Journal Description
International Journal of Environmental Research and Public Health
International Journal of Environmental Research and Public Health
(IJERPH) is a transdisciplinary, peer-reviewed, open access journal that covers global health, healthcare sciences, behavioral and mental health, infectious diseases, chronic diseases and disease prevention, exercise and health related quality of life, environmental health and environmental sciences, and is published monthly online by MDPI. The International Society Doctors for the Environment (ISDE), Italian Society of Environmental Medicine (SIMA) and Environmental Health Association of Québec (ASEQ‑EHAQ) are affiliated with IJERPH and their members receive discounts on the article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, PubMed, MEDLINE, PMC, Embase, GEOBASE, CAPlus / SciFinder, and other databases.
- Journal Rank: CiteScore - Q1 (Public Health, Environmental and Occupational Health)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 29.5 days after submission; acceptance to publication is undertaken in 3.9 days (median values for papers published in this journal in the second half of 2025).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
- Testimonials: See what our editors and authors say about IJERPH.
- Sections: published in 7 topical sections.
- Journal Cluster of Healthcare Sciences and Services: Geriatrics, Journal of Ageing and Longevity, Healthcare, Hospitals, Hygiene, International Journal of Environmental Research and Public Health and Nursing Reports.
Latest Articles
What Drives Nutritional Supplement Use Among Academics? An Intention–Behavior Model of Motivation, Work Stress, and Digital Influences
Int. J. Environ. Res. Public Health 2026, 23(5), 629; https://doi.org/10.3390/ijerph23050629 (registering DOI) - 9 May 2026
Abstract
Nutritional supplement use has emerged as an important health-related consumption behavior in digitalized environments, with implications for both public health and individual well-being. While prior research has largely focused on general populations, limited attention has been paid to how occupational pressures and digital
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Nutritional supplement use has emerged as an important health-related consumption behavior in digitalized environments, with implications for both public health and individual well-being. While prior research has largely focused on general populations, limited attention has been paid to how occupational pressures and digital information contexts jointly shape supplement-related decision-making among highly educated professionals. Addressing this gap, this study examines the behavioral determinants of nutritional supplement use among academics within an intention–behavior framework. Using survey data collected from academic professionals, the proposed model was tested through confirmatory factor analysis and structural equation modeling. The findings reveal that health motivation and academic work stress significantly predict supplement use intention, which, in turn, strongly influences actual consumption behavior. In contrast, digital health literacy and digital marketing exposure do not exert significant direct effects on usage intention. These results provide theoretical insight into the boundary conditions of informational determinants in consumer behavior models, suggesting that intrinsic motivation and contextual stressors may play a more dominant role than digital influences among highly educated consumers. From a practical perspective, the findings highlight the importance of addressing stress-related health coping mechanisms and motivation-driven behaviors in promoting informed supplement use.
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Open AccessArticle
Left Out and At Risk: Post-Pandemic Continuation of Organizational Service Reduction in Metropolitan New York City Coincides with Rise in Opiate Use and Mental Health Problems for Latinos
by
Ruth Lin Campbell and Smita Ekka Dewan
Int. J. Environ. Res. Public Health 2026, 23(5), 628; https://doi.org/10.3390/ijerph23050628 - 8 May 2026
Abstract
Increasing opiate use and mental health problems among younger and older Latinos in urban US contexts prompted this investigation into the organizational resources that facilitate help-seeking efforts of Latinos in New York State (NYS). Guided by a Vulnerability Model and a framework of
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Increasing opiate use and mental health problems among younger and older Latinos in urban US contexts prompted this investigation into the organizational resources that facilitate help-seeking efforts of Latinos in New York State (NYS). Guided by a Vulnerability Model and a framework of organizational enabling resources, this study used complementary longitudinal and cross-sectional designs. The longitudinal component examined changes in levels of organizational facilitators for Latino substance use disorder (SUD) help-seeking in Downstate NYS across three time periods, while the cross-sectional component compared post-pandemic facilitator levels across service types and regions. A convenience sample of 241 SUD clinicians participated in the longitudinal analysis. A sample of 150 clinicians whose practice information varied by location and service type participated in the post-pandemic cross-sectional comparisons. The findings revealed that the proportion of clinicians reporting organizational facilitation of Latino SUD help-seeking in Downstate NYS has diminished significantly from pre-pandemic levels, with little recovery. Cross-sectional analyses revealed no significant differences in clinician estimation of post-pandemic organizational resources by region or service type. The findings suggest that the organizational bulwarks against SUD and mental health problems are not sufficient to mitigate public health risk for NYS Latinos in the post-pandemic period. Recommendations informed by provider perspectives are discussed.
Full article
Open AccessSystematic Review
Spatio-Temporal COVID-19 Modeling: A Global Systematic Review of Data Integration, Equity, and Lessons for Pandemic Preparedness
by
Petra Norlund, Jamal Jokar Arsanjani and Jesper M. Paasch
Int. J. Environ. Res. Public Health 2026, 23(5), 627; https://doi.org/10.3390/ijerph23050627 - 8 May 2026
Abstract
The COVID-19 pandemic generated an unprecedented volume of spatially and temporally resolved data, enabling rapid development of spatio-temporal models for surveillance, forecasting, and policy support. However, the evolution, geographic distribution, and equity implications of these models remain insufficiently synthesized. This study presents a
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The COVID-19 pandemic generated an unprecedented volume of spatially and temporally resolved data, enabling rapid development of spatio-temporal models for surveillance, forecasting, and policy support. However, the evolution, geographic distribution, and equity implications of these models remain insufficiently synthesized. This study presents a global systematic review of 363 peer-reviewed studies published between January 2020 and August 2025 using publicly available data. Following PRISMA 2020 guidelines, studies were classified by geographic scale, modeling approach, data streams, and analytical purpose. The results indicate that Bayesian and compartmental models remained dominant throughout the pandemic, although methodological diversity increased over time with the growing use of machine learning and hybrid frameworks integrating mobility, environmental, and socio-demographic data. Data integration was more common than previously reported. Approximately 30% of studies relied on a single data stream, while 70% incorporated multiple sources, although most multi-source approaches combined only two data types and relatively few studies integrated three or more. Geographic coverage was uneven, with a strong concentration of studies in high-income regions and persistent underrepresentation of low- and middle-income contexts. Models incorporating finer spatial scales and socio-demographic variables more frequently supported geographically targeted interpretation of risk, vulnerability, testing access, and intervention needs. Overall, the findings highlight the importance of multi-source data integration, improved geographic representativeness, and transparent uncertainty communication, alongside the need for FAIR-aligned and equity-aware data infrastructures to strengthen future pandemic preparedness.
Full article
Open AccessStudy Protocol
A Speech Analytics-Based Methodological Protocol for Monitoring Orthopedic Rehabilitation in the Brazilian Unified Health System
by
Rafael Baena Neto and Vicente Idalberto Becerra Sablón
Int. J. Environ. Res. Public Health 2026, 23(5), 626; https://doi.org/10.3390/ijerph23050626 - 8 May 2026
Abstract
The digital transformation of health systems and the increasing adoption of data-driven public health strategies have intensified the need for methods capable of capturing, structuring, and analyzing information derived from clinical interactions. In the Brazilian Unified Health System (SUS), orthopedic rehabilitation and therapeutic
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The digital transformation of health systems and the increasing adoption of data-driven public health strategies have intensified the need for methods capable of capturing, structuring, and analyzing information derived from clinical interactions. In the Brazilian Unified Health System (SUS), orthopedic rehabilitation and therapeutic exercise prescription rely heavily on communication between healthcare professionals and patients, particularly with regard to understanding instructions, reporting symptoms, and identifying barriers to treatment continuity. However, much of this information remains embedded in unstructured spoken interactions, limiting its use for monitoring and evaluation purposes. This study presents a prospective methodological protocol for the future development and validation of a speech analytics architecture designed to analyze verbal interactions in orthopedic rehabilitation within the SUS. The proposed framework integrates automatic speech recognition, speaker diarization, semantic processing with large language models (LLMs), biomedical entity extraction, and retrieval-grounded analytical components to generate structured indicators from clinical speech. In addition, the manuscript includes an illustrative simulation based on administrative proxy data converted into synthetic narratives in order to exemplify the expected structure of downstream analytical outputs. This simulation does not constitute validation of the full audio-based pipeline, but rather serves to clarify the proposed analytical workflow. Overall, the protocol establishes a structured methodological basis for future empirical studies aimed at evaluating the technical performance, semantic validity, and potential public health utility of speech analytics in rehabilitation monitoring, under appropriate ethical, regulatory, and data protection safeguards.
Full article
(This article belongs to the Special Issue The Physiological Effects of Sports and Exercise)
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Open AccessArticle
Evolving Cancer Characteristics Among World Trade Center Survivors: An Updated Analysis from the WTC Environmental Health Center
by
Nedim Durmus, Ziyue Wang, Alan A. Arslan, Emre Goren, Ramazan Alptekin, Yujia Lou, Andrew Shao, Nida Athar, Yibeltal A. Ashebir, Yidan Shi, Leigh Wilson, Joan Reibman and Yongzhao Shao
Int. J. Environ. Res. Public Health 2026, 23(5), 625; https://doi.org/10.3390/ijerph23050625 - 8 May 2026
Abstract
Local community populations (“survivors”) exposed to the World Trade Center (WTC) disaster experienced complex exposures to mixtures of dust and combustion products with potential carcinogenic effects. Survivors with certifiable WTC-related conditions are eligible for inclusion in the federally funded WTC Health Program. We
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Local community populations (“survivors”) exposed to the World Trade Center (WTC) disaster experienced complex exposures to mixtures of dust and combustion products with potential carcinogenic effects. Survivors with certifiable WTC-related conditions are eligible for inclusion in the federally funded WTC Health Program. We provide an updated description of cancers in the WTC Environmental Health Center (EHC), a program for WTC survivors, through 31 December 2024. Using data from the WTC EHC Pan Cancer Database, we summarized demographics, exposure history, and tumor characteristics among enrollees with pathologically confirmed primary cancers meeting WTC Health Program certification criteria. Among 17,449 members, 7274 had a certifiable cancer diagnosis; excluding non-melanoma skin cancers, 6588 patients with 7643 eligible cancers were analyzed. Women comprised 50.3% of the cohort and 47.5% of diagnoses. Solid tumors accounted for 87% of certifications, with breast (22%) and prostate (19%) cancers most frequent, followed by lung (8%), thyroid (6%), colorectal (6%), and melanoma (4.5%). Lymphoproliferative and hematopoietic malignancies represented 13% of cases. Fourteen percent developed multiple primary cancers, and median latency clustered around 14–16 years. Compared with our previous report in 2020, the enrolled number of cancers increased 2.5-fold. These findings support the need for sustained surveillance and additional epidemiologic studies to improve cancer prevention and survivorship in this uniquely exposed population.
Full article
(This article belongs to the Special Issue Long-Term Health Consequences of 9/11: The World Trade Center Disaster 25 Years Later)
Open AccessArticle
A Precision Computational Framework for sLORETA Neurofeedback in Mild Cognitive Impairment: Integration of qEEG Biomarkers and Neuropsychological Metrics
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Viviane Dasilva, Diana Poli and Olimpia Pino
Int. J. Environ. Res. Public Health 2026, 23(5), 624; https://doi.org/10.3390/ijerph23050624 - 8 May 2026
Abstract
This paper proposes a high-precision theoretical and computational neurorehabilitation framework for Mild Cognitive Impairment (MCI), connecting computational neuroscience and clinical practice through qEEG-guided neurofeedback training (NFT). By employing sLORETA to identify putative pathological nodes within the Default Mode Network (DMN)—specifically the Precuneus and
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This paper proposes a high-precision theoretical and computational neurorehabilitation framework for Mild Cognitive Impairment (MCI), connecting computational neuroscience and clinical practice through qEEG-guided neurofeedback training (NFT). By employing sLORETA to identify putative pathological nodes within the Default Mode Network (DMN)—specifically the Precuneus and the Posterior Cingulate—the model utilizes spectral decomposition to isolate the aperiodic 1/f component, reducing background noise bias and allowing the calculation of a pure individual alpha frequency (IAF) to inform recalibration of Weber’s Cognitive Threshold. The core architecture uses Bayesian algorithms and stochastic modeling to drive a Dynamic Weight Change mechanism. To support Long-Term Potentiation (LTP) and Hebbian learning, reward thresholds are modulated in real time to target a 70% success rate, as a strategic rationale to anticipate neural fatigue while maintaining the Reward Prediction Error required for synaptic strengthening. As a prospective validation pathway, future studies may assess clinical value through changes in MoCA and RAVLT scores, as well as by examining normalization of cortical coherence in the Default Mode Network (DMN). By merging computational neuroscience with biological models of synaptic plasticity, this work outlines how individual biology can be mapped into an explicit mathematical model. The proposed framework may inform an individualized protocol that provides an objective model-based measure of cognitive recovery, suggesting a replicable and robust strategy for neurorehabilitation during the prodromal phase of dementia, and providing a new approach to neuroscience-based cognitive rehabilitation. This work is intended as a theoretical and computational framework; no complete empirical dataset is reported in the present manuscript.
Full article
(This article belongs to the Section Health Care Sciences)
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Open AccessArticle
Barriers to Antiretroviral Therapy Adherence Among Children in Ekurhuleni, South Africa: A Descriptive Study
by
Palesa Sokazi, Zelda Janse van Rensburg and Wanda Jacobs
Int. J. Environ. Res. Public Health 2026, 23(5), 623; https://doi.org/10.3390/ijerph23050623 - 8 May 2026
Abstract
This study aimed to explore and describe the barriers to Antiretroviral Therapy (ART) adherence among children in Ekurhuleni, Gauteng. A quantitative, cross-sectional design using a survey method was employed. Convenience sampling was used to recruit 157 parents, guardians, and caregivers (PGCs) who consented
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This study aimed to explore and describe the barriers to Antiretroviral Therapy (ART) adherence among children in Ekurhuleni, Gauteng. A quantitative, cross-sectional design using a survey method was employed. Convenience sampling was used to recruit 157 parents, guardians, and caregivers (PGCs) who consented to participate in the study. Data was collected using self-report questionnaires and analysed using descriptive statistics and frequency distributions. The study was not designed or statistically powered to formally test associations between variables; therefore, only descriptive statistical analyses were conducted. The reliability and validity of the instrument were ensured, and ethical clearance was obtained from the relevant authorities prior to data collection. The study was conducted in accordance with established ethical principles and in compliance with the Declaration of Helsinki. The findings revealed that there were multiple barriers to children’s adherence to ART. Approximately one-third of PGCs reported being fully informed about the importance of ART adherence, while the majority indicated being only partially informed. Missed doses emerged as a significant challenge, with a substantial proportion reporting missed medication on one or more days, and only 31.2% administering ART consistently on time. Difficulties in understanding blood test results were also reported. In addition, a notable proportion of PGCs admitted to missing clinic appointments. These findings emphasize the need for strengthened caregiver education, ongoing support, and tailored interventions directed at primary health care nurses to promote consistent ART adherence among children.
Full article
(This article belongs to the Special Issue Impact of HIV on Children and Adolescents Living with HIV and Their Families)
Open AccessArticle
Area-Level Sociodemographic Differences Between Indian Health Service Purchased/Referred and Non-Purchased/Referred Care Delivery Areas
by
Sarah H. Nash, Rachael Adcock, Chi Wang, Mindy C. Hebert-DeRouen, Natalie S. Joe, Dornell Pete, Tyler B. Kratzer, Charles L. Wiggins, Lihua Liu and Bradley D. McDowell
Int. J. Environ. Res. Public Health 2026, 23(5), 622; https://doi.org/10.3390/ijerph23050622 - 8 May 2026
Abstract
Purpose: Purchased/Referred Care Delivery Area (PRCDA) counties are those where resident American Indian and Alaska Native (AIAN) people are eligible for Indian Health Service care. Due to concerns about racial misclassification, cancer statistics for AIAN people are often restricted to PRCDA counties. Differences
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Purpose: Purchased/Referred Care Delivery Area (PRCDA) counties are those where resident American Indian and Alaska Native (AIAN) people are eligible for Indian Health Service care. Due to concerns about racial misclassification, cancer statistics for AIAN people are often restricted to PRCDA counties. Differences in sociodemographic characteristics may exist between PRCDA and non-PRCDA counties, but have not been described; therefore, the potential selection bias associated with the restriction to PRCDA counties remains unknown. Methods: We used data from the University of California, San Francisco Health Atlas to explore ecological differences in county-level demographic, socioeconomic, healthcare access, and health outcomes data between PRCDA and non-PRCDA counties (n = 3152 counties). We tested for statistical differences in mean levels of demographics between PRCDA and non-PRCDA counties using Pooled or Welch t-tests. Results: We observed small, but statistically significant differences between PRCDA and non-PRCDA counties in county-level demographic and socioeconomic characteristics (age, poverty, utility services threat, unemployment, educational attainment, computer access, and median income), neighborhood and environment characteristics (overcrowding, severe mortgage/rent burden), healthcare access and utilization (uninsured, annual checkup, annual dental visit, mammography, binge drinking, smoking, physical inactivity, social isolation), and health outcomes (poor mental health, arthritis, poor self-rated health, high blood pressure, diabetes, high cholesterol, and obesity). Conclusions: These results indicate variability in county-level measures between PRCDA and non-PRCDA counties. While these data do not speak specifically to AIAN peoples’ experiences, they provide critical contextual information to understand how exclusion of AIAN people residing in non-PRCDA counties from cancer statistics may bias risk estimates.
Full article
(This article belongs to the Special Issue Advances in Indigenous and American Indian and Alaska Native Health and Wellness: 2nd Edition)
Open AccessArticle
Hypertension and Social Capital in Indonesia
by
Younoh Kim and Vlad Radoias
Int. J. Environ. Res. Public Health 2026, 23(5), 621; https://doi.org/10.3390/ijerph23050621 - 8 May 2026
Abstract
Hypertension is a serious public health concern in developing countries, where the lack of resources and the poor infrastructure often lead to a high incidence of disease and also to high rates of underdiagnosis. We study the linkages between hypertension and social capital
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Hypertension is a serious public health concern in developing countries, where the lack of resources and the poor infrastructure often lead to a high incidence of disease and also to high rates of underdiagnosis. We study the linkages between hypertension and social capital in Indonesia. Indonesia is a large developing economy, where social capital is encouraged and plays a significant role. We use participation in community programs as a proxy for social capital, specifically capturing the structural dimension of social networks. By engaging in these programs, individuals create the social ties that facilitate resource sharing and gain access to socially embedded resources. We find significant associations between participating in community programs and having lower blood pressure and lower likelihood of hypertension. These results underscore the public health significance of social capital as a potential non-clinical determinant of health. From a policy perspective, the findings suggest that strengthening community-based social infrastructure could offer an alternative strategy to mitigate hypertension in resource-constrained economies.
Full article
Open AccessArticle
The Role of Sport Coaches in Promoting the Health and Wellbeing of Athletes with Developmental Disabilities
by
Roy McConkey and Fiona Murray
Int. J. Environ. Res. Public Health 2026, 23(5), 620; https://doi.org/10.3390/ijerph23050620 - 8 May 2026
Abstract
Background: Children and adults with disabilities are widely acknowledged to have poorer health and emotional wellbeing than their non-disabled peers, which is further compounded by less access to health services and health-promoting activities. A relatively untried solution is to mobilize community initiatives such
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Background: Children and adults with disabilities are widely acknowledged to have poorer health and emotional wellbeing than their non-disabled peers, which is further compounded by less access to health services and health-promoting activities. A relatively untried solution is to mobilize community initiatives such as sports to promote better health. Method: Special Olympics (SO) is an international sports organization present in over 200 countries and jurisdictions, engaging with just under four million athletes with intellectual disabilities annually. Research on the perceptions of sports coaches around incorporating health promotion within their sports training has been scarce. Likewise, little attention has been paid to identifying athletes’ understanding of what health means to them and actions that would make them healthier. A qualitative, descriptive study was conducted with eight national SO programs involving 62 coaches and 47 athletes. Group interviews were conducted via Zoom and a thematic content analysis was made of their responses. Results: In all countries, coaches and athletes agreed that the most common needs were healthy eating, healthy weight and exercise. Good mental wellbeing and sleeping well were also named. Ideas were sought from both sets of participants regarding how coaches could assist their athletes to attain better health and the barriers they might face in doing so. Conclusions: Three main conclusions emerged. Athletes and coaches were aware of health deficits and knew of ways to reduce them. Both appreciated the contribution that coaches could make through motivating athletes and providing training activities but were dependent on suitable resources being available to them. Engagement with families and available health and social care services was essential. Health-oriented, sporting activities offer promise in improving the health and wellbeing of persons with developmental disabilities, particularly in less affluent countries with fewer health professionals and poorly developed primary care services.
Full article
(This article belongs to the Section Global Health)
Open AccessArticle
Temporal Patterns of Alcohol- and Drug-Related Overdoses During the COVID-19 Pandemic: A National EMS-Based Study by Age and Gender in Israel
by
Anna Khalemsky, Moshe Z. Abramowitz, Roman Sonkin, Haim Y. Knobler and Eli Jaffe
Int. J. Environ. Res. Public Health 2026, 23(5), 619; https://doi.org/10.3390/ijerph23050619 - 7 May 2026
Abstract
The COVID-19 pandemic introduced unprecedented societal disruptions that may have altered patterns of acute substance-related harm. Despite extensive research on overdose mortality, there remains limited real-time, population-level evidence based on Emergency Medical Services (EMS) data. This study provides a national, multi-year characterization of
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The COVID-19 pandemic introduced unprecedented societal disruptions that may have altered patterns of acute substance-related harm. Despite extensive research on overdose mortality, there remains limited real-time, population-level evidence based on Emergency Medical Services (EMS) data. This study provides a national, multi-year characterization of temporal trends in alcohol- and drug-related overdose incidents in Israel across thirteen defined pandemic phases. A total of 18,348 overdose cases recorded between 1 January 2019 and 31 December 2022 were analyzed. Descriptive statistics were calculated, event frequencies were normalized by period length, and loglinear Poisson models were applied to compare occurrences across periods. Cluster analysis was used to explore joint age- and gender-related patterns. Alcohol-related overdoses demonstrated marked fluctuations across pandemic phases, whereas drug-related overdoses showed comparatively moderate variation and a gradual increase over time. Age- and gender-specific heterogeneity was observed across periods. As an observational study based on EMS records, causal inference cannot be established. These findings provide population-level surveillance evidence of dynamic overdose patterns during prolonged societal disruption and highlight the importance of integrating EMS-based monitoring into public health preparedness strategies.
Full article
(This article belongs to the Section Global Health)
Open AccessArticle
Digital Engagement and Health Behaviors Among Village Health Volunteers in Southern Thailand: A Cross-Sectional Study
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Deeyana Binhayeekonoh, Pussadee Laor, Nutnaree Nimsiri, Sujittra Hinwiset, Safeena Tohranee, Rohmatul Fajriyah and Wanvisa Saisanan Na Ayudhaya
Int. J. Environ. Res. Public Health 2026, 23(5), 618; https://doi.org/10.3390/ijerph23050618 - 7 May 2026
Abstract
Village Health Volunteers (VHVs) play an important role in Thailand’s community-based public health system, yet limited evidence is available on how their digital engagement relates to their own health behaviors. This cross-sectional study examined associations between sociodemographic characteristics, digital use frequency, digital literacy,
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Village Health Volunteers (VHVs) play an important role in Thailand’s community-based public health system, yet limited evidence is available on how their digital engagement relates to their own health behaviors. This cross-sectional study examined associations between sociodemographic characteristics, digital use frequency, digital literacy, and health behavior scores among 426 VHVs in southern Thailand. Data were collected using an online questionnaire that included the Mobile Device Proficiency Questionnaire (MDPQ-16) and a 23-item health behavior measure based on the Thai 3A2S framework. The median health behavior score was 61.0 (IQR 13.25). After adjustment, rural residence was associated with higher health behavior scores (β = 1.97, p = 0.043), whereas frequent digital use was associated with lower scores than infrequent use (β = −2.72, p = 0.010). Digital literacy was not independently associated with health behavior scores. The final model explained 4% of the variance, suggesting that additional factors may influence VHVs’ health behaviors. Overall, the findings indicate that digital literacy alone may not explain differences in health behaviors and that context may also play a role. Future research should examine these relationships using broader and more context-sensitive measures.
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Open AccessArticle
Spatial Epidemiology and Ecological Determinants of Ticks and Tick-Borne Pathogens Co—Circulation in Brijuni National Park, Croatia
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Maja Cvek, Emina Pustijanac, Marko Vucelja, Dean Girotto, Josip Margaletić and Linda Bjedov
Int. J. Environ. Res. Public Health 2026, 23(5), 617; https://doi.org/10.3390/ijerph23050617 - 7 May 2026
Abstract
Tick-borne diseases are a growing public health concern in the Mediterranean. Brijuni National Park (BNP), a unique, highly visited island ecosystem characterized by increased large game host density and diverse Mediterranean habitats, presents an elevated risk for pathogen co-circulation. This study addresses the
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Tick-borne diseases are a growing public health concern in the Mediterranean. Brijuni National Park (BNP), a unique, highly visited island ecosystem characterized by increased large game host density and diverse Mediterranean habitats, presents an elevated risk for pathogen co-circulation. This study addresses the lack of spatial and epidemiological data to accurately assess human exposure risk in this environment. We performed a detailed geospatial and epidemiological risk mapping of pathogen co-circulation in BNP. A total of 587 hard ticks were collected across 26 georeferenced micro-locations (2020–2022). Ticks were morphologically identified and subsequently screened for six key zoonotic bacterial pathogens using qPCR. The Minimal Infection Rate (MIR) and a Co-infection Rate (CR) were calculated. Geographic Information System (GIS) mapping was utilized to map ecological determinants of risk. Ixodes ricinus was the overwhelmingly dominant vector (94.0%), peaking in spring, with activity absent in summer. Recorded diverse tick fauna also included Hyalomma marginatum (3%), Haemaphysalis punctata (2%), Ixodes frontalis (0.8%) and Rhipicephalus sanguineus (0.2%). Active circulation of Borrelia burgdorferi s.l. (Bbsl), Anaplasma phagocytophilum, and Ehrlichia canis were confirmed. Bbsl presented the highest MIR (3.05). The Co-infection Rate (CR) was notably high at 29.41%, with triple co-infections (Bbsl, A. phagocytophilum, E. canis) concentrated in cultivated mosaics and holm oak forests (Quercus ilex L.). The highest number of ticks was recovered from ecotone zones, accounting for 50.0% of the total catch, confirming them as high-risk interfaces. The absence of Rickettsia conorii may be attributed to the strict control/absence of its primary host (domestic dogs). The presence of the exotic vector H. marginatum was also confirmed. The high rate of co-infection and the spatial concentration of risk in specific habitats underscore an elevated and complex public health risk in BNP, closely linked to habitat structure and increased game host density. This research provides an essential geospatial framework for targeted ‘One Health’ management, prioritizing vector control in ecotone zones and dense forest refugia. Urgent surveillance for the exotic H. marginatum is warranted to monitor the potential risk of Crimean-Congo Hemorrhagic Fever.
Full article
(This article belongs to the Special Issue Vulnerability and Resilience: A One Health Approach to Environmental and Climate Risks in the Mediterranean)
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Open AccessArticle
Epidemiology of Musculoskeletal Injuries in Frisbee Athletes and Associated Risk Factors: World Beach Ultimate Championship
by
Beatriz Minghelli, Vera Lúcia Ramos Guerreiro, Rodrigo Miguel Coelho Luz, Bruna Raquel Ferreira Rodrigues and Miguel Tomé Carminho
Int. J. Environ. Res. Public Health 2026, 23(5), 616; https://doi.org/10.3390/ijerph23050616 - 7 May 2026
Abstract
Frisbee has gained increasing popularity and is characterized by high-intensity running, rapid changes in direction, jumping, and indirect physical contact, exposing players to a risk of injury. This study aimed to determine the epidemiology of musculoskeletal injuries in frisbee athletes who participated in
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Frisbee has gained increasing popularity and is characterized by high-intensity running, rapid changes in direction, jumping, and indirect physical contact, exposing players to a risk of injury. This study aimed to determine the epidemiology of musculoskeletal injuries in frisbee athletes who participated in the World Beach Ultimate Championship in Portugal, and the risk factors associated with these injuries. The sample included 484 athletes aged 18–64 years, of whom 275 (56.8%) were male. Data was collected using a digital questionnaire. Across their frisbee practice, 391 (80.8%) athletes reported at least one injury, totalling 1685 injuries. A total of 49 (10.1%) athletes reported an injury in the last 7 days. Over the past 12 months, 211 (43.6%) athletes sustained injuries, totalling 358 cases. The injury proportion was 0.44 (95% CI: 39.2–48.0), and the injury rate was 0.67 injuries per 1000 h of training. The most frequent injuries were muscle strains (18.86%) and sprains (13.43%), mainly affecting the ankle (62; 17.71%) and knee (54; 15.43%). Repetitive movements (84; 22.11%) and changes in direction (62; 16.32%) were the most common mechanisms. Athletes with equal or more than 11 years of practice had a higher injury risk (OR = 1.84; 95% CI: 1.16–2.91; p = 0.009). Frisbee athletes present a considerable risk of injuries. Preventive strategies are recommended.
Full article
(This article belongs to the Special Issue Sports Injuries: Epidemiology, Assessment, Prevention and Rehabilitation)
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Open AccessArticle
Experiences of Nature Through Immersive Virtual Reality Among People with Type 2 Diabetes Mellitus
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Monika Norberg, Elisabet Bohlin, Ann Dolling, Benno Krachler, Julia Elfving, Martin Gärdemalm and Kristina Lämås
Int. J. Environ. Res. Public Health 2026, 23(5), 615; https://doi.org/10.3390/ijerph23050615 - 6 May 2026
Abstract
This study explores experiences of spending time in immersive virtual reality with a natural environment among individuals with type 2 diabetes, aiming to enhance perceived wellbeing and reduce perceived stress. Seventeen participants with type 2 diabetes took part in a multimodal lifestyle education
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This study explores experiences of spending time in immersive virtual reality with a natural environment among individuals with type 2 diabetes, aiming to enhance perceived wellbeing and reduce perceived stress. Seventeen participants with type 2 diabetes took part in a multimodal lifestyle education program and used immersive virtual reality with natural environment over a six-month period, selecting from a number of 30 min serene natural environments. Semi-structured interviews were conducted and analyzed using qualitative content analysis. Participants described immersive virtual reality with a natural environment experience as providing tranquility, inspiration, and a sense of transcending time and space (A). Feelings of calm and mental withdrawal from everyday demands were often reported (A2), and memories were evoked (A2). Some participants experienced these effects as extending beyond the immersive virtual reality with natural environment sessions themselves (A3–4). At the same time, several factors were identified that could disrupt the restorative experience (A5), including technical issues, individual preferences for specific environments, health- or situation-related constraints, and difficulties establishing a regular routine for headset use. Immersive virtual reality with natural environment was generally viewed as a valuable complement to real-world nature experiences, particularly for individuals with limited access to outdoor environments (B1–2). Overall, the findings suggest that immersive virtual reality with natural environment experiences may offer a supportive resource for enhancing emotional wellbeing and managing stress in people with type 2 diabetes, while not replacing the benefits of actual nature exposure.
Full article
Open AccessSystematic Review
Racial and Ethnic Disparities in the Diagnosis and Treatment of Obstructive Sleep Apnea: A Systematic Review
by
Siji Thomas, Shafer G. Tharrington, Aditya Patel, Mevelyn Kaalla, Adarsh Thomas, Nikhil Madala, Younghoon Kwon and William J. Healy
Int. J. Environ. Res. Public Health 2026, 23(5), 614; https://doi.org/10.3390/ijerph23050614 - 5 May 2026
Abstract
Background: Sleep apnea is identified and treated less frequently among racial and ethnic minorities. Objective: The purpose of this systematic review was to examine disparities among racial and ethnic minorities and to understand the reasons for poor sleep health. Methods: The authors conducted
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Background: Sleep apnea is identified and treated less frequently among racial and ethnic minorities. Objective: The purpose of this systematic review was to examine disparities among racial and ethnic minorities and to understand the reasons for poor sleep health. Methods: The authors conducted a literature search using PubMed and Cochrane Library databases, last accessed in September 2025, using regular and MeSH keywords. A total of 123 articles were identified. PRISMA guidelines were followed, the PICO framework was applied, and the inclusion criteria were based on studies conducted in the past 10 years. After quality assessment, 18 studies were included for in-depth analysis. Results: The 18 studies included meta-analyses and observational cohort studies. In total, 51,489 patients were represented. Studies revealed that sleep apnea is underdiagnosed and undertreated in ethnic minority populations. Resident location, gender, economic status, and marital status also play an important role. One study noted clinically insignificant differences in positive airway pressure requirements between black and white populations. Nocturnal hypertension and increased left ventricle size are also observed in untreated sleep apnea. Given the heterogenous nature of the studies, quality risk assessment was not possible, which is a limitation of this study. Conclusions: Sleep apnea is underdiagnosed and undertreated among ethnic minorities. Factors such as ancestry, comorbidities, social determinants, geography, and healthcare access drive global inequities. Further sleep apnea phenotyping may be of value in planning treatment strategies.
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(This article belongs to the Special Issue Addressing Health Inequities Among Underserved and Minority Populations Through Cognitive Justice: A Focus on Social Determinants of Health)
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Open AccessArticle
Association Between a History of Sexually Transmitted Diseases and Reproductive Health Knowledge Among Adolescents of Peru: A Cross-Sectional Study
by
Jeel Moya-Salazar, Eliane A. Goicochea-Palomino, María Jesús S. Moya-Salazar, Magaly M. Medina-Rojas and Gloria Cruz-Gonzales
Int. J. Environ. Res. Public Health 2026, 23(5), 613; https://doi.org/10.3390/ijerph23050613 - 5 May 2026
Abstract
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Adolescents are prone to unwanted pregnancies and sexually transmitted infections. It is key that they receive reproductive sexual education during secondary education, which can be important for the prevention of these events. This study aims to compare knowledge of reproductive health between adolescents
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Adolescents are prone to unwanted pregnancies and sexually transmitted infections. It is key that they receive reproductive sexual education during secondary education, which can be important for the prevention of these events. This study aims to compare knowledge of reproductive health between adolescents with and without STI history. A cross-sectional study was carried out on 164 schoolchildren from a national school in Lima (Peru). The AA-20 short questionnaire and the t-test were used to demonstrate differences between students with and without a history of sexually transmitted infections (STIs). Twenty-six (15.9%) students had STIs (mean age 16.6 ± 2.3 years). The average knowledge in students with and without STIs was 15.4 ± 3.7 points and 14.7 ± 3.9 points, respectively (p = 0.417). Among students with and without a previous STI, it was found that the majority used some form of contraception (61.5% vs. 31.9%, p = 0.004) and had received talks on the topic (92.3% vs. 72.5%, p = 0.031). Condom use was the most commonly used method to prevent STIs in both groups. In conclusion, students with a previous STI had slightly better knowledge about pregnancy and infections than students without a history.
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Open AccessArticle
Burnout Risk Among Providers of an Integrated Care Program Supporting Transitions Between the Hospital and Home: A Descriptive Mixed Methods Evaluation
by
Juma Orach, Aysha Afzaal, Aman Bathla, Zhenxiao Yang, Lauren Lapointe-Shaw, Ceara Cunningham, Valeria E. Rac, Shoshana Hahn-Goldberg, Melissa Chang, Christopher Chan, Carolyn Gosse, Emily Hay, Thomas E. MacMillan, Michelle Grinman and Karen Okrainec
Int. J. Environ. Res. Public Health 2026, 23(5), 612; https://doi.org/10.3390/ijerph23050612 - 5 May 2026
Abstract
Integrated care programs (ICPs) are associated with positive patient experiences, but provider experiences remain understudied. We examined burnout in healthcare providers working in an ICP that facilitates hospital-to-home care transitions for patients. We conducted a mixed-methods evaluation comprising a cross-sectional survey of burnout
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Integrated care programs (ICPs) are associated with positive patient experiences, but provider experiences remain understudied. We examined burnout in healthcare providers working in an ICP that facilitates hospital-to-home care transitions for patients. We conducted a mixed-methods evaluation comprising a cross-sectional survey of burnout and provider experience using the Maslach Burnout Inventory, open-ended questions, and semi-structured interviews. Twenty-eight participants completed the surveys (31% response rate). Respondents were 75% female, and, on average, were 42 ± 10 years old, had spent 19 ± 11 months as providers in the ICP and had cared for a median of 170 (IQR = 245) patients. Twenty staff, who were 38 ± 8 years old on average and 95% women, were interviewed. Emotional exhaustion was low (average total score = 14 ± 7 out of 42), depersonalization was moderate (9 ± 6 out of 42), and personal achievement was high (40 ± 5 out of 48), corresponding to low-to-moderate burnout. Respondents cited teamwork as the leading protective factor against emotional exhaustion and positive impact on patients as the leading factor underlying high personal achievement. Perceived under-appreciation was the leading factor for depersonalization, likely moderated by team support and rapport. Burnout was low to moderate in our sample of ICP healthcare providers, who cited several important contextual factors requiring further study.
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(This article belongs to the Topic Health Services Optimization, Improvement, and Management: Worldwide Experiences)
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Open AccessArticle
Effects of Moderate-Intensity Aerobic Exercise on Clinical Symptoms and Physiological Outcomes in Young Adults with Persistent Allergic Rhinitis: A Randomized Controlled Trial
by
Kanphatson Kerdkaew, Phisut Rattanathamma, Wannaporn Tongtako, Timothy Mickleborough and Bulin Jirapongsatorn
Int. J. Environ. Res. Public Health 2026, 23(5), 611; https://doi.org/10.3390/ijerph23050611 - 5 May 2026
Abstract
Allergic Rhinitis (AR) is an IgE-mediated inflammatory disorder that impairs quality of life and systemic function. Following the ‘one airway, one disease’ paradigm, AR-related inflammation often extends to the lower respiratory tract. This randomized controlled trial investigated the effects of an 8-week moderate-intensity
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Allergic Rhinitis (AR) is an IgE-mediated inflammatory disorder that impairs quality of life and systemic function. Following the ‘one airway, one disease’ paradigm, AR-related inflammation often extends to the lower respiratory tract. This randomized controlled trial investigated the effects of an 8-week moderate-intensity aerobic exercise (MOA) program on clinical symptoms, nasal airflow, airway inflammation, pulmonary function, and cardiorespiratory parameters in young adults with physician-confirmed persistent AR. To isolate the exercise effects, all participants discontinued antihistamines, corticosteroids, and leukotriene antagonists before and during the study period. Eighteen participants were allocated to either the MOA group (n = 9), which performed treadmill walking or jogging at 50–60% heart rate reserve three times per week for eight weeks, or a control group (CON, n = 9) that maintained usual daily activities. Clinical symptoms, peak nasal inspiratory flow, fractional exhaled nitric oxide, pulmonary function, heart rate, blood pressure, aerobic fitness, and perceived exertion were assessed at baseline, week 4, and week 8 using standardized procedures. Compared with baseline and the CON group, the exercise intervention resulted in significant reductions in nasal congestion, itching, sneezing, and rhinorrhea, accompanied by increased nasal airflow and reduced airway inflammation. Pulmonary function indices and cardiorespiratory parameters also improved following training. These findings suggest that moderate-intensity aerobic exercise may offer a valuable non-pharmacological approach to support conventional care, potentially enhancing respiratory and physiological outcomes in young adults with persistent AR.
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(This article belongs to the Special Issue Physical Activity Promotion and Exercise Intervention for Persons with Chronic Disease)
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Open AccessReview
Photobiomodulation and Wearable Light Therapies: A Bibliometric Analysis of the Scientific Literature (1970–2025)
by
Alberto Grossi, Francesca Campoli, Giuseppe Messina, Giuseppe Caminiti, Matteo Vitarelli, Gabriele Morganti, Elvira Padua and Bruno Ruscello
Int. J. Environ. Res. Public Health 2026, 23(5), 610; https://doi.org/10.3390/ijerph23050610 - 5 May 2026
Abstract
Background: This study aims to map the temporal evolution of light-based therapies and identify emerging technological trends in wearable photobiomodulation (PBM) devices. Materials and Methods: A bibliometric analysis (1970–2025) was conducted using three major databases: Scopus, PubMed, and Web of Science. The initial
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Background: This study aims to map the temporal evolution of light-based therapies and identify emerging technological trends in wearable photobiomodulation (PBM) devices. Materials and Methods: A bibliometric analysis (1970–2025) was conducted using three major databases: Scopus, PubMed, and Web of Science. The initial dataset, consisting of 117 articles, was processed using the Bibliometrix package in R (version 4.5.0), resulting in a final set of 110 articles. The analysis followed the TALL model (Tracking, Analysis, Layout, and Learning). Results: Scientific production on phototherapeutic devices began in the early 2000s, peaking in 2024, showing a productivity pattern typical of emerging or highly specialized fields. The period 2010–2023 represents a central thematic hub in research. During this time, new light sources (OLED and QLED) enabled the development of flexible, wearable, and implantable photonic devices. In the recent period (2024–2025), light-based therapies are increasingly integrated with network-connected biosensing systems for tissues or accessories, allowing adaptive treatments and remote monitoring. However, these next-generation devices are still undergoing consolidation and scientific maturation. Conclusions: The results highlight the rapid evolution of research on light-based therapies toward more integrated and clinically validated approaches, indicating growing scientific interest in personalized wearable PBM devices.
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(This article belongs to the Topic Smart Healthcare: Technologies and Applications, 2nd Edition)
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