International Journal of Environmental Research and Public Health

44 pages, 837 KiB

Open AccessSystematic Review

Evaluating the Cost-Effectiveness of Air Pollution Mitigation Strategies: A Systematic Review

by Bo Vandenbulcke, Nick Verhaeghe, Lisa Cruycke, Max Lelie, Steven Simoens and Koen Putman

Int. J. Environ. Res. Public Health 2025, 22(6), 926; https://doi.org/10.3390/ijerph22060926 (registering DOI) - 11 Jun 2025

Abstract

Air pollution is the world’s greatest environmental health risk. Pollutants that pose large health concerns are particulate matter (PM_2.5 and PM₁₀), ozone (O₃), carbon monoxide (CO), nitrogen dioxide (NO₂), and sulphur dioxide (SO₂). These [...] Read more.

Air pollution is the world’s greatest environmental health risk. Pollutants that pose large health concerns are particulate matter (PM_2.5 and PM₁₀), ozone (O₃), carbon monoxide (CO), nitrogen dioxide (NO₂), and sulphur dioxide (SO₂). These compounds (especially PM_2.5 and PM₁₀) contribute to the onset of diseases, such as respiratory diseases (e.g., asthma, chronic obstructive pulmonary disease (COPD), or lung cancer) and cardiovascular diseases. Abatement interventions are implemented to reduce air pollution and thereby the risk of these diseases. This systematic review examined the published scientific evidence on the cost-effectiveness of strategies aimed at reducing or controlling air pollution and assessed the reporting quality of included studies. It employed rigorous data extraction and quality scoring procedures to ensure the reliability and validity of our findings. Overall, there is substantial evidence supporting the cost-effectiveness of interventions aimed at reducing air pollution. Seventy-four studies and four policy reports were included in this review. Predominantly, cost–benefit analyses have been reported (n = 40), reflecting the multisectoral impacts and associated costs of air pollution. Only four cost–utility analyses were found, indicating the need for more research within this domain. Additionally, eight articles reported one or more non-economic results. Thirty-nine studies focused on particulate matter (PM), and eleven focused on nitrogen oxides (NOx). The quality assessment yielded moderate results. The heterogeneity of studies and moderate quality of reporting make it difficult to compare results and draw definitive conclusions. Full article

14 pages, 290 KiB

Open AccessArticle

Adherence to Personalised Nutrition Education Based on Glycemic and Food Insulin Index Principles and Their Association with Blood Glucose Control in Individuals with Type 2 Diabetes Mellitus

by Hildegard Strydom, Jane Muchiri, Elizabeth Delport and Zelda White

Int. J. Environ. Res. Public Health 2025, 22(6), 925; https://doi.org/10.3390/ijerph22060925 (registering DOI) - 11 Jun 2025

Abstract

Personalised nutrition education (PNE) can enhance blood glucose control (BGC). We determined whether patients with type 2 diabetes (T2DM) adhered to PNE based on glycemic index (GI), glycemic load (GL), and food insulin index (FII) principles and whether adherence was associated with improved [...] Read more.

Personalised nutrition education (PNE) can enhance blood glucose control (BGC). We determined whether patients with type 2 diabetes (T2DM) adhered to PNE based on glycemic index (GI), glycemic load (GL), and food insulin index (FII) principles and whether adherence was associated with improved BGC. This retrospective cohort included 67 files for patients who received PNE. The patients completed 3-day food and blood glucose records at three points over 90 days. HbA1c values were compared between time points. An adherence score sheet (ASS) was used to determine their adherence to PNE and the main meal adherence classification (MMAC). A one-way repeated measures ANOVA was used to assess the changes over time. A chi-square test determined the association between the MMAC and blood glucose levels falling within the targeted ranges. Correlations between dietary adherence and BGC indicators were examined using Pearson’s product–moment correlation. Adherence ranged from 88 to 95%. MMAC score was significantly associated with blood glucose being within the targeted ranges (p = 0.028). Mean blood glucose decreased over time, but the correlations with adherence were only significant at time point 1 (p = 0.029). HbA1c levels decreased significantly over time (p = 0.003), but their correlation with adherence was not significant (p > 0.05). In patients with T2DM, high adherence to PNE based on GI, GL, and FII principles was associated with improved BGC. Full article

(This article belongs to the Special Issue Nutrition and Diabetes: Advances in Prevention and Management)

12 pages, 562 KiB

Open AccessArticle

Acute Physical Exercise Reduces Mental Stress-Induced Responses in Teachers

by Laura Cristina Nonato, Alexandre Konig Garcia Prado, Daniela Lopes dos Santos, Karen Dennise Lozada Tobar, Jaqueline Alves Araújo, Jacielle Carolina Ferreira and Lucieli Teresa Cambri

Int. J. Environ. Res. Public Health 2025, 22(6), 924; https://doi.org/10.3390/ijerph22060924 - 11 Jun 2025

Abstract

This study assessed the correlation between obesity markers and mental stress reactivity. Mainly, it evaluated whether physical exercise (PE) influences cardiovascular reactivity to the Stroop color word test (SCWT) in teachers. Thirty-one school teachers were evaluated. The SCWT was carried out under (1) [...] Read more.

This study assessed the correlation between obesity markers and mental stress reactivity. Mainly, it evaluated whether physical exercise (PE) influences cardiovascular reactivity to the Stroop color word test (SCWT) in teachers. Thirty-one school teachers were evaluated. The SCWT was carried out under (1) baseline and (2) 30 min after aerobic PE conditions. Teachers performed 30 min of PE. The reactivity to mental stress (Δ) during the SCWT for blood pressure (BP) was determined, with Δ being the highest value observed [Δ2 or Δ4: with pre-test values (0 min)]. Of the teachers, 64.52% were considered overweight/obese and 19.35% had a high clinical BP. However, 67.74% of teachers were considered physically active. Systolic BP (SBP) reactivity to SCWT correlated negatively with obesity markers (Rho = −0.36 to −0.60; p < 0.05). The SBP and diastolic BP (DBP) were higher at 2 and 4 min compared to 0 during the SCWT under both conditions (p < 0.01). Moreover, SBP was always lower after PE (p < 0.01) and DBP was lower at 2 and 4 min after PE (p < 0.01). In summary, SBP reactivity to mental stress correlated negatively with obesity markers. Moderate-intensity acute PE reduced BP reactivity to mental stress in teachers. Full article

(This article belongs to the Topic The Effect of Physical Activity on the Population's Health)

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15 pages, 255 KiB

Open AccessArticle

Work-Related Triggers of Mental Illness Relapse in South African Teachers

by Thembi Nkomo, Mokoko Percy Kekana and Mabitsela Hezekiel Mphasha

Int. J. Environ. Res. Public Health 2025, 22(6), 923; https://doi.org/10.3390/ijerph22060923 - 11 Jun 2025

Abstract

Teachers with mental illness are vulnerable to work-related triggers that can lead to relapse, affecting their mental health and ability to recover, stay employed, and deliver quality education. This empirical study explored such triggers among public school teachers in Limpopo Province, South Africa. [...] Read more.

Teachers with mental illness are vulnerable to work-related triggers that can lead to relapse, affecting their mental health and ability to recover, stay employed, and deliver quality education. This empirical study explored such triggers among public school teachers in Limpopo Province, South Africa. Using Bronfenbrenner’s Ecological Systems Theory, a qualitative phenomenological design was adopted. Semi-structured face-to-face interviews were conducted with 14 participants that were purposively selected across four hospitals. Data were audio-recorded, transcribed verbatim, and analyzed using Tesch’s eight-step open-coding method. Findings revealed being gossiped about by colleagues, excessive workload, limited leadership and parental support, classroom management challenges, high performance expectations without support, and inadequate teacher mental health policies in schools. These triggers can lead to frequent absenteeism and poor teaching outcomes. They will further increase the risk of medication resistance and long-term cognitive decline due to progressive structural brain damage as a result of multiple relapses. The study highlights the urgent need for multi-stakeholder collaboration, including clinicians, academic institutions, union representatives, and the Department of Basic Education, to co-develop effective, context-sensitive strategies to mitigate work-related triggers of mental illness relapse. These strategies are not only essential for enabling long-term workforce participation but also advancing sustainable mental health and well-being. Full article

(This article belongs to the Special Issue SDG 3 in Sub-Saharan Africa: Emerging Public Health Issues)

14 pages, 2801 KiB

Open AccessArticle

Impact of Environmental Microplastic Exposure on Caco-2 Cells: Unraveling Proliferation, Apoptosis, and Autophagy Activation

by Hana Najahi, Nicola Alessio, Massimo Venditti, Gea Oliveri Conti, Margherita Ferrante, Giovanni Di Bernardo, Umberto Galderisi, Sergio Minucci and Mohamed Banni

Int. J. Environ. Res. Public Health 2025, 22(6), 922; https://doi.org/10.3390/ijerph22060922 - 11 Jun 2025

Abstract

Microplastics (MPs) are pervasive environmental pollutants that have raised concerns due to their potential toxic impacts on human health. This study investigates the impact of polyethylene (PE) and polyethylene terephthalate (PET) microplastics on Caco-2 cells, a commonly used in vitro model for the [...] Read more.

Microplastics (MPs) are pervasive environmental pollutants that have raised concerns due to their potential toxic impacts on human health. This study investigates the impact of polyethylene (PE) and polyethylene terephthalate (PET) microplastics on Caco-2 cells, a commonly used in vitro model for the intestinal barrier. Caco-2 cells were exposed to MPs of different sizes (1 µm and 2.6 µm) for 72 h. The results demonstrated a significant decrease in cell viability, accompanied by increased reactive oxygen species (ROS) production, suggesting oxidative-stress-induced cytotoxicity. Flow cytometry and Western blot analyses revealed that the MPs induced apoptosis, as evidenced by an increased Bax/Bcl-2 ratio and caspase-3 activation. Additionally, MPs triggered autophagy, indicated by elevated LC3-II levels and decreased p62 expression. The use of bafilomycin A1 further confirmed the enhancement of autophagic flux. These findings highlight the potential cytotoxic effects of MPs on intestinal epithelial cells, raising concerns about their impact on human health. Full article

(This article belongs to the Section Environmental Health)

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16 pages, 476 KiB

Open AccessArticle

Reimagining Partnerships Between Black Communities and Academic Health Research Institutions: Towards Equitable Power in Engagement

by Khadijah Ameen, Collins O. Airhihenbuwa, Kimberley Freire, Monica Ponder and Alicia Hosein

Int. J. Environ. Res. Public Health 2025, 22(6), 921; https://doi.org/10.3390/ijerph22060921 - 10 Jun 2025

Abstract

Community-Engaged Research (CER) arose as a means of increasing the democratic participation of communities that study outcomes directly impact. CER has been identified as a recommended approach for conducting biomedical and behavioral health research with Black communities, a population that has been excluded [...] Read more.

Community-Engaged Research (CER) arose as a means of increasing the democratic participation of communities that study outcomes directly impact. CER has been identified as a recommended approach for conducting biomedical and behavioral health research with Black communities, a population that has been excluded from and exploited by academic health research for centuries. However, solely increasing community participation without identifying and redressing racialized power imbalances within community–academic partnerships involving Black populations can stall progress towards racial health equity. The purpose of this study was to explore how power can be redistributed equitably in community–academic health research partnerships involving Black populations. Utilizing the qualitative methodological approach of critical narrative inquiry, counter-stories from 12 Black individuals who have served as community partners on U.S.-based academic health research teams were collected via in-depth semi-structured narrative interviews. A reflexive thematic analysis approach was utilized to identify and analyze strategies expressed by study participants for increasing community agency, efficacy, and solidarity in health research. By centering the voices of Black community members who have directly engaged with academic health research institutions, this study sought to amplify the desires and aspirations of Black communities regarding shifting power in health research processes and outcomes. Full article

(This article belongs to the Special Issue Understanding and Addressing Factors Related to Health Inequalities)

18 pages, 564 KiB

Open AccessSystematic Review

A Systematic Review of Cardiovascular Health Among Cancer Survivors

by Miriam A. Miles, Oluseun Akinyele, Abigail A. Ninson, Nicole Caviness-Ashe, Cha’Breia Means, Le’Andrea Anderson-Tolbert, Tuchondriana Smith, Reagan Coleman, Laura Q. Rogers, Joshua J. Joseph, Laura C. Pinheiro and Timiya S. Nolan

Int. J. Environ. Res. Public Health 2025, 22(6), 920; https://doi.org/10.3390/ijerph22060920 - 10 Jun 2025

Abstract

Cardiovascular disease (CVD) is the most common non-cancer cause of death among cancer survivors. Lifestyle and clinical factors associated with cancer mortality are also associated with cardiovascular mortality. The American Heart Association (AHA) has termed these factors “cardiovascular health” (CVH), using Life’s Simple [...] Read more.

Cardiovascular disease (CVD) is the most common non-cancer cause of death among cancer survivors. Lifestyle and clinical factors associated with cancer mortality are also associated with cardiovascular mortality. The American Heart Association (AHA) has termed these factors “cardiovascular health” (CVH), using Life’s Simple 7 (LS7) or “Life’s Essential 8 (LE8)” to determine poor, intermediate, and high (ideal) CVH. Further, less than ideal CVH is associated with higher cancer mortality. Yet, CVH among cancer survivors remains understudied. This systematic review examined the extant literature, providing a comprehensive report of the findings addressing CVH among cancer survivors. Methods: Using PRISMA guidelines, we systematically examined CVH among cancer survivors (including patients) within PubMed, Scopus, CINAHL, and Embase databases without date limitations from June 2024 to December 2024 using the following keywords: “cancer survivors”, “cancer patient”, “cardiovascular health”, and “cardiovascular risk factors”. Two reviewers independently accessed articles in concordance with LS7 and LE8 metrics. The included studies were examined and assessed for risk of bias and synthesized to elucidate themes of CVH among cancer survivors. Results: We retrieved 2935 studies examining breast, gynecological, endometrial, prostate, colon, lung, lymphoma, and skin cancer survivors published from 2002–2024. Overall, 10 studies met criteria utilizing LS7 or LE8 CVH health outcomes (4 LS7, 5 LE8, and 1 LS7/LE8), ages 40–70 years, with a population (n = 35,980) consisting of mostly female, non-Black individuals; mean survivorship was 7.2 years. Four themes emerged: CVH outcomes among cancer survivors, social factors impacting CVH outcomes, associations of CVH, and other health outcomes opportunities for CVH awareness. Conclusions: We found that cancer survivors frequently report less than ideal CVH outcomes and would benefit from education/empowerment to support lifestyle changes that improve CVH. Full article

(This article belongs to the Special Issue Breast Health and Cancer Awareness: Addressing Breast Cancer Disparities from Etiology to Survivorship)

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10 pages, 500 KiB

Open AccessBrief Report

Science Speed Dating to Spur Inter-Institutional Collaborative Research

by Sandra P. Chang, Kathryn L. Braun, Richard Yanagihara, Hendrik De Heer, Yan Yan Wu, Zhenbang Chen, Marc B. Cox, Stacey L. Gorniak, Georges Haddad, Christine F. Hohmann, Eun-Sook Lee, Jonathan K. Stiles, Nicolette I. Teufel-Shone and Vivek R. Nerurkar

Int. J. Environ. Res. Public Health 2025, 22(6), 919; https://doi.org/10.3390/ijerph22060919 - 10 Jun 2025

Abstract

A principal strategic goal of the RCMI Coordinating Center (RCMI-CC) is to improve the health of minority populations and to reduce ethnic and geographic disparities in health by coordinating the development and facilitating the implementation of clinical research across the RCMI Consortium. To [...] Read more.

A principal strategic goal of the RCMI Coordinating Center (RCMI-CC) is to improve the health of minority populations and to reduce ethnic and geographic disparities in health by coordinating the development and facilitating the implementation of clinical research across the RCMI Consortium. To more effectively spur inter-institutional collaborative research, the RCMI-CC supports a Clinical Research Pilot Projects Program for hypothesis-driven clinical research projects proposed by postdoctoral fellows, early-career faculty and/or early-stage investigators from two or more RCMI U54 Centers. The purpose of this brief report is to summarize the Science Speed Dating sessions at the RCMI Investigator Development Core (IDC) Workshop, held in conjunction with the 2024 RCMI Consortium National Conference. RCMI investigators and IDC Directors from 20 RCMI U54 Centers participated in two rounds of highly interactive small-group presentations of research ideas and resource needs in search of new collaborative and mentoring partnerships. Workshop participants expressed a high level of satisfaction with the speed-networking format and strongly agreed that the workshop was beneficial to their professional-development goals. 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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16 pages, 298 KiB

Open AccessArticle

Prevalence and Predictors of Posting Health-Related Content Among US Facebook Users: A Cross-Sectional Survey Study

by Richard Bannor, Ran Xu, Jolaade Kalinowski, Tricia Leahey, Caitlin Caspi, Christie I. Idiong, Jared Goetz and Sherry Pagoto

Int. J. Environ. Res. Public Health 2025, 22(6), 918; https://doi.org/10.3390/ijerph22060918 - 10 Jun 2025

Abstract

Health-related content is prevalent on Facebook, but we know little about how often the typical user posts about health, the nature of such posts, or the characteristics of users who do so. We conducted a cross-sectional survey of 2508 adult US Facebook users [...] Read more.

Health-related content is prevalent on Facebook, but we know little about how often the typical user posts about health, the nature of such posts, or the characteristics of users who do so. We conducted a cross-sectional survey of 2508 adult US Facebook users to assess the frequency and predictors of posting about a health condition, health behavior, and health information on Facebook. The findings revealed that 68.7% of participants posted at least one type of health-related content on Facebook in the past year, and 41.6% posted all three types of health-related content. Approximately 47% posted about a health condition, 56.7% posted about health behavior, and 62.7% posted health information in the past year. Male gender, advanced education, greater Facebook engagement, having a greater number of Facebook friends, and having a chronic disease were associated with more frequent posting of all types of health-related posts (all p-values ≤ 0.05). Older age and longer duration on Facebook were associated with less frequent posting of all types of health-related posts (all p-values ≤ 0.05). Future research should explore the reasons users post health-related content on Facebook and how they evaluate the veracity of the health-related content they see and post on Facebook. Full article

(This article belongs to the Special Issue Evolving Role of Social Media in Health Communication)

45 pages, 1614 KiB

Open AccessReview

Epigenetic Consequences of In Utero PFAS Exposure: Implications for Development and Long-Term Health

by Abubakar Abdulkadir, Shila Kandel, Niya Lewis, Oswald D’Auvergne, Raphyel Rosby and Ekhtear Hossain

Int. J. Environ. Res. Public Health 2025, 22(6), 917; https://doi.org/10.3390/ijerph22060917 - 10 Jun 2025

Abstract

In utero exposure to per- and polyfluoroalkyl substances (PFAS) presents significant health concerns, primarily through their role in inducing epigenetic modifications that have lasting consequences. This review aims to elucidate the impact of prenatal PFAS exposure on epigenetic mechanisms, including DNA methylation, histone [...] Read more.

In utero exposure to per- and polyfluoroalkyl substances (PFAS) presents significant health concerns, primarily through their role in inducing epigenetic modifications that have lasting consequences. This review aims to elucidate the impact of prenatal PFAS exposure on epigenetic mechanisms, including DNA methylation, histone modification, and non-coding RNA regulation, focusing on developmental and long-term health outcomes. The review synthesizes findings from various studies that link PFAS exposure to alterations in DNA methylation in fetal tissues, such as changes in the methylation of genes like IGF2 and MEST, which are linked to disruptions in growth, neurodevelopment, immune function, and metabolic regulation, potentially increasing the risk of diseases such as diabetes and obesity. We also highlight the compound-specific effects of different PFAS, such as PFOS and PFOA, each showing unique impacts on epigenetic profiles, suggesting varied health risks. Special attention is given to hormonal disruption, oxidative stress, and changes in histone-modifying enzymes such as histone acetyltransferases (HATs) and deacetylases (HDACs), which are pathways through which PFAS influence fetal development. Additionally, we discuss PFAS-induced epigenetic changes in placental tissues, which can alter fetal nutrient supply and hormone regulation. Despite accumulating evidence, significant knowledge gaps remain, particularly regarding the persistence of these changes across the lifespan and potential sex-specific susceptibilities. We explore how advancements in epigenome-wide association studies could bridge these gaps, providing a robust framework for linking prenatal environmental exposures to lifetime health outcomes. Future research directions and regulatory strategies are also discussed, emphasizing the need for intervention to protect vulnerable populations from these environmental pollutants. Full article

(This article belongs to the Special Issue Environmental Exposures and Epigenomics in Health and Disease)

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17 pages, 681 KiB

Open AccessArticle

Maternal Stress and Child Development: The Moderating Role of Interactive Shared Reading

by Chrystian R. Kroeff, Juliana R. Bernardi, Clécio H. Da Silva, Nádia C. Valentini, Marcelo Z. Goldani and Denise R. Bandeira

Int. J. Environ. Res. Public Health 2025, 22(6), 916; https://doi.org/10.3390/ijerph22060916 - 10 Jun 2025

Abstract

Research suggests that maternal stress is related to aspects of child development. Positive and stimulating interactions, such as shared reading, may act as protective factors, mitigating the negative effects of maternal stress on children’s development and behavior. This cohort study investigated the predictive [...] Read more.

Research suggests that maternal stress is related to aspects of child development. Positive and stimulating interactions, such as shared reading, may act as protective factors, mitigating the negative effects of maternal stress on children’s development and behavior. This cohort study investigated the predictive relationship between maternal stress and children’s milestones and behavioral problems, with maternal interactive style during shared reading as a moderator. A total of 91 mother–child dyads participated. During the shared reading session, conducted in a private room at a research center, each mother and child interacted freely while reading a book, without specific instructions. The sessions were video-recorded and later analyzed by trained researchers using an established method. Children’s data were assessed using questionnaires completed by the mother on the same day. Descriptive, bivariate, and multivariate analyses were performed to build regression models with moderation analysis. Results revealed that maternal stress significantly predicted children’s internalizing and externalizing symptoms. Notably, more affectionate interactions during shared reading can moderate the effect of stress on children’s externalizing difficulties. These findings suggest that fostering positive and engaging interactions between mothers and children, such as shared reading, may have a beneficial impact on children’s behavioral development, even in the presence of maternal stress. Full article

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15 pages, 266 KiB

Open AccessArticle

When Corona Infested Everything—A Qualitative Interview Study Exploring the Impact of COVID-19 Mitigation Measures on School Life from the Perspectives of English Secondary School Staff and Students

by Sarah Bell, Jane Williams, Jeremy Horwood and Sabi Redwood

Int. J. Environ. Res. Public Health 2025, 22(6), 915; https://doi.org/10.3390/ijerph22060915 - 10 Jun 2025

Abstract

To reduce the risk of COVID-19 infection, transmission and illness during the pandemic, the Department for Education (DfE) issued guidance to schools. However, research on how the school community perceives the impact of the COVID-19 mitigation measures outlined remains limited. This qualitative study [...] Read more.

To reduce the risk of COVID-19 infection, transmission and illness during the pandemic, the Department for Education (DfE) issued guidance to schools. However, research on how the school community perceives the impact of the COVID-19 mitigation measures outlined remains limited. This qualitative study aims to explore the effects of school closures and in-school mitigation measures on daily school life, as well as their impact on mental health and wellbeing from the perspective of English secondary school staff and students. Participants were purposively sampled from English secondary schools serving diverse communities participating in the COVID-19 Mapping and Mitigation in Schools study (CoMMinS). Selection ensured representation of staff roles and student demographics. Semi-structured interviews were conducted remotely, and data analysed thematically. Interviews took place between January and August 2021 with participants from five secondary schools (20 staff and 25 students). Both staff and students reported significant disruption to school life, with four themes identified: (1) teaching and learning impact, (2) social impact, (3) safeguarding impact, and (4) and mental health and wellbeing impact. Findings highlight widespread negative effects across every aspect of school life, for both staff and students. This study suggests that COVID-19 mitigation measures in UK secondary schools led to a sense of loss and uncertainty as well as increased self-reported stress among both staff and students. Full article

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

12 pages, 1225 KiB

Open AccessArticle

Characterization of Tiered Psychological Distress Phenotypes in an Orthopaedic Sports Population

by Billy I. Kim, Nicholas J. Morriss, Taylor P. Stauffer, Julia E. Ralph, Caroline N. Park, Trevor A. Lentz and Brian C. Lau

Int. J. Environ. Res. Public Health 2025, 22(6), 914; https://doi.org/10.3390/ijerph22060914 - 9 Jun 2025

Abstract

Psychological distress and musculoskeletal pain are interconnected with poor functional outcomes. This study sought to classify common phenotypes of psychological distress in an orthopaedic sports population and assess differences in functional outcomes using the Prediction of Referral and Outcome (OSPRO-YF) tool. This was [...] Read more.

Psychological distress and musculoskeletal pain are interconnected with poor functional outcomes. This study sought to classify common phenotypes of psychological distress in an orthopaedic sports population and assess differences in functional outcomes using the Prediction of Referral and Outcome (OSPRO-YF) tool. This was a cross-sectional study on 411 operative patients from a single sports surgeon’s clinical practice with completed OSPRO-YF questionnaires. Latent class analysis was employed to construct distress phenotypes based on binary measures for 11 single-construct psychological questionnaires, spanning two negative and one positive domains of pain-associated psychological distress. Functional outcome measures, including numerical pain scores, the Patient-Reported Outcomes Measurement Information System (PROMIS), the Single Assessment Numeric Evaluation (SANE) American Shoulder and Elbow Surgeons Score (ASES), and the International Knee Documentation Committee Subjective Knee Form (IKDC), were compared. Four psychological distress clusters were derived: low distress (LD-1; n = 111), low self-efficacy (LS-2; n = 101), negative pain coping, low self-efficacy (NP-3; n = 99), and high distress (HD-4; n = 100), with increasing yellow flags proceeding from LD-1 to HD-4. The mean numerical pain scores were highest in HD-4 and lowest in LD-1 and LS-2 (4.6 vs. 2.7 and 2.0, respectively; p < 0.001). The PROMIS depression scores were highest in HD-4 compared to NP-3, LS-2, and LD-1 (57.0 vs. 48.9 vs. 45.6 vs. 46.0; p < 0.001). Phenotyping patients based on OSPRO-YF distress indicators provides an initial framework of the psychological distress burdening the average orthopaedic sports surgical patient population and may aid in targeted psychological treatments. Full article

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8 pages, 451 KiB

Open AccessArticle

Exploring the Impact of the COVID-19 Pandemic on Student Mental Health: A Repeated Cross-Sectional Study

by Joanne Worsley, Jason McIntyre and Rhiannon Corcoran

Int. J. Environ. Res. Public Health 2025, 22(6), 913; https://doi.org/10.3390/ijerph22060913 - 8 Jun 2025

Abstract

Background: Although mental health among students has become a pressing public concern over recent years, the COVID-19 pandemic introduced new stressors, which may further increase the mental health burden for them. While past work has investigated links between pandemic related factors and [...] Read more.

Background: Although mental health among students has become a pressing public concern over recent years, the COVID-19 pandemic introduced new stressors, which may further increase the mental health burden for them. While past work has investigated links between pandemic related factors and student mental health and wellbeing, there is conflicting evidence around some symptoms (e.g., anxiety) and little work has focused on less common mental health conditions (e.g., eating disorders). Aims: The current study aimed to detail the prevalence of mental distress in the student population at an early stage of the COVID-19 pandemic and compare university students’ mental health before and during the COVID-19 pandemic. Specifically, we aimed to compare levels of depression, anxiety, and eating disorders in a large sample of students. Methods: We analysed data from a repeated cross-sectional survey on different samples of UK university students before the pandemic (n = 4812) and during the pandemic (n = 3817). Results: There were high levels of depression and anxiety during the COVID-19 pandemic, with more than 50% experiencing levels above the clinical cut-offs. Findings revealed a significant increase in symptoms of depression and anxiety from pre- to mid-pandemic as well as a significant increase in the prevalence of eating disorders. Conclusions: By late 2020, mental health in the student population had deteriorated compared to pre-pandemic levels. These findings provide evidence for increased levels of depression, anxiety, and eating disorders related to the COVID-19 pandemic. There is a need for better preparedness for future crises in order to mitigate the impact on student mental health. Full article

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

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20 pages, 817 KiB

Open AccessArticle

Prevalence and Contributing Factors of Occupational Injuries Among Nurses in Oshakati District, Namibia

by Maliwa Lichaha Sanjobo, Mpinane Flory Senekane and Kgomotso Lebelo

Int. J. Environ. Res. Public Health 2025, 22(6), 912; https://doi.org/10.3390/ijerph22060912 - 8 Jun 2025

Abstract

Occupational injuries among nurses impact their well-being and health service delivery. This study aimed to determine the prevalence of occupational injuries and their contributing factors among nurses in selected public health facilities. A descriptive cross-sectional study was conducted among 295 randomly selected nurses. [...] Read more.

Occupational injuries among nurses impact their well-being and health service delivery. This study aimed to determine the prevalence of occupational injuries and their contributing factors among nurses in selected public health facilities. A descriptive cross-sectional study was conducted among 295 randomly selected nurses. Primary data were collected using self-administered questionnaires, while secondary data were abstracted from the occupational injuries register. Data were analysed using statistical software. The 12-month prevalence of occupational injuries was 28.8% (95% confidence interval [CI] = 24.3–33.3%), with needlestick injuries being the most common (63.5%). Significant associations were observed between occupational injuries and education level (p = 0.027), employment status (p = 0.012), and years of experience (p = 0.029). Nurses with a bachelor’s degree had 3.30 times higher odds of injury (Adjusted OR [AOR] = 3.30, 95% CI = 1.11–9.81, p = 0.03), while the lack of proper training increased the odds by 3.27 times (AOR = 3.27, 95% CI = 1.62–6.61, p < 0.001). Being a registered nurse reduced the odds by 70% (AOR = 0.30, 95% CI = 0.12–0.74, p = 0.01). Addressing these factors is essential for reducing occupational injuries and improving healthcare outcomes. Full article

(This article belongs to the Section Health Care Sciences)

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13 pages, 327 KiB

Open AccessReview

Family Support Experiences of Adult Persons with Intellectual Disability and Challenging Behaviour: A Scoping Review of Qualitative Studies

by Alice Nga Lai Kwong, Lisa Pau Le Low and Maggie Yat Cheung Wong

Int. J. Environ. Res. Public Health 2025, 22(6), 911; https://doi.org/10.3390/ijerph22060911 - 7 Jun 2025

Abstract

There has been scant research on the experiences of families caring for adults with intellectual disability who use challenging behaviour as a way of making their needs known. The aim of this scoping review was to synthesize the qualitative research data on the [...] Read more.

There has been scant research on the experiences of families caring for adults with intellectual disability who use challenging behaviour as a way of making their needs known. The aim of this scoping review was to synthesize the qualitative research data on the family support experiences of adult family members with intellectual disability who use challenging behaviour in this way. A systematic search was undertaken from five databases during December 2024 and updated in April 2025. A total of 20 studies were included in the review. Data were analysed using a thematic analysis method. The number of study participants in these studies ranged from 4 to 30. Most of them were parents and predominantly mothers. The results show that caring for adults with intellectual disability and challenging behaviour reflects a dual reality. The negative experiences refer to caregiving difficulties and inadequate formal support, while the positive experiences are associated with support from informal sources and caregivers’ fulfilment and gains. The available research did not offer sufficient data for a synthesis of how families might be affected by challenging behaviour. Future research should investigate how the negative and positive aspects of their families can be shaped to make a positive impact on caring for people with intellectual disability and co-existing challenging behaviour. Full article

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18 pages, 2448 KiB

Open AccessSystematic Review

The Effect of Type 2 Diabetes on Bone Quality: A Systematic Review and Meta-Analysis of Cohort Studies

by Omorogieva Ojo, Yemi Onilude, Joanne Brooke, Victoria Apau, Ivy Kazangarare and Osarhumwese Ojo

Int. J. Environ. Res. Public Health 2025, 22(6), 910; https://doi.org/10.3390/ijerph22060910 - 6 Jun 2025

Abstract

Background: There is a significant knowledge gap and limited studies have been carried out to evaluate the effect of type 2 diabetes (T2D) on bone quality and skeletal fragility. Previous reviews have tended to focus primarily on bone mineral density (BMD) as a [...] Read more.

Background: There is a significant knowledge gap and limited studies have been carried out to evaluate the effect of type 2 diabetes (T2D) on bone quality and skeletal fragility. Previous reviews have tended to focus primarily on bone mineral density (BMD) as a measure of bone quality. However, BMD does not fully reflect the risk of fracture, cannot distinguish between cortical and trabecular bone, and bone fragility in patients with T2D results not only from alterations in bone mineralisation, but also due to changes in bone microarchitecture. In this regard, assessment tools such as trabecular bone score (TBS) and trabecular microarchitectural parameters could be useful and practical tools for examining bone status in people with T2D. Aim: This review aims to examine the effect of type 2 diabetes on bone quality based on a variety of assessment tools. Method: The PRISMA checklist and PICOS framework were relied on for this systematic review and meta-analysis. Two researchers conducted the searches from database inception until 24/02/25. Databases including Academic Search Premier, APA PsycArticles, APA PsycInfo, CINAHL Plus with Full Text, MEDLINE, and the Psychology & Behavioral Sciences Collection were searched for relevant articles. The reference lists of articles were also searched. The Review Manager 5.4.1 software was used to carry out the meta-analysis. Results: Ten studies were included in the systematic review, while nine studies were included in the meta-analysis. Based on the narrative synthesis and meta-analysis, four distinct themes were established: bone mineral density, TBS and trabecular microarchitectural parameters, fracture risk, and body mass index (BMI). The meta-analysis of the effect of T2D on BMD showed that T2D significantly (p < 0.05) increased lumbar spine, total hip, femoral neck, and narrow neck BMD compared with controls. The mean differences (MDs) for the respective parameters were 0.04 (95% CI, 0.03, 0.05, p < 0.0001); 0.05 (95% CI, 0.02, 0.08, p = 0.002); 0.07 (95% CI, 0.04, 0.10, p < 0.0001); and 0.03 (95% CI, 0.01, 0.05, p = 0.0005). While there was a significant reduction (p < 0.0001) in the patients with T2D with respect to volumetric BMD, involving two studies and 1037 participants, with an MD of −12.36 (95% CI,−18.15, −6.57, p < 0.0001), T2D did not appear to have a significant effect (p > 0.05) on total BMD and area BMD compared to controls. In relation to TBS and trabecular microarchitectural parameters, the effect of T2D was not significant (p > 0.05) compared with controls. Furthermore, T2D did not have a significant effect (p > 0.05) on the incidence of hip fracture and non-spine fracture compared to controls. Following meta-analysis, it was found that the T2D significantly (p < 0.05) increased BMI compared to controls with an MD of 0.94 (95% CI, 0.74, 1.14, p < 0.0001). Conclusions: Type 2 diabetes significantly increased (p < 0.05) lumbar spine, total hip, femoral neck, narrow neck BMD, and body mass index compared with controls. However, type 2 diabetes did not appear to have a significant effect (p > 0.05) on TBS, trabecular microarchitectural parameters, and the incidence of hip and non-spine fracture. Full article

(This article belongs to the Collection Health Care and Diabetes)

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32 pages, 1082 KiB

Open AccessReview

Urban Microclimates and Their Relationship with Social Isolation: A Review

by David B. Olawade, Melissa McLaughlin, Yinka Julianah Adeniji, Gabriel Osasumwen Egbon, Arghavan Rahimi and Stergios Boussios

Int. J. Environ. Res. Public Health 2025, 22(6), 909; https://doi.org/10.3390/ijerph22060909 - 6 Jun 2025

Abstract

Urban microclimates, which include phenomena such as urban heat islands (UHIs) as well as cooler environments created by shaded areas and green spaces, significantly affect social behavior and contribute to varying levels of social isolation in cities. UHIs, driven by heat-absorbing materials like [...] Read more.

Urban microclimates, which include phenomena such as urban heat islands (UHIs) as well as cooler environments created by shaded areas and green spaces, significantly affect social behavior and contribute to varying levels of social isolation in cities. UHIs, driven by heat-absorbing materials like concrete and asphalt, can increase urban temperatures by up to 12 °C, discouraging outdoor activities, especially among vulnerable populations like the elderly and those with chronic health conditions. In contrast, shaded areas and green spaces, where temperatures can be 2–5 °C cooler, encourage outdoor engagement and foster social interaction. This narrative review aims to synthesize current literature on the relationship between urban microclimates and social isolation, focusing on how UHIs and shaded areas influence social engagement. A comprehensive literature review was conducted, selecting sources based on their relevance to the effects of localized climate variations on social behavior, access to green spaces, and the impact of urban design interventions. A total of 142 articles were initially identified, with 103 included in the final review after applying inclusion/exclusion criteria. Key studies from diverse geographical and cultural contexts were analyzed to understand the interplay between environmental conditions and social cohesion. The review found that UHIs exacerbate social isolation by reducing outdoor activities, particularly for vulnerable groups such as the elderly and individuals with chronic health issues. In contrast, shaded areas and green spaces significantly mitigate isolation, with evidence showing that in specific study locations such as urban parks in Copenhagen and Melbourne, such areas increase outdoor social interactions by up to 25%, reduce stress, and enhance community cohesion. Urban planners and policymakers should prioritize integrating shaded areas and green spaces in city designs to mitigate the negative effects of UHIs. These interventions are critical for promoting social resilience, reducing isolation, and fostering connected, climate-adaptive communities. Future research should focus on longitudinal studies and the application of smart technologies such as IoT sensors and urban monitoring systems to track the social benefits of microclimate interventions. Full article

(This article belongs to the Special Issue The Interaction among Environmental, Climatic, and Socioeconomic Aspects and Their Effects on Society)

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22 pages, 559 KiB

Open AccessArticle

The Longitudinal Relationship Between Physical Functions and Cognitive Functions Among Middle-Aged and Older Adults in Primary Care

by Nan Hu, Wupeng Yin, Rabeya Illyas Noon and Noof Alabdullatif

Int. J. Environ. Res. Public Health 2025, 22(6), 908; https://doi.org/10.3390/ijerph22060908 - 6 Jun 2025

Abstract

(1) Background: Gait speed (GS) and handgrip strength (HGS) have been identified as factors in cognitive impairment, depression, sleep problems, and quality of life. This study aims to comprehensively investigate the longitudinal relationship between physical functions (gait speed and handgrip strength) and cognitive [...] Read more.

(1) Background: Gait speed (GS) and handgrip strength (HGS) have been identified as factors in cognitive impairment, depression, sleep problems, and quality of life. This study aims to comprehensively investigate the longitudinal relationship between physical functions (gait speed and handgrip strength) and cognitive functions, as well as cognitive decline, in middle-aged and older adults in China. (2) Methods: Using longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS), we analyzed 1903 subjects aged 60 and above with repeated measurements of GS, and 4218 subjects aged 45 and above with repeated measurements of HGS. The cognitive functions we considered included drawing ability, word recall, TICS-10, and an overall cognitive score (OCS). Mixed-effect logistic and linear regression were used to analyze the association between GS/HGS and cognitive functions in middle-aged and older adults with repeated measurements. (3) Results: A faster GS is associated with better drawing ability (OR = 1.33, p = 0.045) and TICS-10 (OR = 1.60, p = 0.024). A stronger HGS is associated with higher odds of drawing ability (OR = 1.36, p = 0.012) and better TICS-10 (OR = 1.41, p = 0.018). Both weak HGS and slow GS are significantly associated with a higher decline in cognitive function, while HGS is more predictive of the decline for women and GS is more predictive for men. (4) Conclusions: Both GS and HG are positively associated with cognitive functions cross-sectionally and longitudinally in middle-aged and older adults. Health interventions targeting HGS and GS may help improve cognitive functions. Future research is warranted to establish the causal relationship between these interventions and improvements in cognitive functions. Full article

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

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International Journal of Environmental Research and Public Health

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