International Journal of Environmental Research and Public Health

14 pages, 897 KiB

Open AccessArticle

The Role of Testing and Vaccination in Mediating Social Vulnerability and COVID-19 Prevalence in Southern Nevada

by Andrea Lopez, Lung-Chang Chien, L.-W. Antony Chen, Courtney Coughenour, Erika Marquez and Szu-Ping Lee

Int. J. Environ. Res. Public Health 2025, 22(7), 980; https://doi.org/10.3390/ijerph22070980 (registering DOI) - 21 Jun 2025

Abstract

The COVID-19 pandemic is a catastrophic event highlighting numerous health disparities. The social vulnerability index (SVI) has been widely utilized in COVID-19 research to assess vulnerable communities and to examine how social determinants influence various COVID-19 outcomes. This population-based study aims to determine [...] Read more.

The COVID-19 pandemic is a catastrophic event highlighting numerous health disparities. The social vulnerability index (SVI) has been widely utilized in COVID-19 research to assess vulnerable communities and to examine how social determinants influence various COVID-19 outcomes. This population-based study aims to determine whether COVID-19 testing and vaccination rates mediate the relationship between the SVI and COVID-19 prevalence. Mediation analysis was conducted using data from 535 census tracts in Clark County, Nevada. Findings indicate that COVID-19 testing rates were lower in areas with high SVI scores, potentially leading to more undetected cases. Moreover, COVID-19 testing, full vaccination, and follow-up vaccination rates significantly mediated the relationship between SVI and COVID-19 prevalence. These results suggest that greater location-based social vulnerability is associated with a sequential pathway of reduced testing and vaccination rates, contributing to underreported COVID-19 cases. Full article

(This article belongs to the Collection COVID-19 Research)

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18 pages, 852 KiB

Open AccessArticle

Locating Meaning: Health Professionals’ Views on the Psychological and Clinical Significance of Self-Injury Sites

by Kathryn Jane Gardner, Rachel Smith, Gillian Rayner, Gary Lamph, Lucie Moores, Robyn Crossan, Laura Bisland, Nicky Danino and Peter Taylor

Int. J. Environ. Res. Public Health 2025, 22(7), 979; https://doi.org/10.3390/ijerph22070979 (registering DOI) - 21 Jun 2025

Abstract

Background: This study explored how health professionals construct clinical and psychological meaning based on the location of self-injury on the body, particularly in relation to concealed or visible injuries and how they might inform attributions about risk, self-injury functions, and distress. Methods: This [...] Read more.

Background: This study explored how health professionals construct clinical and psychological meaning based on the location of self-injury on the body, particularly in relation to concealed or visible injuries and how they might inform attributions about risk, self-injury functions, and distress. Methods: This study used qualitative thematic analysis of semi-structured interviews with 19 health professionals with experience working with self-injury, exploring perceptions and attributions about self-injury in different body locations. Results: Seven themes emerged. In some cases, staff’s attributions aligned with the findings from studies of those who self-injure, such as injuries to areas such as the neck are higher risk. Location was one factor among others, such as injury severity, that staff considered when assessing the risk of infection or suicide. Staff often viewed visible injuries as less risky and attributed them to interpersonal communicative functions, and concealed injuries to intrapersonal factors, though not all staff shared these perspectives. Some staff considered other potential drivers of injury location, including past experiences such as trauma, demographic factors, mental health diagnoses, and exposure to social influences. Some staff described the practical determinants of injury location, such as ease of access, and considered the impact of self-injury location on themselves and their colleagues. Conclusions: Injury location can influence staff perceptions of risk, self-injury functions and distress, underscoring the need for individualized assessment and formulation of each self-injury episode to ensure appropriate risk management. Staff training should be adapted to address injury location to improve understanding, raise awareness of related attributions, and enhance the development of clinical skills. Organizations should support staff in their role due to the potential emotional impact of working with individuals who self-injure and are at risk of suicide. Future research should investigate whether location-based attributions are associated with unintended clinical consequences, such as inaccuracies in risk assessment and formulation. Full article

(This article belongs to the Special Issue Research on Suicide Assessment, Prevention and Management)

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11 pages, 252 KiB

Open AccessArticle

Hypertensive Disorders of Pregnancy Deaths: A Four-Year Review at a Tertiary/Quaternary Academic Hospital

by Zeenat L. Khan, Gaynor M. Balie and Lawrence Chauke

Int. J. Environ. Res. Public Health 2025, 22(7), 978; https://doi.org/10.3390/ijerph22070978 - 20 Jun 2025

Abstract

Background: Hypertensive disorders of pregnancy (HDPs) are a major cause of maternal morbidity and mortality worldwide. Very little progress has been made in reducing HDP-related maternal deaths in low- and middle-income countries (LMICs), including South Africa, over the past decade. Aim: The aim [...] Read more.

Background: Hypertensive disorders of pregnancy (HDPs) are a major cause of maternal morbidity and mortality worldwide. Very little progress has been made in reducing HDP-related maternal deaths in low- and middle-income countries (LMICs), including South Africa, over the past decade. Aim: The aim of this study was to describe maternal deaths arising from HDPs at tertiary/quaternary hospital in Johannesburg, South Africa, with specific focus on maternal characteristics, management, timing of death, causes, and avoidable factors and to use the information to inform clinical practice. Methods: We conducted a retrospective review of patient clinical records covering the period 1 January 2015 to 31 December 2018. Data on maternal demographic and pregnancy characteristics, management, causes, and timing of death were extracted from the clinical records and transferred into a Microsoft Excel^® Spreadsheet and analysed using descriptive statistics. Results: During the study period, 70 maternal deaths were recorded, of which 23 (32.8%) were due to HDP-related complications. The majority of the maternal deaths, 20 (86.9%), occurred during the postpartum period, predominantly affecting Black African women, 23 (100%), with a median age of 27 years. Notably, 18 (78.2%) of the deceased had booked early and attended antenatal care (ANC). Eclampsia emerged as the most common final cause of death. Key avoidable factors included non-adherence to established protocols, particularly failure to initiate aspirin prophylaxis in at-risk women, as well as incorrect or inadequate administration of antihypertensive therapy and magnesium sulphate (MgSO₄) prophylaxis. Conclusions: HDP-related maternal deaths are largely preventable. They primarily result from poor quality of care due to a lack of adherence to evidence-based protocol. Full article

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

18 pages, 832 KiB

Open AccessReview

Mental Health Outcomes Among Travestis and Transgender Women in Brazil: A Literature Review and a Call to Action for Public Health Policies

by David R. A. Coelho, Ana Luiza N. Ferreira, Willians Fernando Vieira, Alex S. Keuroghlian and Sari L. Reisner

Int. J. Environ. Res. Public Health 2025, 22(7), 977; https://doi.org/10.3390/ijerph22070977 - 20 Jun 2025

Abstract

Travestis and transgender women in Brazil face a disproportionate burden of mental health conditions, exacerbated by structural discrimination, violence, and social exclusion. This narrative review synthesizes evidence on the prevalence of depression, anxiety, suicidality, and substance use among travestis and transgender women in [...] Read more.

Travestis and transgender women in Brazil face a disproportionate burden of mental health conditions, exacerbated by structural discrimination, violence, and social exclusion. This narrative review synthesizes evidence on the prevalence of depression, anxiety, suicidality, and substance use among travestis and transgender women in Brazil, and examines intersecting social and health disparities. We searched PubMed, Embase, and PsycINFO in April 2025, identifying peer-reviewed studies in English or Portuguese reporting mental health outcomes or associated social determinants of health in this population. Thirty-one studies across twelve different cities (n = 7683) were included and grouped into two thematic domains. Reported prevalence ranged from 16–70.1% for depression, 24.8–26.5% for anxiety, and 25–47.3% for suicidality. Substance use was also highly prevalent, with studies reporting high rates of alcohol (21.5–72.7%), tobacco (56.6–61.6%), cannabis (19–68.9%), and cocaine/crack (6–59.8%) use. Discrimination, violence, economic hardship, and HIV were consistently associated with psychological distress and barriers to care. These findings underscore the urgent need to integrate mental health, gender-affirming care, and HIV services into Brazil’s Unified Health System (Sistema Único de Saúde–SUS), strengthen anti-discrimination and violence-prevention policies, and adopt inclusive public health strategies that prioritize the leadership and lived experiences of transgender, nonbinary, and gender diverse people, particularly amid rising political threats to gender-affirming care. Full article

(This article belongs to the Special Issue Mental Health Challenges Affecting LGBTQ+ Individuals and Communities)

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23 pages, 3173 KiB

Open AccessArticle

Emerging Contaminants in Source and Finished Drinking Waters Across Minnesota (U.S.) and Potential Health Implications

by Sarah M. Elliott, Aliesha L. Krall, Jane R. de Lambert, Maya D. Gilchrist and Stephen W. Robertson

Int. J. Environ. Res. Public Health 2025, 22(7), 976; https://doi.org/10.3390/ijerph22070976 - 20 Jun 2025

Abstract

Relatively little data exist regarding the presence of unregulated contaminants in drinking waters. We sampled source and finished drinking water from 98 community water supply systems throughout Minnesota (U.S.). Facilities were grouped into four networks based on water source and influences from anthropogenic [...] Read more.

Relatively little data exist regarding the presence of unregulated contaminants in drinking waters. We sampled source and finished drinking water from 98 community water supply systems throughout Minnesota (U.S.). Facilities were grouped into four networks based on water source and influences from anthropogenic activities. Measured contaminants were dependent on network and included some combination of pesticides, pharmaceuticals, per- and poly-fluoroalkyl substances (PFAS), benzotriazoles, hormones, wastewater indicators, and illicit drugs. Overall, the number of contaminants detected in samples ranged from 0 to 35 and concentrations ranged from 0.38 ng/L (progesterone) to 47,500 ng/L (bromoform). Fewer contaminants and lower concentrations were detected in finished water samples, compared to source waters. Significantly (p < 0.05) more PFAS and pesticides and higher sample total concentrations were observed in wells designated as vulnerable to contamination. To estimate potential human-health risk from exposure in drinking water, concentrations were compared against bioactivity information from the U.S. Environmental Protection Agency’s ToxCast database and state-based guidance values, when available. Although comparisons could be made for relatively few contaminants, concentrations in finished waters were at least an order of magnitude lower than screening thresholds. Results from this study were used to inform enhancement of the Minnesota Department of Health’s drinking water protection program. Full article

(This article belongs to the Section Environmental Health)

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16 pages, 319 KiB

Open AccessArticle

Sex Specificities in the Association Between Diet, Physical Activity, and Body Composition Among the Elderly: A Cross-Sectional Study in Florence, Italy

by Nora de Bonfioli Cavalcabo’, Luigi Facchini, Melania Assedi, Ilaria Ermini, Flavia Cozzolino, Emma Bortolotti, Calogero Saieva, Davide Biagiotti, Elisa Pastore, Benedetta Bendinelli, Giovanna Masala and Saverio Caini

Int. J. Environ. Res. Public Health 2025, 22(7), 975; https://doi.org/10.3390/ijerph22070975 - 20 Jun 2025

Abstract

The rising prevalence of elderly obesity in developed countries poses a public health challenge, since body composition changes during aging are associated with higher risks of chronic diseases. We cross-sectionally explored the relationship between diet, physical activity, and sex-specific differences in body composition [...] Read more.

The rising prevalence of elderly obesity in developed countries poses a public health challenge, since body composition changes during aging are associated with higher risks of chronic diseases. We cross-sectionally explored the relationship between diet, physical activity, and sex-specific differences in body composition among 378 elderly previously enrolled in the Florence European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Information on dietary habits and lifestyle was collected through validated questionnaires. Adherence to the Italian Mediterranean Index (IMI), Dietary Approaches to Stop Hypertension (DASH), and Greek Modified Mediterranean Diet (GMMD) a priori dietary patterns was calculated. Anthropometric measures were taken by trained personnel, and body composition parameters were estimated via bioelectrical impedance. In age- and energy-intake-adjusted regression models, adherence to the DASH and IMI patterns was associated with healthier body composition among women, while no significant relationship emerged among men. Fitness activities and total recreational physical activity revealed positive associations with healthier body composition (lower % fat mass, higher % muscle mass, and reduced waist circumference) in both sexes. These findings highlight the synergistic effect of diet and physical activity on body composition in the elderly and underscore the need for sex-specific interventions for promoting healthy aging. Full article

18 pages, 1170 KiB

Open AccessReview

What Is the Role of Industry-Based Intermediary Organisations in Supporting Workplace Mental Health in Australia? A Scoping Review

by Kristy Burns, Louise A. Ellis, Abilio De Almeida Neto, Carla Vanessa Alves Lopes and Janaki Amin

Int. J. Environ. Res. Public Health 2025, 22(7), 974; https://doi.org/10.3390/ijerph22070974 - 20 Jun 2025

Abstract

Despite increasing interest in workplace mental health, limited attention has been paid to the role of industry-based intermediary organisations in delivering mental health support. This scoping review addresses this gap by examining the mental health-related activities of industry intermediaries in Australia. A systematic [...] Read more.

Despite increasing interest in workplace mental health, limited attention has been paid to the role of industry-based intermediary organisations in delivering mental health support. This scoping review addresses this gap by examining the mental health-related activities of industry intermediaries in Australia. A systematic search of the peer-reviewed and grey literature from 2010 to 2023, supported by expert consultation and conducted in accordance with the PRISMA-ScR guidelines, identified 35 relevant records. Interventions were categorised using the WHO Guidelines on Mental Health at Work and evaluation activities coded according to the Conceptual Framework for Implementation Research. Organisational-level interventions were the most common (54%), followed by individual psychosocial support for distressed workers (40%). Mental health-specific intermediaries offered more WHO-recommended interventions and were more likely to evaluate their programs. Although evaluations suggested improvements in mental health literacy and high program acceptability, evidence of impact on worker health and organisational outcomes was limited. The findings suggest that intermediary organisations—including unions, business associations, and professional bodies—are well positioned to support tailored mental health strategies. However, the current lack of robust evaluations limits the understanding of their effectiveness. Future efforts should prioritise industry–research collaborations to strengthen the evidence base and inform sustainable investment in workplace mental health initiatives. Full article

(This article belongs to the Special Issue Work Psychology and Occupational Health: 2nd Edition)

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16 pages, 1230 KiB

Open AccessArticle

Examining the Link Between Problematic Smartphone Use and Substance Use Disorders Among College Students: Association Patterns Using Network Analysis

by Amanda Severo Lins Vitta, Wanderlei Abadio de Oliveira, Lucio Garcia de Oliveira, Laura Soares da Silva, Évelin Moreira Freires, Fernando Ferreira Semolini, Makilim Nunes Baptista, Claudio Romualdo, Hyoun S. Kim, Denise de Micheli, Adriana Scatena and André Luiz Monezi Andrade

Int. J. Environ. Res. Public Health 2025, 22(7), 973; https://doi.org/10.3390/ijerph22070973 - 20 Jun 2025

Abstract

This study examines the interplay between problematic smartphone use (PSU) and substance use disorders (SUDs) among Brazilian college students, also addressing associated emotional distress (e.g., depression, anxiety, and stress). A total of 3130 students (M_age = 23.6; SD_age = 5.34) participated in an [...] Read more.

This study examines the interplay between problematic smartphone use (PSU) and substance use disorders (SUDs) among Brazilian college students, also addressing associated emotional distress (e.g., depression, anxiety, and stress). A total of 3130 students (M_age = 23.6; SD_age = 5.34) participated in an online survey featuring validated measures for assessing PSU, alcohol and drug consumption, and emotional distress. Participants were categorized into problematic smartphone use (PSU) and non-problematic use (nPSU) groups. The prevalence of PSU was 46.9%, notably higher among female students, those lacking a religious affiliation, individuals living alone, and the unemployed. PSU individuals showed significantly elevated rates of alcohol, cannabis, and other illicit substance use, along with greater emotional distress. Network analysis revealed that weekly alcohol consumption and stress symptoms exhibited the highest centrality indices (e.g., stress with high betweenness; alcohol with strong expected influence), underscoring their key roles in connecting PSU and SUDs. These findings suggest that PSU and SUDs may share underlying emotional vulnerabilities, highlighting the need for integrated intervention strategies targeting both conditions concurrently. Full article

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

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14 pages, 715 KiB

Open AccessArticle

Preferences of South African Adolescents Living with HIV in the Western Cape Province Regarding the Use of Digital Technology for Self-Management

by Leonie Weyers, Talitha Crowley and Lwandile Tokwe

Int. J. Environ. Res. Public Health 2025, 22(7), 972; https://doi.org/10.3390/ijerph22070972 - 20 Jun 2025

Abstract

Adolescents living with HIV (ALHIV) face significant challenges in self-managing their chronic condition. Digital health technology (DHT) has become increasingly common and understanding ALHIVs’ preferences is essential for developing interventions tailored to this unique population. This study aimed to explore the preferences of [...] Read more.

Adolescents living with HIV (ALHIV) face significant challenges in self-managing their chronic condition. Digital health technology (DHT) has become increasingly common and understanding ALHIVs’ preferences is essential for developing interventions tailored to this unique population. This study aimed to explore the preferences of ALHIV regarding the use of DHT for self-management. A qualitative research approach with an exploratory and descriptive design was used. Participants were recruited using a purposive sampling method. Data were gathered through six nominal focus groups with 29 participants at two Community Health Centers in the Western Cape Province, South Africa. The participants were ALHIV aged 15–24 years. Discussions focused on current technology usage and the ranking of desired DHT features. The transcripts were analyzed using thematic analysis. Three main themes emerged: (1) everyday usage of digital technology where participants frequently used digital devices for communication, social media, and finding information; (2) the role of digital technology in self-management; a strong interest in digital technology that provides medication reminders, health education, and peer support; and (3) factors influencing digital technology, including the cost of data, limited connectivity, and issues of privacy related to participants’ HIV status. The ALHIV showed a strong willingness to use digital platforms for health information, reminders, and peer support, although concerns about connectivity, data cost, and privacy remain. These findings underscore the need for flexible, user-centered approaches when designing DHT interventions for self-management in South Africa. Full article

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15 pages, 534 KiB

Open AccessReview

Interventions by Rehabilitation Nurse Specialists in the Training of Informal Carers of Older People at Home with Chronic Diseases: A Scoping Review

by Ana Rita Bento, Ana Rita Duque, Nelson Gonçalves, Paulo Vaz, Susana Calção, Vanessa Benedito, Rogério Ferreira, César Fonseca and Celso Silva

Int. J. Environ. Res. Public Health 2025, 22(7), 971; https://doi.org/10.3390/ijerph22070971 - 20 Jun 2025

Abstract

Background: The aging population is increasing, leading to a greater need for home care for older adults, often provided by informal caregivers (ICs). These caregivers face numerous challenges, requiring adequate training and support. Objectives: This study aimed to map the main interventions performed [...] Read more.

Background: The aging population is increasing, leading to a greater need for home care for older adults, often provided by informal caregivers (ICs). These caregivers face numerous challenges, requiring adequate training and support. Objectives: This study aimed to map the main interventions performed by the Rehabilitation Nursing Specialist in empowering ICs of older adults at home. Methods: A scoping review was conducted following the Joanna Briggs Institute methodology. The search included seven articles published between 2019 and 2024, in Portuguese, English, and Spanish, available in the PubMed e CINHAL Ultimate databases. The descriptors used were (Rehabilitation Nursing) AND (Informal Caregivers OR Caregivers) AND (Elderly OR Aged) AND (mentoring OR Training. Results: The RNS interventions focused on training caregivers in technical skills (e.g., positioning, transfers, hygiene care, feeding, medication administration), preventing caregiver burden, managing behavioral and psychological symptoms of dementia, promoting self-care, and emotional support. Educational programs and the use of technologies (telehealth) were identified as effective strategies. Conclusions: RNS interventions are crucial for enhancing the skills and well-being of ICs, improving the quality of care provided to older adults at home, and reducing caregiver burden. Person-centered care, continuous support, and recognizing the caregiver’s role are fundamental aspects of these interventions. Full article

(This article belongs to the Special Issue The Health-Related Quality of Life of Older People with Chronic Disease)

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14 pages, 555 KiB

Open AccessArticle

Increasing Care Partners’ Capacity for Supporting Individuals Living with Dementia Through Bravo Zulu: Achieving Excellence in Relationship-Centered Dementia Care

by Jennifer Carson, Taniya J. Koswatta, Samantha Hoeper and Peter S. Reed

Int. J. Environ. Res. Public Health 2025, 22(7), 970; https://doi.org/10.3390/ijerph22070970 - 20 Jun 2025

Abstract

The need for person- and relationship-centered care (PCC/RCC) in Alzheimer’s disease and other dementias is well established. Recognizing the limitations of PCC in fully honoring the intricate interdependencies between care partners and persons living with dementia, a new training program called Bravo Zulu [...] Read more.

The need for person- and relationship-centered care (PCC/RCC) in Alzheimer’s disease and other dementias is well established. Recognizing the limitations of PCC in fully honoring the intricate interdependencies between care partners and persons living with dementia, a new training program called Bravo Zulu was developed. This comprehensive, 12-hour dementia training program aims to enhance personhood beliefs and self-efficacy among care partners, improving the experience of care and support for both people living with dementia and their care partners. Responses from 182 participants who completed the training were analyzed using paired t-tests to assess changes in personhood beliefs and self-efficacy. The Bravo Zulu training produced significant increases in both personhood beliefs and self-efficacy. Notably, healthcare professionals without prior care partner training exhibited the greatest gains in personhood beliefs, while participants who were not direct care partners showed substantial improvements in self-efficacy. Overall, these findings support the concept of tailoring dementia education to ensure care partners and healthcare professionals are able to provide culturally competent care that is aligned with the diverse backgrounds of people living with dementia. Expanding access to high-quality interactive programs such as Bravo Zulu can contribute to strengthening the dementia care workforce and improving care experiences for all involved. Full article

(This article belongs to the Special Issue Promoting Mentation: Assessment and Support for Dementia, Depression and Delirium)

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13 pages, 327 KiB

Open AccessArticle

Association Between Movement Behaviors and Health-Related Quality of Life in Adolescents: A Cross-Sectional Study

by Pedro Henrique Garcia Dias, Maria Carolina Juvêncio Franscisquini, Thais Maria de Souza Silva, Géssika Castilho dos Santos, Rodrigo de Oliveira Barbosa, Jadson Márcio da Silva and Antonio Stabelini Neto

Int. J. Environ. Res. Public Health 2025, 22(6), 969; https://doi.org/10.3390/ijerph22060969 - 19 Jun 2025

Abstract

Health-related quality of life (HRQoL) is a multidimensional construct that encompasses physical, emotional, psychological, and social domains, according to an individual’s perception. Studies have indicated that lifestyle-related factors, such as engaging in physical activity (PA), reducing screen time (ST), and maintaining adequate sleep [...] Read more.

Health-related quality of life (HRQoL) is a multidimensional construct that encompasses physical, emotional, psychological, and social domains, according to an individual’s perception. Studies have indicated that lifestyle-related factors, such as engaging in physical activity (PA), reducing screen time (ST), and maintaining adequate sleep duration, may contribute to improved HRQoL in adolescents. The present study aimed to examine the associations of the 24 h movement behaviors (PA, ST, and sleep duration) with physical and psychological well-being, and HRQoL in adolescents. This study included 746 adolescents of both sexes, aged 11 to 15 years, enrolled in public schools. Sleep duration was assessed through a specific question related to habitual bedtime and wake-up time. ST was evaluated using a question regarding the daily time spent using recreational electronic devices. PA was measured using accelerometers (ActiGraph GT3X-BT). The KIDSCREEN questionnaire was used to assess physical and psychological well-being and HRQoL. Generalized linear models were used for statistical analysis. Significant associations were observed between meeting sleep duration recommendations and higher HRQoL scores (β = 1.05, 95% CI: 1.01–1.08), as well as psychological well-being (β = 1.07, 95% CI: 1.03–1.11). Additionally, adherence to ST recommendations was significantly associated with higher physical well-being scores (β = 1.07, 95% CI: 1.01–1.14). Concerning the combination of adherence to guidelines, meeting both sleep duration and ST recommendations was significantly associated with higher HRQoL scores (β = 1.08, 95% CI: 1.02–1.15), physical well-being (β = 1.11, 95% CI: 1.03–1.21), and psychological well-being (β = 1.09, 95% CI: 1.01–1.18). The findings of this study highlight the importance of adhering to the 24 h movement guidelines, which may contribute to improved adolescent well-being. Full article

16 pages, 783 KiB

Open AccessArticle

Family Members’ Help-Seeking Behaviour for Their Relative Who Uses Substances: A Cross-Sectional National Study in Brazil

by Cassandra Borges Bortolon, Martha Canfield, Maria de Fatima Rato Padin, Jim Orford and Ronaldo Laranjeira

Int. J. Environ. Res. Public Health 2025, 22(6), 968; https://doi.org/10.3390/ijerph22060968 - 19 Jun 2025

Abstract

The affected family members (AFM) of relatives with substance use problems (RSU) play an important role in supporting their relatives to enter substance use treatment. This study investigated the help-seeking behaviours for their relatives by AFM in Brazil, including the characteristics of those [...] Read more.

The affected family members (AFM) of relatives with substance use problems (RSU) play an important role in supporting their relatives to enter substance use treatment. This study investigated the help-seeking behaviours for their relatives by AFM in Brazil, including the characteristics of those who sought help and the risk factors for delaying it. A secondary analysis from a national cross-sectional study of 3030 AFM was performed. Participants were recruited from a range of services focused on AFM across each of the five Brazilian regions (North, Northeast, Central-West, Southeast, South). While 92.7% sought help, 66.0% delayed for an average of 37.2 (SD 70.71) months. Help seeking was associated with higher socioeconomic status and being from the Southeastern region. Barriers included the relative refusing help (31.5%) and the belief that help was not needed (20.6%). Longer delays were associated with female AFM, residents in the Central-West region, non-parents, older RSU, alcohol use, and withdrawal coping strategies. The findings show disparities in help-seeking behaviour across socioeconomic groups, regions, and substance types, highlighting the need for better healthcare workforce distribution and targeted interventions to educate AFMs on the importance of engagement with healthcare services. Full article

(This article belongs to the Section Health Care Sciences)

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19 pages, 457 KiB

Open AccessArticle

Users’ Perceptions of Access to and Quality of Public Health Services in Brazil: A Cross-Sectional Study in Metropolitan Rio de Janeiro, including Pharmaceutical Services

by Mariana Crespo Raimundo, Edna Afonso Reis, Igor Fradique Leandro Ferraz, Carlos Podalirio Borges de Almeida, Brian Godman, Stephen M. Campbell, Johanna C. Meyer and Isabella Piassi Dias Godói

Int. J. Environ. Res. Public Health 2025, 22(6), 967; https://doi.org/10.3390/ijerph22060967 - 19 Jun 2025

Abstract

Background: This study evaluates one of the five regions of the state of Rio de Janeiro, Brazil, as part of a broader research project examining users’ perceptions of the Unified Health System (SUS), which has already generated publications in previous phases. The aim [...] Read more.

Background: This study evaluates one of the five regions of the state of Rio de Janeiro, Brazil, as part of a broader research project examining users’ perceptions of the Unified Health System (SUS), which has already generated publications in previous phases. The aim was to assess users’ perceptions of the SUS regarding access to and the quality of public health services, including pharmaceutical services, in the Metropolitan Region of Rio de Janeiro State. Method: A cross-sectional study was conducted between January and August 2024 with 200 participants, using a 66-item survey addressing access to and the quality of SUS services, appointment scheduling, medication acquisition, and the pharmacist’s role. Associations between variables were investigated using the Pearson Chi-Square Test in R software. Results: Frequent SUS users rated access as very good/good (p = 0.002) and overall quality as very good/good (p = 0.045). Reported challenges included the need for improved infrastructure (48.5%), better professional qualifications (30.6%), and easier access to medicines (16.8%). Higher ratings were given by those who used the SUS more frequently, and, in general, there was a tendency for participants with lower socioeconomic conditions to provide more favorable assessments of access to public health services (p = 0.024). Conclusion: A universal health system should cover diverse regions with unique needs. However, 49.4% of participants stated they never received information on how to store their medicines, and 42.3% reported never encountering a pharmacist in public pharmacies. Further ongoing studies assessing user perceptions are essential to ensure users play a central role in health decision-making, contributing to the system’s strengthening and improvement. Full article

(This article belongs to the Special Issue Social Medicine and Healthcare Management)

12 pages, 1028 KiB

Open AccessArticle

Physiotherapy Intervention Improves Clinical Outcomes and Quality of Life in Elderly Patients with Osteoarthritis: A Prospective Cohort Study

by Jeel Moya-Salazar, Jordy R. Olortegui-Panaifo, Hans Contreras-Pulache, Eliane A. Goicochea-Palomino and Marx E. Morales-Martinez

Int. J. Environ. Res. Public Health 2025, 22(6), 966; https://doi.org/10.3390/ijerph22060966 - 19 Jun 2025

Abstract

Osteoarthritis is the most common disease among the elderly population and is expected to be one of the leading causes of physical disability worldwide. Our objective was to compare the effects of physiotherapeutic interventions versus pharmacological treatment on outcomes and quality of life [...] Read more.

Osteoarthritis is the most common disease among the elderly population and is expected to be one of the leading causes of physical disability worldwide. Our objective was to compare the effects of physiotherapeutic interventions versus pharmacological treatment on outcomes and quality of life in elderly patients with osteoarthritis. This cohort study was conducted on 119 elderly individuals aged 60 to 95 years (58.8% women) from the YUYAQ nursing home. Two groups were divided: the intervention group (58 individuals–48.7%) received a two-month physiotherapy program, and the control group (61–51.5%) received exclusive use of anti-inflammatories. Between the intervention and control groups, we observed significant improvements (all p < 0.001) regarding pain (93.1% vs. 60.75%), stiffness (94.8% vs. 62.3%), and functional capacity (96.6% vs. 68.9%). Additionally, the intervention group showed better quality of life than the control group (13.81 vs. 41.38, p < 0.001). Quality of life improvement and clinical outcomes in the treatment group significantly improved in all areas of osteoarthritis, primarily in hip, spine, and knee osteoarthritis (p < 0.001). In conclusion, the physiotherapy intervention improved pain, stiffness, functional capacity, and quality of life in elderly patients with osteoarthritis after two months of treatment. Transitioning from pharmacological treatment to physiotherapeutic treatment in patients with osteoarthritis may substantially improve quality of life and disease symptomatology, but long-term studies are needed. Full article

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14 pages, 254 KiB

Open AccessArticle

Barriers and Facilitators to Accessing Mental and Physical Health Care Among Sexual Minority Women: A Qualitative Exploration

by Charlotte A. Dawson, Alicia Moulder and Kristin E. Heron

Int. J. Environ. Res. Public Health 2025, 22(6), 965; https://doi.org/10.3390/ijerph22060965 - 19 Jun 2025

Abstract

Cisgender sexual minority women (SMW, e.g., lesbian, queer) are at greater risk for poor mental and physical health compared to heterosexual women and face challenges when accessing health care. Previous research has largely focused on general sexual and gender minority barriers to health [...] Read more.

Cisgender sexual minority women (SMW, e.g., lesbian, queer) are at greater risk for poor mental and physical health compared to heterosexual women and face challenges when accessing health care. Previous research has largely focused on general sexual and gender minority barriers to health care, but more research is needed on the experiences of specific subgroups, including cisgender SMW. The current study qualitatively explored barriers and facilitators for cisgender SMW seeking health care. Twenty cisgender SMW aged 18–40 recruited using Meta advertisements and past participant lists completed 45 min semi-structured interviews and a brief survey. Thematic analysis conducted by two coders revealed a barrier theme with six subthemes, and a facilitator theme with seven subthemes. The barrier subthemes included discrimination, dominant culture centric, unsupportive socio-political environment, lack of patient-centered care, avoidance/concealment of sexual identity, and socio-economic challenges. The facilitator subthemes included supportive socio-political environment, advance identification of LGBTQ-affirming HCPs, patient-centered care, HCP identity similar to patient, social support, re-engagement with care after bad experiences, and socio-economic advantages. This study provides insight into the lived experiences of cisgender SMW that can help improve knowledge about health care disparities and inform health care interventions for this population. Full article

(This article belongs to the Special Issue Mental Health Challenges Affecting LGBTQ+ Individuals and Communities)

9 pages, 253 KiB

Open AccessBrief Report

Urban–Rural Disparities in Non-Adherence to Iron Supplementation Among Pregnant Women Aged 15 to 49 in Sub-Saharan Africa

by Yibeltal Bekele, Bircan Erbas and Mehak Batra

Int. J. Environ. Res. Public Health 2025, 22(6), 964; https://doi.org/10.3390/ijerph22060964 - 19 Jun 2025

Abstract

Background: Adherence to iron supplementation is influenced by systemic barriers, including poor healthcare infrastructure, shortage of healthcare providers, and limited access to antenatal care (ANC) services. These challenges are more pronounced in rural areas. However, evidence on urban–rural disparities in non-adherence to iron [...] Read more.

Background: Adherence to iron supplementation is influenced by systemic barriers, including poor healthcare infrastructure, shortage of healthcare providers, and limited access to antenatal care (ANC) services. These challenges are more pronounced in rural areas. However, evidence on urban–rural disparities in non-adherence to iron supplementation remains limited, particularly in sub-Saharan Africa. This study examined these regional differences, stratified by income levels and national contexts. Method: This analysis utilised Demographic Health Survey (DHS) data conducted between 2015 and 2023 from 26 sub-Saharan African countries, including 287,642 women from urban (n = 91,566) and rural areas (n = 196,076). The outcome of this study was non-adherence to iron supplementation, defined as taking iron supplementation for less than 90 days during pregnancy. This study examines urban–rural differences in non-adherence stratified by country income levels based on World Bank 2022 income classifications and national context. A chi-square test was used to assess urban–rural differences, with a p-value of <0.05 considered statistically significant. Results: Non-adherence was significantly higher in rural areas (68.42%) than in urban areas (51.32%) (p < 0.001), with the disparity more pronounced in low-income countries (LICs). Ethiopia, Madagascar, Uganda, and Burundi were among the countries with the highest rural non-adherence, reflecting severe poverty and limited access to ANC. In contrast, Zimbabwe showed an inverse trend, where rural adherence was higher than urban. Conclusions: Rural sub-Saharan Africa has significantly higher non-adherence to iron supplementation, particularly in LICs, likely driven by systemic barriers such as poor infrastructure and limited access to healthcare. This non-adherence in rural areas undermines efforts to improve pregnancy and birth outcomes across the region. Targeted interventions, like those in Zimbabwe, can help address these inequities and improve maternal health outcomes. Full article

16 pages, 295 KiB

Open AccessArticle

Occupational Health and Safety Among Brazilian Immigrant Women in the United States: A Cross-Sectional Survey

by Ashley Scott, Salima F. Taylor and Jennifer D. Allen

Int. J. Environ. Res. Public Health 2025, 22(6), 963; https://doi.org/10.3390/ijerph22060963 - 19 Jun 2025

Abstract

The Brazilian population in the United States is growing, and many Brazilian workers are employed in settings that may lack occupational health and safety (OHS) protections. In this study, we examined two domains of OHS (measured by the Occupational Health and Safety Vulnerability [...] Read more.

The Brazilian population in the United States is growing, and many Brazilian workers are employed in settings that may lack occupational health and safety (OHS) protections. In this study, we examined two domains of OHS (measured by the Occupational Health and Safety Vulnerability Survey), namely, Workplace Hazards (potential dangers that may result in injury or illness) and Workplace Vulnerability (inadequate occupational health and safety resources), and described health and demographic characteristics associated with these conditions. Eligible participants were women aged 18 and over, born in Brazil, currently residing in the United States, and employed. A cross-sectional online survey was conducted between July and August 2020. Recruitment occurred through community partnerships and social media. Multivariable models among n = 191 women revealed that greater exposure to Workplace Hazards was associated with employment in private household settings, including childcare and housecleaning (p < 0.001). The association between Workplace Vulnerability and jobs in private household services approached statistical significance (p = 0.07). Both Workplace Hazards and Workplace Vulnerability were associated with lower incomes and educational attainment, as well as having public insurance. Our findings suggest the need for stronger OHS protections and policies, particularly among those working in private household services, to ensure safer working conditions for Brazilian immigrant women. Full article

(This article belongs to the Section Global Health)

15 pages, 3866 KiB

Open AccessArticle

Prevalence and Factors Associated with Anaemia and Undernutrition Among Children Aged 6–24 Months in Rural Tanzania

by Naelijwa Mshanga, Sally Moore, Neema Kassim, Carolyn I. Auma, Yun Yun Gong and Haikael D. Martin

Int. J. Environ. Res. Public Health 2025, 22(6), 962; https://doi.org/10.3390/ijerph22060962 - 19 Jun 2025

Abstract

Background: Anaemia and undernutrition remain a significant public health problem in low and middle-income countries (LMICs), particularly affecting under-five children. In Tanzania, the prevalence of anaemia and undernutrition in under-five children is still high; however, less is known about the prevalence and predictors [...] Read more.

Background: Anaemia and undernutrition remain a significant public health problem in low and middle-income countries (LMICs), particularly affecting under-five children. In Tanzania, the prevalence of anaemia and undernutrition in under-five children is still high; however, less is known about the prevalence and predictors of these conditions in rural areas. Therefore, the current cross-sectional study presents the prevalence and determinants of anaemia and undernutrition among 457 children aged 6–24 months in the Babati and Hanang districts of Tanzania. Method: Haemoglobin concentration was assessed through capillary blood samples. Anaemia was classified according to WHO 2011 guidelines using a cut-off of <11.0 g/dL for children under five, while the WHO 2006 growth indicators were used to classify the nutritional status (i.e., stunting, wasting and underweight). Results: The results from this study show that 32%, 32%, 20% and 4% of children aged 6–24 months were anaemic, stunted, underweight and wasted, respectively, while only 33% had an adequate minimum dietary diversity (MDD). In addition, the child’s age (13–24 months) was significantly associated with anaemia (AOR: 2.1 95% CI 1.4, 3.1), stunting (AOR:17.4 95% CI 10.3, 29.4) and underweight (AOR: 15.9 95% CI 7.9, 32.0). Moreover, male children were three times more likely to be wasted (AOR: 3.5 95% CI 1.1, 10.9) than their female counterparts. Anaemia and stunting were the most prevalent nutritional disorders among 6–24-month-old children in the Hanang and Babati districts. Moreover, age (13–24 months) was found to be the common predictor for anaemia, stunting and underweight. Conclusion: The observed association between age and anaemia, as well as undernutrition, suggest that age may be an essential factor when designing nutrition-related programs in similar rural settings. Full article

(This article belongs to the Special Issue Early Childhood Nutrition and Associated Food Preferences, Dietary Patterns, and Health Outcomes)

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