, and cultural-level factors concurrently inform caregiving groups within multicultural [...] Read more.

Patterns of family caregiving of older adults have been identified based on aspects such as care-related tasks and intensity and are associated with caregiver well-being. A gap remains, however, in understanding how individual-, relational-, and cultural-level factors concurrently inform caregiving groups within multicultural families. In this study, we identified caregiving patterns among Mexican American individuals aiding older adults by drawing from a variety of care recipient and caregiver characteristics. We also assessed relationships between established subgroups and perceived caregiver stress. Using data from the 2016 Hispanic Established Populations for the Epidemiological Study of the Elderly (Caregiver supplement, Wave 9, N = 460), we performed latent class analysis to determine caregiving subgroups from 8 indicator variables representing patient needs, family characteristics, and caregiver health and support. Findings identified four caregiving subgroups that varied based on older adults’ care needs and caregivers’ family status, nativity, and health. Results from multivariable linear regression indicated that caregivers from the Moderate Burden/Non-cohabitating group perceived significantly less stress than those in the Elevated Burden & Health Risk group. In conclusion, we demonstrated how multi-level factors shape caregiving patterns, which can inform support efforts for multicultural families. Full article

(This article belongs to the Special Issue Family Caregiving of Older Adults)

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17 pages, 325 KB

Open AccessArticle

Illicit Drug Use and Sociodemographic Correlates Among Adolescents in a Brazilian Metropolitan Region: A School-Based Cross-Sectional Study

by Luíza Eduarda Portes Ribeiro, Luisa Sorio Flor, Carlos Augusto Lopes and Franciéle Mabotti Costa Leite

Int. J. Environ. Res. Public Health 2025, 22(9), 1373; https://doi.org/10.3390/ijerph22091373 - 31 Aug 2025

Abstract

(1) Introduction: Drug use among adolescents remains persistent, including in school settings, thus requiring attention. This study analyzed the prevalence of drug experimentation and current use among high school students and their associated factors. (2) Methods: An analytical cross-sectional study was conducted in [...] Read more.

(1) Introduction: Drug use among adolescents remains persistent, including in school settings, thus requiring attention. This study analyzed the prevalence of drug experimentation and current use among high school students and their associated factors. (2) Methods: An analytical cross-sectional study was conducted in 2023 with 4610 students from public and private high schools in the Metropolitan Region of Grande Vitória, Brazil. Data were collected using tablets and a questionnaire. Sociodemographic variables were considered. Bivariate analyses and Poisson regression were used. (3) Results: Drug experimentation was reported by 22% of students (23.5% girls; 19.8% boys), and current use by 8.7% (9.2% girls; 8.0% boys). Higher lifetime use was observed among older adolescents (RP: 1.44) and those from higher socioeconomic classes (RP: 1.24). Statistically significant associations were found in LGBTQIAPN+ students (RP: 1.54 experimentation; RP: 1.76 current use) and Black students (RP: 1.33; 1.59). Being in a relationship (RP: 1.41; 1.42), currently working (RP: 1.36; 1.62), and having separated parents (RP: 1.29; 1.37) were also associated. (4) Conclusions: The high prevalence of drug use among adolescents highlights the need for targeted public policies, especially school-based actions promoting mental health, diversity, and racial equity. This study identifies vulnerable subgroups at greater risk. Full article

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

13 pages, 534 KB

Open AccessArticle

Safety Climate and Occupational Injuries in the Iron and Steel Industries in Tanzania

by Saumu Shabani, Bente Elisabeth Moen, Teferi Abegaz and Simon Henry Mamuya

Int. J. Environ. Res. Public Health 2025, 22(9), 1372; https://doi.org/10.3390/ijerph22091372 - 31 Aug 2025

Abstract

The iron and steel industries globally have a high prevalence of occupational injuries, which need to be reduced. Obtaining safety climate information from workers assists in understanding the safety status at the workplace. This study aimed to assess the safety climate in the [...] Read more.

The iron and steel industries globally have a high prevalence of occupational injuries, which need to be reduced. Obtaining safety climate information from workers assists in understanding the safety status at the workplace. This study aimed to assess the safety climate in the iron and steel industries and its association with occupational injuries. A cross-sectional study was conducted in four iron and steel industrial sites in Tanzania. Three hundred and twenty-one workers from the production lines and 50 managers/supervisors participated. The data were collected by interviews using the Kiswahili version of the Nordic Safety Climate Questionnaire (NOSACQ-50) and the modified International Labor Organization (ILO) manual on methods for occupational injuries. The managers/supervisors scored higher than the workers in five of the NOSACQ-50 dimensions. Most workers with low scores on safety climate had experienced occupational injuries. Analyses of the workers who had been injured at work showed that the dimensions ‘management safety priority and ability’, and ‘management safety justice’ were significant predictors of occupational injuries in the iron and steel industries, when adjusting for working years and working hours per day. This indicates that safety climate is a predictor of occupational injuries, and it is important to improve the safety priorities and commitments among the employees. Full article

(This article belongs to the Section Global Health)

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19 pages, 642 KB

Open AccessArticle

Trauma-Informed Understanding of Depression Among Justice-Involved Youth

by Richard Dembo, Alexis Swezey, Rachel Herrera, Luz Melendez, Camille Geiger, Kerry Bittrich, Jennifer Wareham and James Schmeidler

Int. J. Environ. Res. Public Health 2025, 22(9), 1371; https://doi.org/10.3390/ijerph22091371 - 31 Aug 2025

Abstract

The association between adverse childhood experiences (ACEs) and depression has been the focus of a number of prevalent studies in recent years—particularly among high-risk youth. Depression remains a significant mental health issue among justice-involved youth. There is a well-established correlation between depressed mood [...] Read more.

The association between adverse childhood experiences (ACEs) and depression has been the focus of a number of prevalent studies in recent years—particularly among high-risk youth. Depression remains a significant mental health issue among justice-involved youth. There is a well-established correlation between depressed mood and conduct problems (e.g., conduct disorder and oppositional defiant disorder) during childhood and adolescence, which tends to become more prevalent during adolescence. Studies of justice-involved youth reveal high prevalence rates of depression and other mood disorders. Drawing on the relevant literature, we conducted multigroup structural equation model (SEM) analyses to assess the relationships between experiencing ACEs, sexual assault victimization, and depression among male (n = 226) and female (n = 98) youth entering a post-arrest intake facility in the Florida, U.S.A. juvenile justice system in 2024–2025. The youths averaged 15 years in age, and most were attending middle school or high school. Confirmatory factor analyses (CFAs) were completed to estimate a latent variable labeled depression. Sexual assault victimization and ACEs were hypothesized to be related to each other and were specified as predictors of depression. This trauma/stress experiences and depression model was estimated in two multigroup analyses, across birth gender groups (male or female) and race groups (non-Black or Black) for the youth in this study. The results indicated that there are several notable conclusions from the SEM analyses. First, depression was a scalar invariant in the two multigroup analyses, permitting clearer comparisons of the specified predictors of this construct across groups. Second, for the race-based SEM, experience of sexual assault and the total ACE score were significantly related only in the model for Black youth. The fit of the model was “poorest” among non-Black youth, although even in this case, sexual assault experiences were a significant predictor of depression. Finally, for the gender-based model, sexual assault and ACEs were significant predictors of depression among both male and female youth. Model fit results underscore the important role of abuse trauma and ACEs in understanding these youths’ depression symptoms, and they help contribute to the literature on this topic. Full article

(This article belongs to the Special Issue Public Health Advances in the Recognition and Response to Gender-Based Violence, Sexual Assault, and Domestic Violence)

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11 pages, 301 KB

Open AccessArticle

Factors Preventing Students with Disabilities from Participating in Sports at Rural Universities in Limpopo Province

by Tobias Johannes Mokwena, Takalani Grace Tshitangano and Shonisani Elizabeth Tshivhase

Int. J. Environ. Res. Public Health 2025, 22(9), 1370; https://doi.org/10.3390/ijerph22091370 - 31 Aug 2025

Abstract

Students with disabilities face challenges that limit their participation in sports activities designed to promote social cohesion. This study examined factors that discourage students with disabilities from engaging in sports at rural universities in Limpopo Province. A qualitative research approach with an exploratory [...] Read more.

Students with disabilities face challenges that limit their participation in sports activities designed to promote social cohesion. This study examined factors that discourage students with disabilities from engaging in sports at rural universities in Limpopo Province. A qualitative research approach with an exploratory design was employed. Purposive sampling was used to select participants. Trustworthiness was ensured through measures of credibility, confirmability, transferability, and dependability. Credibility was established through prolonged engagement with participants during the data collection process. Confirmability was maintained by transcribing interview recordings verbatim without alterations. Transferability was supported by employing an appropriate study approach, design, target population, and inclusion criteria. Dependability was ensured by minimizing bias in participant selection. Data were collected through semi-structured interviews with sixteen students with disabilities, ten staff members from disability units at rural universities, and three staff members from sports and recreation units. Ethical principles-including informed consent, anonymity, privacy, confidentiality, and harm prevention-were consistently upheld throughout the study. Data analysis was conducted using a thematic reflexive analysis approach. Five main themes emerged: perceptions of including students with disabilities in sports programs; barriers preventing their participation; university support for students with disabilities interested in sports; the importance of engaging in sports programs; and interventions to encourage participation among students with disabilities. People with disabilities experience social exclusion, discrimination, and a lack of trained staff to support them in sports. The development and implementation of inclusive sports facilities can help address the challenges that prevent people with disabilities from participating in sports programs. An intersectoral approach is needed to ensure that people with disabilities participate in sports activities that promote a healthy lifestyle at universities. Full article

27 pages, 2792 KB

Open AccessArticle

The Gut Microbiota of Peruvian Children Under the Age of Two During the Complementary Feeding Period

by Ayat Kutbi, Junming Gong, Douglas Dluzen, Mihai Pop and Yuejin Li

Int. J. Environ. Res. Public Health 2025, 22(9), 1369; https://doi.org/10.3390/ijerph22091369 - 30 Aug 2025

Abstract

The gut microbiota plays a crucial role in early childhood development. Dysbiosis in this community has been linked to risk of disease. The transition from an exclusive milk-based diet to complementary feeding and eventual weaning is crucial for the development and maturation of [...] Read more.

The gut microbiota plays a crucial role in early childhood development. Dysbiosis in this community has been linked to risk of disease. The transition from an exclusive milk-based diet to complementary feeding and eventual weaning is crucial for the development and maturation of the gut microbiota. However, the impact of breastfeeding duration during the complementary feeding period (typically 6 to 24 months of age) on microbial development trajectories remains incompletely characterized. Here, we investigated whether prolonged breastfeeding during the complementary feeding window influences gut microbiota succession by comparing children who continued breastfeeding with those who were fully weaned at the same ages. We analyzed 16S rRNA gene sequencing profiles of fecal samples collected from a cohort of Peruvian children at 6, 12, 18, and 24 months of age. Samples were categorized into two groups: a complementary feeding group (BF), which received both complementary foods and breast milk, and a post-weaning group (NBF), which had stopped receiving breast milk for over 7 days. We conducted both alpha and beta diversity to assess within- and between-sample microbial variation. Relative abundances of microbial taxa at the phylum and genus levels were also quantified. The results showed a clear age-related increase in both species richness and species evenness across early childhood, while BF had more gradual changes relative to NBF. Marked differences in community composition were observed between BF and NBF children at 12, 18, and 24 months, respectively. Children who continued breastfeeding maintained a Bifidobacterium-rich, lower-diversity microbiota for a longer period, whereas weaned children at the same age exhibited accelerated microbiota development toward an adult-like profile enriched in Bacteroidota and Bacillota (formerly Firmicutes). These findings suggest that breastfeeding during the complementary feeding period exerts a significant influence on gut microbiota development through the first two years of life, which is most likely independent of complementary food. The study provides potential implications for children’s health and nutrition guidelines from a perspective of gut microbiota succession. Full article

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

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28 pages, 2735 KB

Open AccessArticle

Getting To(wards) Know(ing) Together: An Innovative Collaborative Approach in Residential Care for People with (Severe) Intellectual Disabilities and Behaviour That Challenges

by Gustaaf F. Bos, Vanessa C. Olivier-Pijpers and Alistair R. Niemeijer

Int. J. Environ. Res. Public Health 2025, 22(9), 1368; https://doi.org/10.3390/ijerph22091368 - 30 Aug 2025

Abstract

People with moderate to severe intellectual disabilities (M/S ID) and behaviour that challenges are still almost exclusively encountered and understood within a highly specialized professional care system context. They are almost invisible in the societal mainstream, where a wider variety of perspectives on [...] Read more.

People with moderate to severe intellectual disabilities (M/S ID) and behaviour that challenges are still almost exclusively encountered and understood within a highly specialized professional care system context. They are almost invisible in the societal mainstream, where a wider variety of perspectives on (everyday) manners, encounters, relationships and life applies. These (and other) exclusionary dynamics render everyday relations with residents with M/S ID whose behaviours challenge still largely dependent on the interpretative frameworks and actions of professionals. Professionals are trained and socialized within highly specialized professional care system contexts, despite a growing scientific and professional awareness that behaviour that challenges is a multifaceted and contextual phenomenon. In this paper, we report on a pioneering initiative (titled Project WAVE) which aimed to cultivate a fresh and comprehensive approach to behaviours that challenge within stagnant care practices. Our goal was to foster an innovative collaborative paradigm by facilitating an extensive and enduring exchange between “insiders”—professionals of specialized care system contexts—and “outsider-researchers”—individuals socialized through alternative avenues. We present our epistemological and methodological approach, the data collection process (a multiple case-informed community of practice), and the most important lessons learned. Full article

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

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17 pages, 817 KB

Open AccessArticle

Sedentary Behavior, Physical Inactivity, and the Prevalence of Hypertension, Diabetes, and Obesity During COVID-19 in Brazil

by Jeferson Roberto Collevatti dos Anjos, Igor Massari Correia, Chimenny Auluã Lascas Cardoso de Moraes, Jéssica Fernanda Corrêa Cordeiro, Atila Alexandre Trapé, Jorge Mota, Dalmo Roberto Lopes Machado and André Pereira dos Santos

Int. J. Environ. Res. Public Health 2025, 22(9), 1367; https://doi.org/10.3390/ijerph22091367 - 30 Aug 2025

Abstract

Objectives: To analyze, across the periods before, during, and after the implementation of Social Isolation and Distancing Measures (IMDIS): (a) changes in the prevalence of non-communicable chronic diseases (NCDs), stratified by age group in the Brazilian population; and (b) the association between physical [...] Read more.

Objectives: To analyze, across the periods before, during, and after the implementation of Social Isolation and Distancing Measures (IMDIS): (a) changes in the prevalence of non-communicable chronic diseases (NCDs), stratified by age group in the Brazilian population; and (b) the association between physical inactivity (PI), insufficient moderate-to-vigorous physical activity (MVPA), and sedentary behavior (SB) with the occurrence of these conditions. This cross-sectional study used data from VIGITEL (Brazil’s Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey), an annual population-based telephone survey conducted across the country. Data were collected in 2019, 2021, and 2023, with a total sample size of 101,226 participants. Arterial hypertension (AH) and diabetes mellitus (DM) were self-reported, and obesity (OB) was diagnosed using body mass index. PI, insufficient MVPA, and SB were identified via VIGITEL indicators. Chi-square tests assessed differences in prevalence overall and by age group. Logistic regression models estimated odds ratios (ORs) for associations between demographic variables, behavioral factors, and the studied periods. The prevalence of AH and DM was highest among individuals over 60 years, reaching 61% after IMDIS, a period when OB also peaked across all age groups. Individuals aged 30–59 and those over 60 had higher odds of AH, DM, and OB across all periods. Female participants had higher ORs for AH and DM both before and after IMDIS. PI and insufficient MVPA were associated with increased odds of AH, DM, and OB in all periods, while SB significantly elevated the OR for OB at all time points. After IMDIS, there was an increase in the prevalence of AH, DM, and OB among older adults and younger individuals. PI, insufficient MVPA, SB, and advanced age were all associated with a greater likelihood of NCDs at every stage of the study. The high post-IMDIS rates of AH, DM, and OB highlight the need for urgent public health strategies. Low-cost programs, such as live videos and online group sessions, should be included in national physical activity guidelines. These initiatives are affordable, aligned with WHO goals, and reduce PI in IMDIS scenarios. Incorporating them into Academia da Saúde and Agita Brasil strengthens NCD prevention and increases the resilience of the health system for future health crises. Full article

(This article belongs to the Special Issue Physical Activity Promotion and Exercise Intervention for Persons with Chronic Disease)

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27 pages, 1473 KB

Open AccessArticle

Noise Annoyance and Sleep Disturbance Due to Road Traffic and Railway Noise in Germany

by Sarah Leona Benz, Julia Kuhlmann, Jonas Bilik, Manfred Liepert and Dirk Schreckenberg

Int. J. Environ. Res. Public Health 2025, 22(9), 1366; https://doi.org/10.3390/ijerph22091366 - 30 Aug 2025

Abstract

Environmental noise exposure is omnipresent, but the type of noise source and its appraisal may differ in varying contexts. For instance, studies have found significant differences in annoyance ratings between urbanisation levels. In this article, a re-analysis of existing survey data is presented, [...] Read more.

Environmental noise exposure is omnipresent, but the type of noise source and its appraisal may differ in varying contexts. For instance, studies have found significant differences in annoyance ratings between urbanisation levels. In this article, a re-analysis of existing survey data is presented, assessing noise annoyance and sleep disturbance from road traffic and railway noise in a random sample stratified by rural, suburban, and inner-city areas. Noise exposure was estimated using modelled L_den and L_night levels. Exposure–response curves showed greater annoyance at lower road traffic noise levels compared to the WHO guidelines (10% highly annoyed at 35 dB L_den vs. WHO 53 dB L_den). Railway noise annoyance aligned with the WHO estimates; however, sleep disturbance was lower at comparable exposure levels (3% highly sleep-disturbed at 53 dB L_night vs. WHO 44 dB). This re-analysis provides robust exposure–response relationships. The findings indicate higher levels for road traffic noise annoyance in Germany compared to international standards. A resulting policy implication is to link regular population surveys to noise action planning as a form of public participation. This approach enables the development of measures tailored to local conditions and supports the estimation of potential impacts, such as the number of people who may benefit from reduced noise exposure. Full article

(This article belongs to the Special Issue Community Response to Environmental Noise)

10 pages, 490 KB

Open AccessArticle

Effect of Spherical Adsorptive Carbon Among Chronic Kidney Disease Patients: A Nationwide Cohort Study

by Dong Hui Shin, Keunryul Park, Jae Won Yang and Jun Young Lee

Int. J. Environ. Res. Public Health 2025, 22(9), 1365; https://doi.org/10.3390/ijerph22091365 - 30 Aug 2025

Abstract

Spherical Adsorptive Carbon (SAC), a type of oral sorbent, is prescribed to chronic kidney disease (CKD) patients to remove uremic toxins. However, evidence regarding its effectiveness in delaying chronic kidney disease (CKD) progression remains insufficient. We aimed to evaluate the impact of SAC [...] Read more.

Spherical Adsorptive Carbon (SAC), a type of oral sorbent, is prescribed to chronic kidney disease (CKD) patients to remove uremic toxins. However, evidence regarding its effectiveness in delaying chronic kidney disease (CKD) progression remains insufficient. We aimed to evaluate the impact of SAC on CKD progression in patients with CKD stage 3 or higher using nationwide data. In this retrospective cohort study, we included patients diagnosed with CKD stage ≥3 from the Korea National Health Insurance System database between January 2020 and December 2022. Outcomes were compared between SAC users (N = 1289) and non-users (N = 1289) after 1:1 propensity score matching (PSM). After PSM, the time from index date to end-stage kidney disease (ESKD) was significantly longer in the SAC user group compared to the non-user group (246.8 days vs. 118.6 days, p < 0.001). In Cox regression analysis, the risk of ESKD was significantly lower in the SAC group (HR = 0.37, 95% CI: 0.29–0.48). However, the risk of dialysis initiation did not show a significant difference between the two groups (HR = 0.83, 95% CI: 0.27–2.59). This nationwide cohort study suggests that SAC treatment may delay progression from CKD stage 3 to ESKD, although it did not significantly reduce the risk of dialysis initiation. Full article

(This article belongs to the Section Global Health)

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11 pages, 415 KB

Open AccessArticle

Impacts of Ambient Temperatures on Pediatric Anemia in Sub-Saharan Africa: A Regional Ecological Study

by Muhammad A. Saeed, Adeena Zaidi, Mohammad R. Saeed, Harris Khokhar, Binish Arif Sultan, Sami Khan, Adam Dawer and Haris Majeed

Int. J. Environ. Res. Public Health 2025, 22(9), 1364; https://doi.org/10.3390/ijerph22091364 - 30 Aug 2025

Abstract

Anemia has been a growing concern for the pediatric population in sub-Saharan Africa. Emerging risk factors for anemia under five years of age in low-income countries are multifaceted, including infectious diseases, nutritional deficiencies, hidden hunger, and various economic determinants, and its health burdens [...] Read more.

Anemia has been a growing concern for the pediatric population in sub-Saharan Africa. Emerging risk factors for anemia under five years of age in low-income countries are multifaceted, including infectious diseases, nutritional deficiencies, hidden hunger, and various economic determinants, and its health burdens include childhood stunting and reduced cognitive function diminished school performance in children. However, the influence of climatic factors, particularly ambient temperatures, on pediatric anemia remains understudied. In this population-based study, we assess the region-specific associations between pediatric anemia and ambient temperatures in 43 countries in Africa from 2000 to 2019. Using generalized linear regression models (upon adjusting for covariates), we found that the risk of temperatures on pediatric anemia varies across four African regions, whereby the Central and Southern African regions have a positive association between pediatric anemia and ambient temperatures, and Western and Eastern regions are negatively affected. The study aims to provide evidence to stakeholders to curtail the onset of pediatric anemia in high-risk African regions to set up key interventions based on the sustainability goals set by the World Health Organization. Full article

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26 pages, 337 KB

Open AccessArticle

Exploring Stakeholders’ Perceptions of Electronic Personal Health Records for Mobile Populations Living in Disadvantaged Circumstances: A Multi-Country Feasibility Study in Denmark, Ghana, Kenya, and The Netherlands

by Paulien Tensen, Maria Bach Nikolajsen, Simeon Kintu Paul, Princess Ruhama Acheampong, Francisca Gaifém, Frederick Murunga Wekesah, Ulrik Bak Kirk, Ellis Owusu-Dabo, Per Kallestrup, Erik Beune, Charles Agyemang and Steven van de Vijver

Int. J. Environ. Res. Public Health 2025, 22(9), 1363; https://doi.org/10.3390/ijerph22091363 - 29 Aug 2025

Abstract

(1) Background: Mobile populations living in disadvantaged circumstances often face disrupted continuity of care due to incomplete or inaccessible health records. This feasibility study explored the perceived usefulness of Electronic Personal Health Records (EPHRs) in enhancing access to and continuity of care for [...] Read more.

(1) Background: Mobile populations living in disadvantaged circumstances often face disrupted continuity of care due to incomplete or inaccessible health records. This feasibility study explored the perceived usefulness of Electronic Personal Health Records (EPHRs) in enhancing access to and continuity of care for mobile populations across Denmark, Ghana, Kenya, and The Netherlands. (2) Methods: A qualitative study using ninety semi-structured interviews, with multi-level stakeholders ranging from policymakers to mobile individuals, recruited through purposive and convenience sampling. Interview guides and analysis were informed by the Technology Acceptance Model (TAM), and analysis by the Unified Theory of Acceptance and Use of Technology (UTAUT). (3) Results: Stakeholders highlighted the value of improved medical data sharing and ownership and considered EPHRs promising for enhancing care continuity and efficiency. Key concerns included limited digital and health literacy, and data security and privacy, underscoring the need for education and safeguards against inappropriate data sharing. Due to differences in digital readiness and privacy guidelines, a one-size-fits-all EPHR is unlikely to succeed. (4) Conclusions: EPHRs are considered valuable tools to enhance care continuity and increase patient ownership, but they face technical, structural, and social challenges, including data security and varying levels of digital (health) literacy. Successful implementation requires context-sensitive, co-created solutions supported by strong policy frameworks. Full article

(This article belongs to the Special Issue Migrant Health Challenges in Infectious and Non-Communicable Disease Epidemiology)

17 pages, 579 KB

Open AccessReview

Long COVID Symptom Management Through Self-Care and Nonprescription Treatment Options: A Narrative Review

by Preeti Kachroo, Guy Boivin, Benjamin J. Cowling, Will Shannon, Pascal Mallefet, Pranab Kalita and Alexandru M. Georgescu

Int. J. Environ. Res. Public Health 2025, 22(9), 1362; https://doi.org/10.3390/ijerph22091362 - 29 Aug 2025

Abstract

Many patients experience unique or persistent symptoms several months following the onset of infection with severe acute respiratory syndrome coronavirus 2, the causative agent of COVID-19. While this condition is commonly referred to as long COVID, no universally accepted definition exists; therefore, many [...] Read more.

Many patients experience unique or persistent symptoms several months following the onset of infection with severe acute respiratory syndrome coronavirus 2, the causative agent of COVID-19. While this condition is commonly referred to as long COVID, no universally accepted definition exists; therefore, many patients go underrecognized and underreported. Long COVID can involve almost any major organ system and is characterized by widely heterogeneous persistent or recurrent symptoms including fatigue, headache, cough, dyspnea, chest pain, cognitive dysfunction, anxiety, and depression. In line with the wide array of symptoms, numerous potential underlying pathophysiologic pathways, including viral persistence, prolonged inflammation, autoimmune reactions, endothelial dysfunction, and dysbiosis of the microbiome of the gut, may contribute to the symptomology of long COVID. Therapy is directed at symptomatic control; however, no pharmacologic treatments are specifically approved for the management of symptoms associated with long COVID. Several common symptoms of long COVID may be managed with nonprescription treatments (pharmacologic and nonpharmacologic). The goal of this review is to provide clinicians with a better understanding of long COVID and review the latest recommendations for managing common mild-to-moderate symptoms with nonprescription treatment options. Full article

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30 pages, 1931 KB

Open AccessArticle

Quantification of Urticating Setae of Oak Processionary Moth (Thaumetopoea processionea) and Exposure Hazards

by Paula Halbig, Horst Delb and Axel Schopf

Int. J. Environ. Res. Public Health 2025, 22(9), 1361; https://doi.org/10.3390/ijerph22091361 - 29 Aug 2025

Abstract

Potential climatic and land-use changes may favor an increase in the population densities and range expansion of oak processionary moth (OPM) in Central and Western Europe in the future. This could lead to more significant threats to human and animal health, caused by [...] Read more.

Potential climatic and land-use changes may favor an increase in the population densities and range expansion of oak processionary moth (OPM) in Central and Western Europe in the future. This could lead to more significant threats to human and animal health, caused by the urticating setae released by OPM larvae, and more severe oak defoliation by the larvae. To cope with the public health issue, a basis for OPM hazard assessment and management was created by quantifying the setae formation potential of OPM. While a single larva forms ca. 857,000 setae during its lifespan, a single infested oak tree may be contaminated with up to 10–24 billion (10⁹) setae during an OPM outbreak. Moreover, the possible setae contamination threat to humans through airborne setae dispersion was studied in worst-case exposure simulations in the field. The highest airborne setae concentration was straight downwind, but turbulences up to 150° from the air flow were observed. The findings of this study will improve biohazard quantification as a basis for decision-making on preventive or mechanical control measures and enable an effective protection of human health. This study provides applicable information to derive warnings and recommendations for the public, as well as land managers and authorities. Full article

(This article belongs to the Special Issue Feature Papers in Environmental Exposure and Toxicology)

10 pages, 279 KB

Open AccessArticle

Prevalence, Risk Factors, and Multimorbidity Patterns in Climacteric Women with Hypertension

by Juliene Gonçalves Costa, Ana Luiza Amaral, Julia Buiatte Tavares, Aline Keli de Oliveira, Ana Clara Ribeiro Cunha, Juliana Cristina Silva and Guilherme Morais Puga

Int. J. Environ. Res. Public Health 2025, 22(9), 1360; https://doi.org/10.3390/ijerph22091360 - 29 Aug 2025

Abstract

Although the relationship between risk factors and disease patterns still remains poorly understood, arterial hypertension in climacteric women is a substantial risk factor for multimorbidity. This cross-sectional study analyzed data from 1003 women aged ≥40 years attending Brazilian Basic Health Units to assess [...] Read more.

Although the relationship between risk factors and disease patterns still remains poorly understood, arterial hypertension in climacteric women is a substantial risk factor for multimorbidity. This cross-sectional study analyzed data from 1003 women aged ≥40 years attending Brazilian Basic Health Units to assess multimorbidity (≥2 chronic conditions) and its patterns (cardiometabolic, musculoskeletal, and neuropsychological). An adjusted logistic regression revealed that postmenopausal status (OR: 2.17; 95% CI: 1.05–4.48) and an age of ≥70 years (OR: 2.85; 95% CI: 1.16–6.99) were key risk factors for multimorbidity. Notably, 86% of hypertensive women had multimorbidity, most frequently dyslipidemia (50%), type 2 diabetes (37%), and thyroid disorders (18%). The cardiometabolic pattern (86% prevalence) was strongly associated with hypertension, especially among women aged ≥50 years (OR: 2.10; 95% CI: 1.10–3.98) and those with obesity grade I+ (OR: 2.30; 95% CI: 1.36–3.89). Musculoskeletal disorders were associated with postmenopausal status (OR: 2.41; 95% CI: 1.05–5.51) and obesity (OR: 1.92; 95% CI: 1.08–3.43), while neuropsychological diseases showed no significant associations. These findings highlight that hypertensive climacteric women—especially postmenopausal, older, or those with obesity—face elevated risks of cardiometabolic and musculoskeletal multimorbidity, underscoring the need for targeted preventive strategies in this population. Full article

(This article belongs to the Special Issue Advances in Primary Health Care and Community Health)

30 pages, 393 KB

Open AccessArticle

Stress and Coping Strategies of Hong Kong University Students During the COVID-19 Pandemic: A Qualitative Study

by Tingyin Wong and Daniel T. L. Shek

Int. J. Environ. Res. Public Health 2025, 22(9), 1359; https://doi.org/10.3390/ijerph22091359 - 29 Aug 2025

Abstract

The COVID-19 pandemic brought significant challenges to university students in China, including the Hong Kong Special Administrative Region. To understand the stress and coping strategies of university students during the pandemic, we conducted focus groups with 56 Hong Kong university students from late [...] Read more.

The COVID-19 pandemic brought significant challenges to university students in China, including the Hong Kong Special Administrative Region. To understand the stress and coping strategies of university students during the pandemic, we conducted focus groups with 56 Hong Kong university students from late December 2022 to mid-January 2023. Thematic analysis using a deductive data analytic approach based on the Transactional Theory of Stress and Coping was applied to form concepts on coping strategies. The findings revealed four major challenges faced by Hong Kong university students, which were the accumulation of negative emotions, health-related anxiety and frequent change in pandemic-related policies, conflict with family members, and challenges in online learning and academic and career development. When coping with these challenges, students used the following coping strategies: (1) seeking social support, emphasizing the positive and tension reduction to manage their negative emotions; (2) problem-focused coping and emphasizing the positive to deal with health-related anxiety and stress arising from the frequent change in pandemic-related policies; (3) seeking social support, tension reduction, distancing/detachment and self-isolation/keeping to themselves to handle conflict with family members; (4) seeking social support, problem-focused coping, emphasizing the positive and using distancing/detachment to cope with challenges in online learning and academic and career development. Moreover, comparing students with different backgrounds, the findings showed that more students with a high level of self-perceived resilience employed the emphasizing the positive coping strategy, while more students with financial difficulties applied tension-reduction coping strategies. This study contributes to the stress and coping literature by illustrating Hong Kong young people’s stress and coping strategies during the COVID-19 pandemic. This study also supports the Transactional Theory of Stress and Coping and extends the discussion to various coping theories. Full article

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

10 pages, 304 KB

Open AccessArticle

Influence of the Training Process on the Health Literacy of Angolan Health Promoters

by Manuela Ferreira, Eduardo Santos, Joana Andrade, Inês Figueiredo, Vitor Martins and Sofia Campos

Int. J. Environ. Res. Public Health 2025, 22(9), 1358; https://doi.org/10.3390/ijerph22091358 - 29 Aug 2025

Abstract

Background: As part of the research project ‘Seigungo–Gungo’s Health, Education, and Maternal and Child Quality of Life: An Action-Research Project’, a study was conducted in the Gungo community in Angola, a region facing significant challenges in terms of access to healthcare and health [...] Read more.

Background: As part of the research project ‘Seigungo–Gungo’s Health, Education, and Maternal and Child Quality of Life: An Action-Research Project’, a study was conducted in the Gungo community in Angola, a region facing significant challenges in terms of access to healthcare and health literacy. The primary aim of the study was to evaluate the effectiveness of an intervention training model designed to improve the health literacy of the participants. Methods: The sample consisted of 30 trainees, 60% of whom were male, with an average age of 45.6 years. Most participants were single (53.3%) and had completed 6 years of formal education (26.7%). Health literacy levels were assessed using the HLS-EU-PT-Q16, a short 16-item questionnaire designed to assess three key domains: healthcare, disease prevention, and health promotion. These domains are related to the focus of the training programme. Data collection took place throughout the year 2024. Results: According to the data obtained, prior to attending the training program, 60% of the participants demonstrated an inadequate level of health literacy. Following the intervention, this percentage dropped significantly to 20%. In contrast, the proportion of participants with sufficient to excellent health literacy rose from 16.7% to approximately 40%. The results indicate that the training program had a positive and statistically significant impact on improving health literacy in the Gungo community. Conclusions: These findings highlight the importance of targeted training and sustained intervention efforts to address the specific health education needs currently affecting this community. Full article

11 pages, 264 KB

Open AccessArticle

Assessing Preparedness and Preventive Measures for Managing Food Allergy and Anaphylaxis in Primary Schools of Rabigh, Saudi Arabia

by Saddiq Habiballah, Nojoud Faqerah, Abdullah Alsaggaf, Majdi Damanhori and Manal Ahmed Halwani

Int. J. Environ. Res. Public Health 2025, 22(9), 1357; https://doi.org/10.3390/ijerph22091357 - 29 Aug 2025

Abstract

Background and Aims: Anaphylaxis is a severe allergic reaction that can lead to life-threatening consequences. Despite growing awareness of food allergies, schools in Saudi Arabia remain underprepared to manage allergic reactions. This study aimed to evaluate the preparedness of primary schools in Rabigh, [...] Read more.

Background and Aims: Anaphylaxis is a severe allergic reaction that can lead to life-threatening consequences. Despite growing awareness of food allergies, schools in Saudi Arabia remain underprepared to manage allergic reactions. This study aimed to evaluate the preparedness of primary schools in Rabigh, Saudi Arabia, in managing allergic reactions, with a focus on their policies and training practices to prevent food-related anaphylaxis. Methods: A cross-sectional survey was conducted involving all 24 primary schools in Rabigh. We used a previously published questionnaire that was translated into Arabic and contextually adapted; however, no formal psychometric validation was performed. The questionnaire assessed school preparedness to manage allergic reactions and existing protocols for allergy management. Data were analysed using IBM SPSS Statistics version 25 to examine associations between preparedness level and the presence of pupils with food allergy or anaphylaxis. Results: Nineteen schools (79%) completed the survey. Most schools (95%) had emergency communication systems, and 74% designated a staff member to manage allergic reactions. However, only 58% were aware of pupils with food allergies. Preventive measures such as food-handling guidance and a no-nut policy were present in most schools. Still, policies against food sharing and closer supervision of high-risk pupils were inconsistently implemented. A comparison between schools with and without pupils with allergies revealed that schools with such pupils were more likely to identify allergy risks and provide closer supervision during mealtimes (p = 0.042). Conclusions: While some primary schools in Rabigh reported strengths such as designated staff and emergency communication systems, substantial gaps were observed in preventive measures, including mealtime supervision and food-sharing policies. Preparedness varied across schools, with those without known allergic pupils less likely to implement preventive practices. These findings underscore the importance of standardised policies and regular staff training to ensure readiness for allergic emergencies in all schools. Full article

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