International Journal of Environmental Research and Public Health

12 pages, 427 KB

Open AccessArticle

Impact of Pre-Diagnosed Depressive Symptoms on Treatment Choice, Delay in Initiating Treatment, and Mortality Among Women Aged ≥65 Years with Breast Cancer

by David Gbogbo, Rima Tawk, Askal A. Ali, Carlos A. Reyes-Ortiz and Gebre-Egziabher Kiros

Int. J. Environ. Res. Public Health 2026, 23(3), 361; https://doi.org/10.3390/ijerph23030361 - 12 Mar 2026

Abstract

Studies that have sought to describe and account for pre-diagnosed depressive symptoms on BC treatment choice, delay in initiating treatment, and mortality have been inconsistent. The purpose of the study is to examine the association between pre-diagnosed depressive symptoms and their impact on [...] Read more.

Studies that have sought to describe and account for pre-diagnosed depressive symptoms on BC treatment choice, delay in initiating treatment, and mortality have been inconsistent. The purpose of the study is to examine the association between pre-diagnosed depressive symptoms and their impact on breast cancer (BC) treatment, treatment delays, and mortality. We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results–Medicare Health Outcomes Survey (SEER-MHOS) dataset among women aged 65 years and older diagnosed with BC. Among 3840 eligible patients, 28.1% had pre-diagnosed depressive symptoms. Patients with pre-diagnosed depressive symptoms who were diagnosed with early-stage BC were significantly more likely (OR = 1.52; 95% CI: 1.26–1.84) to undergo mastectomy or receive breast-conserving surgery (BCS) alone rather than BCS plus radiation therapy (RT) compared to patients who were not pre-diagnosed with depressive symptoms. Among patients with advanced-stage BC, pre-diagnosed depressive symptoms were not significantly associated with treatment type. Among Hispanic patients, pre-diagnosed depressive symptoms were associated with treatment delays. Overall, patients with pre-diagnosed depressive symptoms had a 16% increased adjusted risk of BC-related mortality compared to those who were not pre-diagnosed with depressive symptoms, and those with advanced-stage cancer had an 18% higher adjusted risk of death than early-stage BC. Conclusions: Overlooking depressive symptoms management prior to a breast cancer diagnosis may result in poorer survival outcomes. Early detection and consistent management of depression are critical for improving patient survival. Full article

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

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15 pages, 300 KB

Open AccessArticle

Absence of a Written Employment Contract and Health Outcomes Among Employed Adults in Chile

by Gonzalo Bravo-Rojas, Maythe Páez-Guajardo, Carlos Viviani and Ignacio Castellucci

Int. J. Environ. Res. Public Health 2026, 23(3), 360; https://doi.org/10.3390/ijerph23030360 - 12 Mar 2026

Abstract

Precarious and informal employment has been increasingly recognized as a key social determinant of health, particularly in countries of the Global South. In Chile, despite relatively strong labor institutions, informal employment remains widespread, yet contemporary evidence on its health implications is limited. This [...] Read more.

Precarious and informal employment has been increasingly recognized as a key social determinant of health, particularly in countries of the Global South. In Chile, despite relatively strong labor institutions, informal employment remains widespread, yet contemporary evidence on its health implications is limited. This study examines the association between the absence of a written employment contract, used as an indicator of labor informality, and multiple health and well-being outcomes among employed adults in Chile. A cross-sectional analysis was conducted using data from the nationally representative 2022–2023 National Health and Sexuality Survey (ENSEX), restricted to the urban employed population (n = 5193). Informal employment was defined by self-reported absence of a written contract. Health outcomes included perceived general health, quality of life, physician-diagnosed conditions, and recent anxiety–depressive symptoms assessed with the PHQ-4. Weighted descriptive analyses and logistic regression models were estimated, accounting for the complex survey design and adjusting for sex, age, and educational level. Approximately 12.8% of employed individuals reported not having a written contract. Contract absence was associated with higher odds of anxiety–depressive symptoms and lower odds of reporting good quality of life after adjustment. Associations with general health and chronic physical conditions were weaker and not statistically significant. These findings suggest that contractual informality is particularly linked to reduced psychological well-being and quality of life, highlighting the relevance of informal employment as a public health concern beyond traditional disease outcomes. Full article

(This article belongs to the Special Issue Occupational Risks, Health Risk Assessments, Social Inclusion and Well-Being of Informal Workers)

19 pages, 322 KB

Open AccessArticle

Student Perspectives on a Smoothie-Based Educational Program Designed Using Social Cognitive Theory and Choice Architecture

by Amelia Sullivan, Bryn Kubinsky, Emma Watras, Kathyrn Yerxa, Kayla Gayer, Elizabeth Hufnagel, Kathleen A. Savoie and Jade McNamara

Int. J. Environ. Res. Public Health 2026, 23(3), 359; https://doi.org/10.3390/ijerph23030359 - 12 Mar 2026

Abstract

Background/Objective: Helping Early Adolescents Live Their Healthiest Youth (HEALTHY) is a four-session, smoothie-based nutrition education program grounded in Social Cognitive Theory (SCT) and Choice Architecture, designed to promote nutrition security among rural adolescents. This study examined students’ experiences with the program, including perceptions [...] Read more.

Background/Objective: Helping Early Adolescents Live Their Healthiest Youth (HEALTHY) is a four-session, smoothie-based nutrition education program grounded in Social Cognitive Theory (SCT) and Choice Architecture, designed to promote nutrition security among rural adolescents. This study examined students’ experiences with the program, including perceptions of likeability and perceived learning, as well as the theoretical mechanisms shaping engagement. Methods: A mixed-methods evaluation was conducted in two rural middle schools where the programming was delivered. Process indicators were assessed using brief paper-based surveys administered after each program session. Quantitative items captured likability and willingness to consume smoothies again (at home or school lunch), and qualitative open-ended responses were analyzed inductively. Post-program focus groups were conducted with a subsample of participants (N = 18) and analyzed deductively using a coding framework aligned with SCT constructs. Results: Across sessions, students (N = 360) reported high smoothie likeability, with fewer than 15% indicating dislike of any recipe. Willingness to consume smoothies again remained high, with affirmative responses ranging from 72% to 94% at home and 79% to 97% at school lunch. Inductive thematic analysis indicated that 53% of survey responses reflected session-aligned nutrition knowledge, along with themes related to acceptability and suggestions for improvement. Focus group findings reflected multiple SCT constructs, including knowledge awareness, self-efficacy, and goal-setting, as well as environmental influences regarding engagement, consistent with Choice Architecture. Conclusions: Findings indicate that the HEALTHY program was well received by rural adolescents and reflected key theoretical mechanisms underlying its design. Student feedback guides future program refinement. Full article

18 pages, 636 KB

Open AccessArticle

Identity Resilience, Community Connectedness, and Sociosexuality Among Gay and Bisexual Men: The Mediating Effect of Internalized Homonegativity

by Anthony J. Gifford and Rusi Jaspal

Int. J. Environ. Res. Public Health 2026, 23(3), 358; https://doi.org/10.3390/ijerph23030358 - 12 Mar 2026

Abstract

Sociosexuality refers to the proclivity to engage in casual sex without commitment and is generally operationalized in terms of attitudes, behavior, and desire. Moving beyond the dominant focus on sexual risk and pathology in studies of sociosexuality, this study conceptualizes sociosexuality as a [...] Read more.

Sociosexuality refers to the proclivity to engage in casual sex without commitment and is generally operationalized in terms of attitudes, behavior, and desire. Moving beyond the dominant focus on sexual risk and pathology in studies of sociosexuality, this study conceptualizes sociosexuality as a positive psychological variable that reflects the enactment of sexual identity among gay and bisexual men. Using cross-sectional correlational survey data from 512 gay and bisexual men in the United Kingdom, the direct associations between sociosexuality and identity resilience and LGBT+ community connectedness, and indirect associations through the mediation of internalized homonegativity, were examined. Results showed that identity resilience was indirectly associated with higher sociosexuality via decreased internalized homonegativity, and that LGBT+ community connectedness was directly and positively associated with sociosexuality and indirectly via decreased internalized homonegativity. The findings suggest that the adaptive self-schema of identity resilience and the adaptive relational schema of community connectedness may militate against internalized homonegativity, which in turn may facilitate sociosexuality among gay and bisexual men. Interventions to support sexual identity enactment should therefore focus on developing these adaptive schemas. Full article

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17 pages, 477 KB

Open AccessArticle

Professional Pride During COVID-19 in a Cohort of Healthcare Workers

by Tanis Zadunayski, Anil Adisesh, France Labrèche, Shannon M. Ruzycki and Nicola Cherry

Int. J. Environ. Res. Public Health 2026, 23(3), 357; https://doi.org/10.3390/ijerph23030357 - 11 Mar 2026

Abstract

We aimed to identify circumstances associated with feelings of pride in healthcare workers (HCWs) during the COVID-19 pandemic. A prospective cohort of Canadian HCWs reported pride-reinforcing events in April 2020 (Phase 1). In spring/summer 2022 (Phase 4), they completed a self-reported retrospective comparison [...] Read more.

We aimed to identify circumstances associated with feelings of pride in healthcare workers (HCWs) during the COVID-19 pandemic. A prospective cohort of Canadian HCWs reported pride-reinforcing events in April 2020 (Phase 1). In spring/summer 2022 (Phase 4), they completed a self-reported retrospective comparison rating of whether they ‘now feel more [professional] pride than before the pandemic’. Among 4964 HCWs, 4360 (88%) described pride-reinforcing events in Phase 1; 3926 (79%) rated feeling more professional pride than before the pandemic in Phase 4. Teamwork (34%) and public appreciation (13%) were most cited in Phase 1. At Phase 4, male and older HCWs and community-based staff reported feeling more pride. Working as a physician, in hospital, with COVID-19 patients, and early anxiety/depression were associated with lower pride. Higher ratings were associated with greater organizational support. Many HCWs reported feeling more professional pride than before the pandemic. External support may help mitigate negative feelings. Full article

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

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15 pages, 767 KB

Open AccessArticle

Development and Psychometric Testing of an Infectious Disease Knowledge Questionnaire in a Convenience Sample

by Selda Seçginli, Nesrin İlhan, Gizemnur Torun, Merve Altıner Yaş and Seda Doğru Bolat

Int. J. Environ. Res. Public Health 2026, 23(3), 356; https://doi.org/10.3390/ijerph23030356 - 11 Mar 2026

Abstract

Objective: This study aimed to develop the Infectious Diseases Knowledge Questionnaire (IDKQ) and evaluate its psychometric properties for use in community settings. Methods: This methodological study was conducted with 533 adults aged ≥ 18 years. Data were collected using a sociodemographic information form [...] Read more.

Objective: This study aimed to develop the Infectious Diseases Knowledge Questionnaire (IDKQ) and evaluate its psychometric properties for use in community settings. Methods: This methodological study was conducted with 533 adults aged ≥ 18 years. Data were collected using a sociodemographic information form and the IDKQ. Content validity was assessed by expert evaluation. Construct validity was examined using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Reliability was evaluated through item–total correlations, internal consistency (KR-20), test–retest reliability, and intraclass correlation coefficients (ICC). Data analyses were performed using SPSS 25.0 and AMOS 21.0. Results: Content validity index values ranged from 0.94 to 1.00. EFA revealed a four-factor structure consisting of 17 items, explaining 45.66% of the total variance (KMO = 0.784; Bartlett’s test, p < 0.001). CFA demonstrated good model fit (χ²/df = 2.329, RMSEA = 0.074, CFI = 0.946, AGFI = 0.847, GFI = 0.887, SRMR = 0.045). The KR-20 coefficient was 0.735, the test–retest correlation was 0.604, and the ICC was 0.781. Conclusions: The IDKQ demonstrates acceptable internal consistency and moderate temporal stability, providing preliminary evidence of reliability and construct validity. It may serve as a tool for assessing infectious disease knowledge, although further validation in independent samples is recommended. Full article

(This article belongs to the Section Infectious Diseases, Chronic Diseases, and Disease Prevention)

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15 pages, 338 KB

Open AccessReview

The Role of Omega-3 Polyunsaturated Fatty Acids on Sarcopenia and Aging Muscle

by Behzad Varamini, Jonah O. Yang, Benjamin J. Merry and Daniel J. Dau

Int. J. Environ. Res. Public Health 2026, 23(3), 355; https://doi.org/10.3390/ijerph23030355 - 11 Mar 2026

Abstract

Sarcopenia, characterized by the progressive loss of skeletal muscle mass, strength, and function, represents a major public health challenge in aging populations. This condition affects approximately 10–16% of community-dwelling older adults and is associated with increased risks of falls, frailty, functional decline, and [...] Read more.

Sarcopenia, characterized by the progressive loss of skeletal muscle mass, strength, and function, represents a major public health challenge in aging populations. This condition affects approximately 10–16% of community-dwelling older adults and is associated with increased risks of falls, frailty, functional decline, and mortality. The pathogenesis of sarcopenia involves chronic low-grade inflammation (inflammaging), oxidative stress, mitochondrial dysfunction, and anabolic resistance. Omega-3 polyunsaturated fatty acids (PUFAs), particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have emerged as promising nutritional interventions due to their anti-inflammatory properties and potential anabolic effects on skeletal muscle. This comprehensive review evaluates the current evidence on omega-3 PUFA supplementation for the attenuation and management of sarcopenia. Mechanistically, omega-3 PUFAs appear to enhance muscle protein synthesis through activation of the mTOR-p70S6K signaling pathway, reduce inflammation via specialized pro-resolving mediators (SPMs), improve mitochondrial bioenergetics, and attenuate muscle disuse atrophy. Clinical trials demonstrate that omega-3 supplementation, particularly at doses exceeding 2 g/day of combined EPA and DHA, can increase thigh muscle volume, handgrip strength, and one-repetition maximum strength in older adults. When combined with resistance exercise training, the benefits appear more pronounced, especially in women. However, heterogeneity in study designs, intervention durations, dosages, and outcome measures has produced some conflicting results. Large-scale trials, such as the MAPT study, have shown null findings for long-term supplementation alone, suggesting that omega-3s may be most effective as part of multimodal interventions. The evidence also supports benefits in clinical populations at risk for muscle wasting, including cancer patients experiencing cachexia and individuals with neuromuscular disorders. Future research should focus on identifying optimal dosing strategies, understanding sex-specific responses, and elucidating the mechanisms underlying the synergistic effects of omega-3s with exercise. Overall, omega-3 PUFA supplementation represents a safe, accessible, and potentially effective nutritional strategy for attenuating muscle decline in aging and clinical populations, though its benefits appear most pronounced when combined with resistance exercise as part of a multimodal approach. Full article

(This article belongs to the Topic Endurance and Ultra-Endurance: Implications of Training, Recovery, Nutrition, and Technology on Performance and Health)

13 pages, 368 KB

Open AccessArticle

Competitive Anxiety as a Predictor of the Occurrence, Quantity, and Severity of Injuries in Young Cuban Athletes

by Jesús Ríos-Garit, Yanet Pérez-Surita, Verónica Gómez-Espejo, Mario Reyes-Bossio and Verónica Tutte-Vallarino

Int. J. Environ. Res. Public Health 2026, 23(3), 354; https://doi.org/10.3390/ijerph23030354 - 11 Mar 2026

Abstract

Previous studies suggest that elevated competitive anxiety may increase the likelihood of injury. The present research aims to examine the role of competitive anxiety as a predictor of injury occurrence, frequency, and severity. A cross-sectional, correlational design was conducted with 131 athletes (mean [...] Read more.

Previous studies suggest that elevated competitive anxiety may increase the likelihood of injury. The present research aims to examine the role of competitive anxiety as a predictor of injury occurrence, frequency, and severity. A cross-sectional, correlational design was conducted with 131 athletes (mean age = 16.49 years), predominantly male. Injury data were obtained through medical record review, and competitive anxiety was assessed using the Competitive Anxiety Inventory-2. Empirical frequency distributions, descriptive statistics, non-parametric tests, and logistic and ordinal regression models were employed. A high incidence of injuries was observed, although most were minor. Competitive anxiety was characterized by elevated levels of cognitive anxiety and self-confidence. Injured athletes exhibited greater overall competitive anxiety (r = 0.31, p < 0.001), with higher levels observed among those who sustained more injuries (ε² = 0.12, p = 0.001), and a very large effect was found in relation to injury severity (ε² = 0.17, p < 0.001). The occurrence of injury can only be predicted in 10.9–14.7% of cases through increased cognitive and somatic anxiety, whereas an increase across all dimensions of competitive anxiety predicts a greater number (13–14%) and severity (20.3–21.8%) of injuries. These findings underscore the importance of developing skills to manage competitive anxiety, particularly its cognitive dimension and maintaining optimal levels of self-confidence in young athletes. Full article

(This article belongs to the Special Issue Mental Health in Sport Injury and Rehabilitation: Intersecting Public Health Concerns)

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17 pages, 669 KB

Open AccessArticle

Assessing Surgical Capacity in Guam: Current Strengths and Future Goals

by Ryan V. Benavente, Eduardo B. Biala, Jr., Brandon A. Lopez, Megan Y. Gimmen, Eric T. Pineda, John Reinier F. Narvaez, Russell K. Woo, Neal A. Palafox and Lee E. Buenconsejo-Lum

Int. J. Environ. Res. Public Health 2026, 23(3), 353; https://doi.org/10.3390/ijerph23030353 - 11 Mar 2026

Abstract

Introduction: Guam, the largest U.S. territory in Micronesia, plays a central role in surgical care for the local indigenous community and surrounding Pacific Island nations, yet remains underrepresented in surgical systems research. Methods: We conducted a mixed-methods study. Quantitative data were collected on [...] Read more.

Introduction: Guam, the largest U.S. territory in Micronesia, plays a central role in surgical care for the local indigenous community and surrounding Pacific Island nations, yet remains underrepresented in surgical systems research. Methods: We conducted a mixed-methods study. Quantitative data were collected on operating volume, personnel, infrastructure, and surgical services at Guam Memorial Hospital (GMH) and Guam Regional Medical City (GRMC). Semi-structured interviews with hospital leadership and surgical providers captured qualitative insights on strengths, challenges, and future plans. Results: GMH and GRMC collectively provide general emergency, obstetric, and basic pediatric surgery, although advanced subspecialty and oncologic care remain limited. Although surgeons are highly adaptable with broad-practice capability, challenges, including resource limitations, aging facilities, advanced presentation, and subspecialty recruitment, limit the cases that are operable on Guam, resulting in expensive medical transfer. Anticipated stressors such as oncologic and non-communicable disease burden may further strain the system, emphasizing the necessity for modernized facilities and targeted recruitment of surgeons with regional ties. Conclusion: Strengthening Guam’s surgical capacity is essential for the provision of oncologic care and the advancement of health equity across the Pacific region, emphasizing an urgent need for investment in infrastructure, locally relevant workforce training, and regional policy development. Full article

(This article belongs to the Special Issue Cancer Health Disparities in Prevention and Care)

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21 pages, 784 KB

Open AccessArticle

Assessment of Pregnant Women’s Knowledge, Attitudes, and Habits Regarding Oral Health: Development and Validation of a Measurement Instrument

by Helena Glibotić Kresina, Ivana Dabo, Sandro Kresina, Elizabeta Dadić Hero, Sara Kresina, Danko Bakarčić, Martina Mavrinac and Neda Smiljan Severinski

Int. J. Environ. Res. Public Health 2026, 23(3), 352; https://doi.org/10.3390/ijerph23030352 - 11 Mar 2026

Abstract

Oral health during pregnancy is a critical factor in preventing caries in both mothers and children. Croatia currently lacks validated psychometric instruments for reliably assessing knowledge, attitudes, and oral hygiene practices in the general population. This study aimed to develop and provide initial [...] Read more.

Oral health during pregnancy is a critical factor in preventing caries in both mothers and children. Croatia currently lacks validated psychometric instruments for reliably assessing knowledge, attitudes, and oral hygiene practices in the general population. This study aimed to develop and provide initial psychometric evidence for a comprehensive instrument for this purpose in Croatia, with potential relevance for future cross-cultural adaptation. Following Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines, an initial item pool was generated through literature review and expert consultation. The study was conducted from May 2024 to February 2025 in primary healthcare settings across Primorje-Gorski Kotar County (PGC). The validation study included 319 pregnant women. Exploratory factor analysis (EFA) revealed a six-factor structure with acceptable to strong factor loadings (ranging from 0.423 to 0.984). The instrument showed acceptable to good internal consistency (Cronbach’s α = 0.61–0.87) and excellent test–retest reliability (Pearson r = 0.993). Results indicated that knowledge about oral health was independent of attitudes and practices during pregnancy. Regression analyses were exploratory and did not provide evidence of predictive validity at this stage, suggesting that additional contextual and psychosocial factors should be considered in future modelling. The present study provides initial psychometric evidence supporting the proposed structure and reliability of the instrument; however, further confirmatory and longitudinal validation studies are required before broader implementation and generalization can be fully justified. Full article

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17 pages, 953 KB

Open AccessArticle

Socioeconomic Interventions for WHO’s End TB Strategy Targets: Insights from SIR Modelling in Kazakhstan

by Temirlan Ukubayev, Berik Koichubekov, Marina Sorokina and Donatas Austys

Int. J. Environ. Res. Public Health 2026, 23(3), 351; https://doi.org/10.3390/ijerph23030351 - 11 Mar 2026

Abstract

Background: Tuberculosis remains a major global public health challenge. Mathematical models are essential for strategic planning and evaluation of tuberculosis control programs, while addressing socioeconomic risk factors has proven key to accelerating incidence declines. Therefore, this study quantitatively assesses the impact of socioeconomic [...] Read more.

Background: Tuberculosis remains a major global public health challenge. Mathematical models are essential for strategic planning and evaluation of tuberculosis control programs, while addressing socioeconomic risk factors has proven key to accelerating incidence declines. Therefore, this study quantitatively assesses the impact of socioeconomic interventions on tuberculosis incidence in Kazakhstan. Methods: A modified SIR compartmental model was developed in Python 3.12 to simulate tuberculosis transmission dynamics. Parameters were calibrated using the Nelder–Mead simplex algorithm, and predictive performance was evaluated via hold-out validation. Scenario-based projections were generated to explore the impact of socioeconomic improvements on future tuberculosis incidence. Results: The calibrated SIR model demonstrated strong predictive accuracy, achieving a mean absolute percentage error of 2.3%. The sensitivity analysis revealed that the model is robust to moderate socioeconomic perturbations, with healthcare funding and unemployment rate as the primary uncertainty drivers. Scenario simulations showed that enhanced financial assistance for tuberculosis patients produced the largest effect beyond baseline. Optimization results indicate that 7.4% rise in GDP per capita, 10.2% increase in healthcare funding, 23.1% and 19.1% reductions in poverty and unemployment rates, and 40.2% growth in tuberculosis patient financial support relative to 2024 are sufficient to achieve the WHO’s End TB Strategy 2030 target. Conclusions: The model offers a valuable tool for tuberculosis forecasting and intervention evaluation, highlighting the synergistic role of socioeconomic measures in achieving global elimination goals. Full article

(This article belongs to the Section Infectious Diseases, Chronic Diseases, and Disease Prevention)

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31 pages, 874 KB

Open AccessArticle

Impact of the Osijek Multidisciplinary Biopsychosocial Program on Chronic Low Back Pain: A Prospective Randomized Controlled Study

by Dijana Hnatešen, Ivan Radoš, Iva Dimitrijević, Dino Budrovac, Vanja Matković and Ivana Gusar

Int. J. Environ. Res. Public Health 2026, 23(3), 350; https://doi.org/10.3390/ijerph23030350 - 11 Mar 2026

Abstract

This study aimed to assess the relative impact of the Osijek multidisciplinary biopsychosocial program for chronic low back pain (CLBP) compared with standard multimodal care with respect to pain intensity, disability, health-related quality of life, anxiety, depression, stress, and sleep quality using standardized [...] Read more.

This study aimed to assess the relative impact of the Osijek multidisciplinary biopsychosocial program for chronic low back pain (CLBP) compared with standard multimodal care with respect to pain intensity, disability, health-related quality of life, anxiety, depression, stress, and sleep quality using standardized self-assessment questionnaires and a smartwatch. A total of 128 patients treated at the Department of Pain Management, University Hospital Osijek, were randomly allocated to two groups. The multidisciplinary biopsychosocial group participated in a structured four-week program combining education, exercise, and individualized multidisciplinary care, while the multimodal group received conventional conservative treatment including pharmacotherapy and selected physical therapy modalities. The four-week intervention included standardized self-report questionnaires, a sociodemographic data form, and a Fitbit Charge 3 smartwatch for objective monitoring of sleep and physical activity. A significant reduction in pain intensity was observed across numerical scales and most questionnaire measures (Wilcoxon test, p < 0.01), except for the subscale assessing difficulties in performing daily activities due to sleep deprivation. Participants who underwent the multidisciplinary biopsychosocial treatment exhibited significant improvements (p < 0.03) in pain intensity, disability, health-related quality of life, stress, anxiety, and sleep quality compared with those receiving multimodal treatment. In both groups, a weak negative correlation was found between sleep quality and daily step count (Spearman’s rho = −0.234, p = 0.04). A multidisciplinary biopsychosocial program was associated with greater improvements in health-related quality of life, psychological well-being, and sleep quality in patients with chronic low back pain compared with a multimodal conservative approach. Increased daily physical activity was linked to improvements in anxiety and sleep. Although this study was designed as a randomized controlled trial, certain baseline differences between groups should be considered when interpreting the findings. Full article

(This article belongs to the Special Issue Exploring Quality of Life in Nursing and Patient Care)

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21 pages, 369 KB

Open AccessArticle

How Mothers and Childfree Women Redefine Fulfillment: A Comparative Study of Life and Marital Satisfaction in a Pronatalist Society

by Sinem Burcu Uğur, Nehir Yasan-Ak, Aylin Çiçekli and Seda Tan

Int. J. Environ. Res. Public Health 2026, 23(3), 349; https://doi.org/10.3390/ijerph23030349 - 10 Mar 2026

Abstract

In pronatalist societies where motherhood remains symbolically central to feminine identity, women’s well-being is shaped by gendered expectations surrounding reproduction. Within such contexts, understanding how different reproductive trajectories relate to marital and life satisfaction becomes particularly important. This study compared the marital and [...] Read more.

In pronatalist societies where motherhood remains symbolically central to feminine identity, women’s well-being is shaped by gendered expectations surrounding reproduction. Within such contexts, understanding how different reproductive trajectories relate to marital and life satisfaction becomes particularly important. This study compared the marital and life satisfaction of mothers and voluntarily childless women in Türkiye, a pronatalist society. A sequential explanatory mixed-method design was employed. Quantitative data were collected from 178 employed married women (31 voluntarily childless, 147 mothers) using standardized life and marital satisfaction scales. This was followed by in-depth interviews with 22 participants (11 from each group). The quantitative findings indicated no statistically significant differences in marital or life satisfaction between the two groups. However, qualitative analysis revealed that comparable experiences of satisfaction were constructed through distinct normative pathways. Mothers derived fulfillment from culturally validated maternal identities despite increased responsibilities, whereas childfree women constructed satisfaction around autonomy, relational equality, and deliberate ethical choice within a pronatalist context. While voluntary childlessness broadens the repertoire of feminine identities, motherhood remains a powerful symbolic reference point for both groups. Rather than signaling the erosion of pronatalist norms, the findings suggest their ongoing renegotiation within contemporary Turkish society. These dynamics underscore the importance of addressing role-based stigma and supporting diverse reproductive choices in efforts to promote women’s psychological well-being and social equity. Full article

(This article belongs to the Special Issue Reproductive Health Decision-Making Among Women and Couples)

18 pages, 445 KB

Open AccessArticle

Information Needs of Culturally and Linguistically Diverse Women with Endometriosis in Australia: A Qualitative Study

by Deniz Senyel, James H. Boyd and Melissa Graham

Int. J. Environ. Res. Public Health 2026, 23(3), 348; https://doi.org/10.3390/ijerph23030348 - 10 Mar 2026

Abstract

Culturally and linguistically diverse (CALD) women make up an important population of women with endometriosis in Australia. However, their experiences with the condition, particularly regarding their experiences with information on endometriosis, have not yet been studied. This qualitative descriptive study aimed to explore [...] Read more.

Culturally and linguistically diverse (CALD) women make up an important population of women with endometriosis in Australia. However, their experiences with the condition, particularly regarding their experiences with information on endometriosis, have not yet been studied. This qualitative descriptive study aimed to explore the information needs and preferences of CALD women living with endometriosis. A qualitative descriptive study, using semi-structured individual interviews with 11 CALD women aged 23–46 from Victoria, Australia, was undertaken. The data were analysed using thematic analysis. The women’s information needs focused on disease pathogenesis—including causes, symptoms, and progression—as well as disease management, such as medication and surgery, lifestyle factors, fertility treatment, and mental health support. The women suggested resources should be easy to understand, written in simple English, with minimal text and added visual elements. Stories from other women with endometriosis were also recommended, as were interactive formats that enable women to ask questions. While the women primarily preferred written information, they also welcomed formats such as webinars or workshops. This study highlights a need for improved information for CALD women with endometriosis. Information resources should be designed to meet women’s needs in both content and delivery. Full article

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21 pages, 482 KB

Open AccessReview

Effects of Bathtub Bathing and Sauna Practices on Cardiovascular and Systemic Health: A Narrative Review

by Masayo Nagai and Akiko Tanaka

Int. J. Environ. Res. Public Health 2026, 23(3), 347; https://doi.org/10.3390/ijerph23030347 - 10 Mar 2026

Abstract

Thermal bathing practices, including domestic hot-water immersion and sauna use, have been linked to cardiovascular and systemic health outcomes. However, the amount and type of evidence differ between these practices. This review examines current epidemiological and mechanistic findings and discusses their relevance to [...] Read more.

Thermal bathing practices, including domestic hot-water immersion and sauna use, have been linked to cardiovascular and systemic health outcomes. However, the amount and type of evidence differ between these practices. This review examines current epidemiological and mechanistic findings and discusses their relevance to cardiovascular health. A narrative review was conducted using Ichushi-Web and PubMed. Observational and interventional studies evaluating habitual bathtub bathing or sauna use in relation to physiological or health-related outcomes were included. Studies involving children or pregnant/postpartum women and those without relevant biological endpoints were excluded. In total, 45 studies met the inclusion criteria (17 on bathtub bathing and 28 on sauna use). Studies of habitual bathtub bathing, conducted mainly in Japan, have reported associations with lower arterial stiffness, improved glycemic control, and selected inflammatory or stress-related markers. Experimental work shows that hot-water immersion increases core body temperature, promotes peripheral vasodilation, and induces heat shock protein expression. Sauna bathing, investigated primarily in Finnish prospective cohorts, has been associated with lower cardiovascular and all-cause mortality, as well as favorable inflammatory and endothelial markers. Bathing conditions, age, sex, and cultural context appear to influence these findings. Thermal exposure produces circulatory and molecular responses relevant to cardiovascular regulation. Prospective data support associations between frequent sauna use and long-term outcomes, whereas evidence for domestic bathtub bathing is limited to observational studies of intermediate markers. Further research with clearly defined exposure parameters and clinical endpoints is needed to better understand the long-term cardiovascular implications of habitual thermal practices. Full article

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12 pages, 321 KB

Open AccessArticle

Association Between Daily Steps Measured by Accelerometry and Diabetes in ELSA-Brasil Participants

by Matheus Hortélio, Maria da Conceição Chagas de Almeida, Sheila Maria Alvim de Matos, Cristiano Penas Seara Pitanga, Ciro Oliveira Queiroz and Francisco José Gondim Pitanga

Int. J. Environ. Res. Public Health 2026, 23(3), 346; https://doi.org/10.3390/ijerph23030346 - 10 Mar 2026

Abstract

Diabetes mellitus (DM) is a chronic disease characterized by hyperglycemia and alterations in lipid and protein metabolism. Daily step count, measured using accelerometers integrated into wearable devices with artificial intelligence support, represents an important indicator of physical activity for the prevention and management [...] Read more.

Diabetes mellitus (DM) is a chronic disease characterized by hyperglycemia and alterations in lipid and protein metabolism. Daily step count, measured using accelerometers integrated into wearable devices with artificial intelligence support, represents an important indicator of physical activity for the prevention and management of DM when performed regularly at a minimum daily volume. Objective: We aimed to investigate the association between daily step count and DM and to determine the daily step cutoff point necessary to provide a protective effect among participants in the Longitudinal Study of Adult Health (LSAH). Methods: We performed a cross-sectional study that analyzed data from Wave 3 (2016–2018), including 12,636 participants. DM was the dependent variable, assessed by laboratory tests, and daily step count was the independent variable, measured by accelerometry. Associations were assessed using logistic regression, with odds ratios (ORs) and 95% confidence intervals (CIs). Results: A significant association was observed between daily step count and DM (OR = 0.76; 95% CI: 0.70–0.83). A cutoff point of 6880 steps/day was identified, with an area under the ROC curve of 0.58 (95% CI: 0.57–0.59). Conclusion: Daily step count appears to be associated with a protective effect against DM. Full article

(This article belongs to the Special Issue Physical Activity and Sedentary Behavior Across the Life Course: The Emerging Role of Artificial Intelligence)

16 pages, 720 KB

Open AccessArticle

The Impact of Parental Engagement in an Electronic Health (EHealth) Intervention on Physical Activity, Dietary Behaviors, and Sleep in Preschool-Aged Children

by Peng Zhou, Wenjiao Liu and Di Li

Int. J. Environ. Res. Public Health 2026, 23(3), 345; https://doi.org/10.3390/ijerph23030345 - 10 Mar 2026

Abstract

Background/Objectives: The characterization of varying levels of parental engagement is important for increasing understanding of how to tailor and maximize the effectiveness of parent-based eHealth interventions. In this study, we aimed to determine if parental engagement in the WeChat group of a [...] Read more.

Background/Objectives: The characterization of varying levels of parental engagement is important for increasing understanding of how to tailor and maximize the effectiveness of parent-based eHealth interventions. In this study, we aimed to determine if parental engagement in the WeChat group of a parent-based eHealth intervention affected preschoolers’ physical activity, diet, or sleep. Methods: We utilized baseline, post-test (12 weeks after baseline), and follow-up (12 weeks after post-test measurement) data from the intervention group in a parent-based eHealth intervention concerning children aged from three to six years, designed as a single-blinded randomized controlled trial with two parallel arms to explore the intervention’s influence on preschoolers’ physical activity, diet, and sleep. The parents in the intervention group were categorized into two groups: (1) The actively engaged group (53 parent–child dyads), defined as parents who actively posted and commented on modules at least once a week, either in the WeChat groups or through private messages with the researchers. (2) The lurker group (67 parent–child dyads), defined as parents who only responded to the weekly self-assessment messages and who, aside from this, showed no interaction within WeChat groups and did not privately message the researchers. Preschoolers’ physical activity was measured using ActiGraph wGT3X-BT, while their dietary behaviors and sleep were measured using parent-reported questionnaires. Generalized Estimating Equations using group and time as main effects and adjusted demographic information for covariates were computed to examine the effects of parental engagement in the eHealth intervention on preschoolers’ physical activity, diet, and sleep. Results: At post-test, higher levels of parental engagement were significantly associated with a marked increase in preschoolers’ moderate-to-vigorous and vigorous physical activity, alongside a notable reduction in weekend screen time. Furthermore, active parental engagement was linked to greater decreases in satiety responsiveness, desire to drink, and food fussiness compared to the ‘lurker’ group. However, no significant associations were observed between the level of parental engagement and preschoolers’ sleep-related outcomes. Conclusions: Further research with larger sample sizes and longer durations is needed to better investigate the potential of social media in parent-based interventions for promoting healthy lifestyles in children. Full article

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16 pages, 281 KB

Open AccessArticle

The Association Between Sociodemographic and Socioeconomic Factors and Meeting the Recommended Physical Activity Guidelines in Older Adults in the U.S.

by Betty R. Sierra Tamargo, Pura Rodríguez de la Vega and Noël C. Barengo

Int. J. Environ. Res. Public Health 2026, 23(3), 344; https://doi.org/10.3390/ijerph23030344 - 9 Mar 2026

Abstract

This study aimed to identify socioeconomic and demographic factors associated with meeting the recommended physical activity (PA) guidelines for older adults. This analytical, cross-sectional study used data from the 2022 NHIS, including 8189 older adults (≥65 years). Compliance with aerobic and strengthening PA [...] Read more.

This study aimed to identify socioeconomic and demographic factors associated with meeting the recommended physical activity (PA) guidelines for older adults. This analytical, cross-sectional study used data from the 2022 NHIS, including 8189 older adults (≥65 years). Compliance with aerobic and strengthening PA guidelines was the main outcome variable. Covariates included sex, education, income, relationship status, race, housing stability, urban/rural county, health status, and region. Unadjusted and adjusted logistic regression analyses estimated odds ratios (ORs) and 95% confidence intervals (CIs). Only 14.4% (n = 1235) of older adults met the PA guidelines. Odds of complying decreased by 40% in NH single/multiple races (OR 0.6; 95% CI 0.4–1.0). Men had higher odds (OR 1.4; 95% CI 1.2–1.6) of adhering than women. Compared with those with a bachelor’s degree, the odds of adhering were 1.4 (95% CI 1.2–1.7) for graduate participants, 0.3 (95% CI 0.2–0.4) for participants with less than HS education, 0.4 (95% CI 0.3–0.5) for HS graduates, and 0.7 (95% CI 0.6–0.8) for those with some college education. The odds decreased by 40% for those with an income-to-poverty ratio threshold < 1 (OR 0.6; 95% CI 0.4–0.9), 1–1.99 (OR 0.6; 95% CI 0.4–0.7), and 2–3.99 (OR 0.6; 95% CI 0.5–0.8) compared with ≥5. Healthcare providers should develop targeted interventions to address individuals’ unique circumstances and reduce these inequities. Full article

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

12 pages, 540 KB

Open AccessArticle

Factors Limiting Access to Surgical Treatment of Focal Epilepsy in Kazakh Population

by Mukhit Dossov, Balzhan Kassiyeva, Nazira Bekenova, Assel Baibussinova, Tamara Vochshenkova, Alisher Aitkaliyev, Akmaral Suleimenova and Aigul Kaptagayeva

Int. J. Environ. Res. Public Health 2026, 23(3), 343; https://doi.org/10.3390/ijerph23030343 - 9 Mar 2026

Abstract

Background/Objectives: Effective management represents a real opportunity to reduce the economic burden of focal epilepsy, which leads to the withdrawal of at least 0.7% of the working-age population from the labor force. The aim of this retrospective observational cross-sectional study is to identify [...] Read more.

Background/Objectives: Effective management represents a real opportunity to reduce the economic burden of focal epilepsy, which leads to the withdrawal of at least 0.7% of the working-age population from the labor force. The aim of this retrospective observational cross-sectional study is to identify barriers that limit access to surgical treatment for epilepsy among patients with focal epilepsy in Kazakh population. Methods: Medical reports from epileptologists on 3112 patients of the Epilepsy Center (Astana) in 2024 were reviewed. The study included original information on 1361 patients with a confirmed diagnosis of focal epilepsy, in accordance with ICD-10 codes G40.0–G40.2. Results: Timely detection of focal epilepsy was not associated with socio-demographic or regional factors in our sample. Logistic regression analysis showed that sex and social status did not affect whether patients underwent surgery. However, marital status, employment, and region were significant factors. Married and employed patients had higher odds of remaining non-operated. Among candidates for surgical treatment, 38.68% underwent surgery. Conclusions: The markedly higher odds of remaining non-operated outside Astana point to gaps in referral pathways and service availability, emphasizing the need for a comprehensive approach to managing focal epilepsy in countries undergoing rapid technological development. Full article

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