International Journal of Environmental Research and Public Health

19 pages, 1414 KB

Open AccessArticle

Impacts of Social Environments on Neighborhood Depression Incidence: Fully Accounting for Spatial Effects

by Peter Congdon and Esmail Abdul-Fattah

Int. J. Environ. Res. Public Health 2026, 23(2), 247; https://doi.org/10.3390/ijerph23020247 - 16 Feb 2026

Neighborhood variations in depression, an important aspect of the overall mental health burden, have been linked both to environmental context (e.g., area crime, neighborhood cohesion), and to area socio-demographic composition. Previous models seeking to explain such spatial variations in mental health, such as [...] Read more.

Neighborhood variations in depression, an important aspect of the overall mental health burden, have been linked both to environmental context (e.g., area crime, neighborhood cohesion), and to area socio-demographic composition. Previous models seeking to explain such spatial variations in mental health, such as those based on Bayesian disease mapping, follow a standard approach defined by: spatially stationary effects of area predictors; predictor effects neglecting potential spatial spillover; and a spatially structured residual to account for unmodelled spatial dependencies. In a study of depression incidence in England neighborhoods, we consider the gains from an alternative strategy, allowing nonstationary environmental impacts; spillover effects of environmental factors, and a non-stationary spatial intensity. We focus particularly on impacts of socio-behavioral environments, namely neighborhood cohesion and crime. We find these to be major influences on neighborhood depression incidence, and also find major gains in model performance by explicitly considering non-stationarity and spillovers. Allowing context heterogeneity, varying spatial intensity and spillover are shown to enhance the impacts of socio-behavioral environments on depression incidence, and such findings have broader relevance to disease mapping regression. Public health policy framing may therefore need to be tailored to locally specific environmental impacts, and to inter-agency collaboration across arbitrary boundaries. Full article

(This article belongs to the Special Issue How and Why Do Neighbourhood Environments Affect Population Mental Health?)

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11 pages, 346 KB

Open AccessArticle

Feasibility of Using College Students to Increase Cancer Screening Behaviors Among Their Parents

by Caitlin C. Abar, Logan Robert Kayser, Amanda Lewis, Hannah Randolph and Beau Abar

Int. J. Environ. Res. Public Health 2026, 23(2), 246; https://doi.org/10.3390/ijerph23020246 - 16 Feb 2026

Abstract

This study evaluated the feasibility of using college students to encourage cancer screening among their parents or other close adults. Methods: A sample of college students were surveyed on their willingness to discuss cancer screening with their parents and their perceived importance of [...] Read more.

This study evaluated the feasibility of using college students to encourage cancer screening among their parents or other close adults. Methods: A sample of college students were surveyed on their willingness to discuss cancer screening with their parents and their perceived importance of cancer screening. Individuals reporting high levels (≥7/10) on each were offered a brief intervention (i.e., basic cancer screening information) and a follow-up survey. Results: A total of 189 students completed the baseline survey. A subset of 92 students met intervention criteria (49%), with 54 of 92 accepting (59%). Of those who accepted, 19 of 54 were reached at follow-up (35%). Roughly half of those reached engaged in cancer screening discussions with a parent, most speaking with their mother. Open-ended feedback was positive and commonly focused on the desire for additional knowledge. Conclusions: Results demonstrate that college students are a promising target for future intergenerational intervention work. Full article

(This article belongs to the Collection Health Behaviors, Risk Factors, NCDs and Health Promotion)

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15 pages, 595 KB

Open AccessArticle

Physical Activity During Pregnancy: Associations Between Levels and Types of Physical Activity and Low Back Pain–Related Disability in Portuguese Pregnant Women

by Isabel Teixeira, Paula Clara Santos, Clarinda Festas and Diana Bernardo

Int. J. Environ. Res. Public Health 2026, 23(2), 245; https://doi.org/10.3390/ijerph23020245 - 15 Feb 2026

Abstract

Low back pain (LBP) is one of the most prevalent musculoskeletal conditions during pregnancy and frequently impairs daily living activities and quality of life. The association between different levels and types of physical activity (PA) and LBP-related functional disability remains insufficiently explored. This [...] Read more.

Low back pain (LBP) is one of the most prevalent musculoskeletal conditions during pregnancy and frequently impairs daily living activities and quality of life. The association between different levels and types of physical activity (PA) and LBP-related functional disability remains insufficiently explored. This study aimed to examine the association between PA levels and types and functional disability among pregnant women with LBP. A cross-sectional analytical study was conducted involving 192 Portuguese pregnant women. Data were collected through an online questionnaire comprising the Pregnancy Physical Activity Questionnaire and the Oswestry Disability Index (ODI). Most participants engaged predominantly in light-intensity or sedentary activity (69.1%), with minimal participation in vigorous activity (0.8%). Functional disability was generally mild (mean ODI = 11.5 ± 7.35); however, 42.2% of participants reported moderate disability and 11.0% severe disability. Advancing gestational age showed weak associations with increased domestic activity (r = 0.146, p = 0.044), decreased occupational activity (r = −0.295, p = 0.001), and higher functional disability scores (r = 0.142, p = 0.049). Parity was associated with differences in total PA levels (p = 0.005) and domestic activity (p = 0.001). Higher ODI scores were weakly associated with light-intensity and sedentary activity (r = 0.144, p = 0.047), whereas severe disability demonstrated a moderate association with sedentary behavior (r = 0.529, p = 0.014). Overall, lower levels of PA, particularly sedentary behavior, were weakly associated with higher LBP-related disability; however, the observed associations were generally weak and should be interpreted with caution considering the cross-sectional design. Full article

(This article belongs to the Special Issue Advances in Women’s Health and Pelvic Health: Lifelong Care)

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15 pages, 330 KB

Open AccessArticle

Do Higher-Quality Regulatory Measures Promote a Healthier School Food Environment?

by Ana Carolyne Lima Lino Sandes, Ariene Silvado Carmo, Larissa L. Mendes and Mariana C. de Menezes

Int. J. Environ. Res. Public Health 2026, 23(2), 244; https://doi.org/10.3390/ijerph23020244 - 14 Feb 2026

Abstract

This present study analyzed the association between the presence and quality of regulatory measures and the promotion of healthy eating in canteens of 2241 private elementary and secondary schools located in 27 Brazilian state capitals. Three strategic axes were evaluated: food and nutrition [...] Read more.

This present study analyzed the association between the presence and quality of regulatory measures and the promotion of healthy eating in canteens of 2241 private elementary and secondary schools located in 27 Brazilian state capitals. Three strategic axes were evaluated: food and nutrition education (implementation of actions promoting healthy eating), food commercialization (healthiness index, number of unprocessed, minimally processed or processed foods and culinary preparations based on these foods—UMPCP; ultra-processed foods and culinary preparations based on these foods—UpCP; comparison of UMPCP versus UpCP variety; and prohibition of food sales), and marketing communication strategies (advertising strategies for UMPCP and UpCP). The presence and quality of municipal and state regulations in force up to the month prior to data collection were assessed using a score, with a score ≥8 indicating higher quality. Analyses were conducted using binary logistic regression and adjusted generalized linear models in Stata 17.0. More than half of the canteens (51.1%) were located in areas without regulations, and only 17.8% had high-quality regulations. Canteens in areas with regulations, especially those with a score ≥8, had 1.73 times higher odds of implementing food and nutrition education actions, 2.49 times higher odds of prohibiting the sale of certain foods, and 36% lower odds of selling a higher variety of UpCP compared to UMPCP. The healthiness index was higher, the number of UpCP sold was lower, and the number of UMPCP sold was higher, while the adoption of advertising strategies was less frequent in canteens with higher-quality regulations. These findings indicate that the presence and particularly the quality of regulatory measures is associated with healthier school food environments, highlighting the positive impact of well-structured public policies. Full article

(This article belongs to the Special Issue Bridging the Gap in Studies on the Food Environment: The State of the Art in Low- and Middle-Income Countries (LMICs): 2nd Edition)

16 pages, 332 KB

Open AccessReview

Physical Activity Interventions for Mental Health Among Youth in South Africa: A Scoping Review

by Osia Livhuwani Munyangane, Lebogang Faith Thaga and Ronald Vele

Int. J. Environ. Res. Public Health 2026, 23(2), 243; https://doi.org/10.3390/ijerph23020243 - 14 Feb 2026

Abstract

Mental health problems are increasing among young people in South Africa due to diverse determinants such as, poverty, social shame, and lack of proper access to health services. Although physical activity is a low-cost and non-medical way to help improve mental health, its [...] Read more.

Mental health problems are increasing among young people in South Africa due to diverse determinants such as, poverty, social shame, and lack of proper access to health services. Although physical activity is a low-cost and non-medical way to help improve mental health, its effects in rural areas are still not clearly understood. A scoping review was carried out following the PRISMA-ScR guidelines. We systematically searched three online databases (PubMed, CINAHL, and Google Scholar) for studies published from 2014 through 2025. Studies met eligibility criteria if they targeted youth aged 14–35 years living in rural South Africa and reported on physical activity interventions designed for mental health. Two reviewers independently carried out data extraction and came up with the overall result. Overall, 42,384 records were identified, of which only 12 studies met all the specified criteria. The findings of the study were that participation in organised forms of physical activity (including school-based aerobic sessions, community-based walking groups, and charity training programmes) was associated with reductions in mental health issues. Even with these issues, the findings show that physical activity can be a useful, efficient, and practical way to support mental health among rural South African youth. To improve the evidence, strong trials, community-based plans, and sessions at schools and clinics are needed. In addition, policy cooperation across health, education, and sports sectors is essential for lasting impact. Full article

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

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25 pages, 1065 KB

Open AccessArticle

Objective Physical Activity and Sedentary Behaviour Patterns Among Informal Carers in the BCS70 Cohort

by Eilidh Russell, Alison Kirk, Mark D. Dunlop, Dwight C. K. Tse and Kieren Egan

Int. J. Environ. Res. Public Health 2026, 23(2), 242; https://doi.org/10.3390/ijerph23020242 - 14 Feb 2026

Abstract

While the health benefits of physical activity (PA) and reduced sedentary behaviour (SB) are well established, informal carers remain an under-researched group. Despite being known to face many barriers to PA, informal carers’ activity levels remain unclear due to mixed findings from previous [...] Read more.

While the health benefits of physical activity (PA) and reduced sedentary behaviour (SB) are well established, informal carers remain an under-researched group. Despite being known to face many barriers to PA, informal carers’ activity levels remain unclear due to mixed findings from previous research. Specifically, objective PA and SB levels of informal carers in Great Britain are currently unknown. The aim of this study was to examine PA and SB among informal carers using accelerometer data from the ‘Age 46’ Survey of the 1970 British Cohort Study (BCS70). Analyses of Covariance and Logistic Regressions were performed to: (i) compare carers’ and non-carers’ PA and SB, (ii) examine the impact of caring hours on PA and SB, and (iii) identify predictors of adherence to the UK Chief Medical Officers’ PA guidelines. After adjusting for covariates, (i) no differences were observed in PA or SB outcomes between carers and non-carers (p > 0.05) (e.g., mean daily step count 9316.06 vs. 9554.11 and mean sitting time 1.09 h/day vs. 1.19 h/day, respectively). (ii) Caring hours were not associated with differences in PA or SB (p > 0.05). (iii) Logistic regressions revealed very low adherence to PA guidelines among carers: 2% met the moderate-to-vigorous PA guideline, 26% met the muscle-strengthening guideline, and only 1% met the combined recommendations. Demographic and health variables did not explain adherence to these guidelines. This study found no significant differences in objectively measured PA and SB between informal carers and non-carers or caring hours. However, adherence to the UK CMOs’ PA guidelines among carers was extremely low. These findings provide the first objective benchmark of carers’ PA and SB patterns in Great Britain and highlight guideline adherence as a key area for future interventions. Future research should consider the wider context of caring in order to develop flexible, tailored interventions that can support carers in achieving an active lifestyle whilst managing responsibilities. Full article

(This article belongs to the Special Issue Family Caregiving, Nursing and Health Promotion)

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20 pages, 1139 KB

Open AccessReview

Diversity and Representation in Cardiovascular Research: Evidence Gaps, Emerging Models, and Policy Implications

by Simran Grewal, James Wildish, Catherine Chalmers, Christine Dedding, Jeanine Suurmond, Charles Agyemang and Nimrat Grewal

Int. J. Environ. Res. Public Health 2026, 23(2), 241; https://doi.org/10.3390/ijerph23020241 - 14 Feb 2026

Abstract

Although cardiovascular disease (CVD) is the leading cause of mortality globally, it remains insufficiently understood in large parts of the world. The scientific foundations underpinning CVD risk prediction, diagnostics, and treatment are extensively derived from homogenous datasets, primarily including White, male participants from [...] Read more.

Although cardiovascular disease (CVD) is the leading cause of mortality globally, it remains insufficiently understood in large parts of the world. The scientific foundations underpinning CVD risk prediction, diagnostics, and treatment are extensively derived from homogenous datasets, primarily including White, male participants from high-income countries. This lack of diversity and inclusion can lead to biased evidence, which in turn contributes to reduced diagnostic accuracy and the under-representation of key populations, and ultimately limits the generalizability of trial results and guidelines. In this paper, we discuss that diversity in cardiovascular data is a scientific necessity for valid and globally applicable knowledge and not just a matter of fairness. Drawing from emerging initiatives in genomics, digital health, and participatory research, we propose a global roadmap to reshape how cardiovascular research is conducted. This includes strategies such as data donation frameworks, inclusive biobanking, equitable AI development, and international policy change. Only by integrating diversity into scientific methodologies can we ensure that cardiovascular guidelines are effective, inclusive, and just. Full article

(This article belongs to the Special Issue Inequities in Health and Well-Being)

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16 pages, 882 KB

Open AccessArticle

Factors Associated with Nutritional Status in Grassroots Recyclers in Ecuador: A Machine Learning Approach

by Jenny Albarracín-Méndez, Diana Morales-Avilez, Francisco Arias-Pallaroso, Gabriele Davide Bigoni-Ordoñez and Andrea Gómez-Ayora

Int. J. Environ. Res. Public Health 2026, 23(2), 240; https://doi.org/10.3390/ijerph23020240 - 14 Feb 2026

Abstract

Grassroots recyclers play a fundamental role in solid waste management in Ecuador; however, they often work under precarious conditions that may compromise their health. This study aimed to identify factors associated with nutritional status, operationalized as the presence or absence of nutritional alterations, [...] Read more.

Grassroots recyclers play a fundamental role in solid waste management in Ecuador; however, they often work under precarious conditions that may compromise their health. This study aimed to identify factors associated with nutritional status, operationalized as the presence or absence of nutritional alterations, among grassroots recyclers through supervised machine learning approaches. Data from 303 recyclers from three Ecuadorian cities (Cuenca, Macas, and La Libertad) were analyzed, incorporating sociodemographic, occupational, and health-related variables. Nutritional alterations were defined based on anthropometric and biochemical indicators, specifically, excess body weight and/or elevated total lipid levels. The results showed that 71% presented nutritional alterations, evidencing an important public health problem in this vulnerable population. Significant associations were observed with sex, age, canton of residence, ability to ride a bicycle, bicycle use for work, and attendance at medical check-ups. Among the evaluated models, CatBoost trained with SMOTE achieved the highest ROC-AUC value and the most balanced performance between classes, although sensitivity for individuals without nutritional alterations remained limited. Feature importance analysis highlighted sociodemographic, occupational, economic, and healthcare access factors, underscoring the multidimensional nature of nutritional risk and supporting the use of machine learning as a support tool for public health planning and targeted interventions. Full article

(This article belongs to the Section Global Health)

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13 pages, 357 KB

Open AccessArticle

Domestic Medical Waste Management: An Assessment of Knowledge and Disposal Practices in the City of Tshwane Metropolitan Municipality

by Reneilwe Prudence Mariba, Matodzi Michael Mokoena, Thabiso John Morodi and Gomotsegang Fred Molelekwa

Int. J. Environ. Res. Public Health 2026, 23(2), 239; https://doi.org/10.3390/ijerph23020239 - 14 Feb 2026

Abstract

The improper disposal of domestic medical waste (DMW) constitutes a significant public health and environmental concern; however, limited studies exist concerning DMW disposal practices in South Africa. This study evaluated the knowledge and practices involving the disposal of domestic medical waste (DMW) in [...] Read more.

The improper disposal of domestic medical waste (DMW) constitutes a significant public health and environmental concern; however, limited studies exist concerning DMW disposal practices in South Africa. This study evaluated the knowledge and practices involving the disposal of domestic medical waste (DMW) in the City of Tshwane Metropolitan Municipality. The study investigated common disposal methods, levels of awareness of appropriate techniques, and associated health risks. Data were collected using structured questionnaires (Annexure A) with closed-ended questions, administered both physically at shopping complexes and electronically via LinkedIn, WhatsApp, and email to eligible participants. Data analysis was conducted using the Statistical Package for the Social Sciences (SPSS) Version 29 and Microsoft Excel, with results presented in graphical form. Findings revealed that 78.3% of residents disposed of DMW in general waste bins, while 85.8% reported discarding medicine bottles in the same manner, and only 5.2% returned unused medications to pharmacies. The findings highlight gaps in awareness, infrastructure, and policy, necessitating comprehensive education programs, improved waste management services, and policy revisions to include DMW. A proposed model emphasizes education, community involvement, infrastructure enhancement, and ongoing policy evaluation to address these challenges. These efforts aim to reduce health risks, mitigate environmental impacts, and promote safe DMW disposal practices, safeguarding public health and creating a sustainable environment. Full article

(This article belongs to the Section Environmental Health)

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24 pages, 872 KB

Open AccessArticle

Towards Caring Technologies in Older Adult Care Through the Co-Creation of an Ethical Process Guide

by Elisabeth Honinx, Cato van Schyndel, Arend Roos, Emily Paulding, Toni Wright, Kathleen Galvin, Theofanis Fotis, Jorg Huber, Erik Laes and Nathalie Lambrechts

Int. J. Environ. Res. Public Health 2026, 23(2), 238; https://doi.org/10.3390/ijerph23020238 - 13 Feb 2026

Abstract

As populations age, the gap between care needs and available support systems is widening, leading to critical vulnerabilities in staffing, infrastructure, and funding. The need for accessible, human-centred, and ethically grounded care technologies is growing. However, the development of digital health tools often [...] Read more.

As populations age, the gap between care needs and available support systems is widening, leading to critical vulnerabilities in staffing, infrastructure, and funding. The need for accessible, human-centred, and ethically grounded care technologies is growing. However, the development of digital health tools often lacks inclusivity and practical guidance. Existing ethical frameworks tend to remain abstract, which limits their real-world application. This study examines how such frameworks support the responsible development and implementation of caring technologies in older adult care. To achieve this, in-depth interviews were conducted with care providers, technology developers, and policymakers from partner organisations of the EMPOWERCARE project in the four participating countries: the UK, the Netherlands, Belgium and France. A core challenge was the limited applicability of abstract ethical principles in daily care settings. While existing initiatives often define ethical domains, few offer a structured, actionable process to guide implementation in practice. The proposed guide responds with a step-by-step structure, practical examples, and participatory tools to support inclusive, value-driven technology adoption. It is envisioned both as an implementation aid and a quality label to align stakeholders. Future research should validate the guide’s usability, explore its role across care contexts, and examine how ethics can be more firmly embedded in innovation governance. Full article

(This article belongs to the Special Issue Public Mental Health Promotion for Vulnerable Populations: Opportunities in the Digital Era)

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12 pages, 582 KB

Open AccessArticle

Preliminary Findings of a Chronic Disease Management Program in Medicare Advantage Enrollees with Mild to Moderate Kidney Disease

by Trevon Morales, Rubette Harford, Dulcie Kermah, Jose Flaque, Michelle Camacho, Damaris Vasquez, Vanessa Schmidt, Inés Hernández-Roses, James P. O’Drobinak and Keith C. Norris

Int. J. Environ. Res. Public Health 2026, 23(2), 237; https://doi.org/10.3390/ijerph23020237 - 13 Feb 2026

Abstract

Background: Chronic kidney disease (CKD) is traditionally viewed as a condition marked by a progressive reduction in kidney function leading to the need for kidney dialysis or transplantation. The estimated prevalence of CKD in adults in Puerto Rico is ~20% higher than that [...] Read more.

Background: Chronic kidney disease (CKD) is traditionally viewed as a condition marked by a progressive reduction in kidney function leading to the need for kidney dialysis or transplantation. The estimated prevalence of CKD in adults in Puerto Rico is ~20% higher than that of the overall United States (US). To address the disproportionately high rate of CKD in Puerto Rico, we created a multidisciplinary chronic disease management (CDM) program targeting CKD and diabetes mellitus (DM), the leading CKD risk factor. Methods: Over 7200 eligible enrollees in a Puerto Rico-Managed Medicare Program participated in a CDM program targeting individuals with CKD or DM as determined by administrative review. Evaluations were conducted on 4068 program participants with baseline glomerular filtration rate (eGFR) and codifying CKD stage by eGFR. A dietitian/nurse team provided dietary and lifestyle recommendations to the patient/family and a nephrologist/endocrinologist made diabetes and CKD recommendations to the primary care provider. Findings on 2095 participants with Stages 1–3 CKD with follow-up eGFR at least 6 months but less than 2 years after baseline are presented. Results: At baseline, the mean age was 74 years (range 30–101), 59% of patients were female and mean duration of follow-up from initial evaluation to second evaluation was 407 days (±159 days SD). Most participants had Stage 2 CKD (34.8%), followed by CKD Stage 1 and 3 (33.5 and 31.7%). During the follow-up period, 55.9% of participants with Stage 1 CKD remained in Stage 1, 84.9% of patients with Stage 2 remained in Stage 2 or regressed to Stage 1, while 96.1% of patients with Stage 3 remained in Stage 3 or regressed to Stage 2. Only 15.1% of patients in Stage 2 progressed to Stage 3 and 3.9% of patients in Stage 3 progressed to Stage 4 or 5. A secondary analysis comparing all 665 CDM Stage 3 participants to 117,249 historical controls found CDM participants demonstrated a higher rate of regression (20.3% vs. 15.2%; absolute difference +5.1 percentage points; p = <0.01) and a lower rate of progression (3.9% vs. 15.3%; absolute difference −11.4 percentage points; p < 0.001). Conclusions: Early findings of a multidisciplinary CDM intervention indicate that 79% of participants with CKD Stages 1–3 by eGFR had stabilized or improved CKD status. Comparison to a randomized control group to better assess for causality and longer-term CDM program follow-up on CKD status and clinical outcomes is warranted. Full article

(This article belongs to the Special Issue Exploring and Addressing Healthcare Inequalities in Marginalized Communities)

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11 pages, 1395 KB

Open AccessBrief Report

Prevalence of Multiple Chemical Sensitivity in Canada Between 2000 and 2020

by Stephanie Robins, John Molot and Rohini Peris

Int. J. Environ. Res. Public Health 2026, 23(2), 236; https://doi.org/10.3390/ijerph23020236 - 13 Feb 2026

Abstract

Multiple chemical sensitivity (MCS) describes an acquired condition characterized by recurrent, non-specific symptoms attributed to previously tolerated chemical exposure. Although Canada collects national data on MCS through population health surveys, the condition remains poorly understood and under-studied. This study analyzes data from the [...] Read more.

Multiple chemical sensitivity (MCS) describes an acquired condition characterized by recurrent, non-specific symptoms attributed to previously tolerated chemical exposure. Although Canada collects national data on MCS through population health surveys, the condition remains poorly understood and under-studied. This study analyzes data from the Canadian Community Health Survey (2000–2020) to examine trends in MCS prevalence across demographic characteristics, including province of residence, sex, and age. Descriptive analyses were used to assess temporal changes and differences between regions and population subgroups. Between 2000 and 2020, the proportion of Canadians reporting an MCS diagnosis increased from 1.9% to 3.5%. Prevalence varied geographically, with higher rates consistently observed in the Atlantic provinces compared with the Prairie provinces. MCS prevalence increased with age in both sexes; however, rates were higher among young males than females, with this pattern reversing in mid-life as prevalence became higher among females. These findings provide a national overview of MCS prevalence over two decades and offer relevant information for public health authorities, healthcare professionals, and researchers. The observed prevalence aligns with international estimates, underscoring MCS as an emerging public health concern in Canada. Full article

(This article belongs to the Special Issue Understanding Multiple Chemical Sensitivity (MCS): Interdisciplinary Insights into Science, Policy, and Lived Experience)

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14 pages, 1164 KB

Open AccessSystematic Review

Epidemiological Characteristics of Dengue Infection in Bangladesh: A Systematic Review

by Md Moustafa Kamal, Tsheten Tsheten, Rashidul Haque and Syeda Zakia Hossain

Int. J. Environ. Res. Public Health 2026, 23(2), 235; https://doi.org/10.3390/ijerph23020235 - 13 Feb 2026

Abstract

Background: Dengue infection (DI) is a mosquito-borne arboviral disease primarily transmitted by infected female Aedes mosquitoes. In Bangladesh, DI poses a substantial public health challenge with recurrent outbreaks and rising incidence rates. This systematic review assesses the epidemiological characteristics of dengue infection in [...] Read more.

Background: Dengue infection (DI) is a mosquito-borne arboviral disease primarily transmitted by infected female Aedes mosquitoes. In Bangladesh, DI poses a substantial public health challenge with recurrent outbreaks and rising incidence rates. This systematic review assesses the epidemiological characteristics of dengue infection in Bangladesh, focusing on demographic, clinical, and geographic trends. Objectives: To analyze dengue prevalence, demographic distribution, clinical symptoms, and serotype patterns in Bangladesh, with an emphasis on urban–rural disparities, gender differences, and serotype evolution. Methods: A systematic search was conducted across PubMed, Scopus, Web of Science, and Global Health (Ovid) databases, reviewing studies published from 2000 to 2024. Following PRISMA guidelines, 25 studies meeting eligibility criteria were selected. Data extraction and quality assessment were independently performed by three reviewers, ensuring methodological rigor. Results: Dengue incidence was higher in urban areas, mainly affecting males aged 20–34, with dengue virus serotype 3 (DENV-3) as the dominant serotype. Fever, headache, and joint pain were the most common symptoms, while severe cases often presented with respiratory and hemorrhagic complications. Acute symptoms like dyspnea and dehydration spread rapidly in densely populated areas. In rural areas, dengue showed a more endemic pattern, with persistent symptoms such as gastroenteritis and muscle pain. Conclusion: Dengue is now firmly endemic in Bangladesh, with clear geographic, demographic, and clinical differences. The dominance of DENV-3 and its association with more severe illness highlight the need for targeted and context specific interventions. Control efforts should prioritize vector management, public education, and continuous surveillance in urban areas, while strengthening community surveillance and primary healthcare in rural settings. Further research on rural transmission and the clinical impact of DENV-3 is essential to guide effective and tailored dengue control strategies. Full article

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16 pages, 316 KB

Open AccessCommentary

Genomic Medicine and Individual Autonomy: Reflections on Knowledge Societies and Governmentality

by Richard H. Parrish II

Int. J. Environ. Res. Public Health 2026, 23(2), 234; https://doi.org/10.3390/ijerph23020234 - 13 Feb 2026

Abstract

This paper offers a comprehensive analysis of the multifaceted implications of genomic medicine’s evolving regulatory frameworks on individual autonomy. As genomic technologies increasingly permeate healthcare and society, they fundamentally reshape the boundaries of health and disease, profoundly impacting personal identity and self-understanding. The [...] Read more.

This paper offers a comprehensive analysis of the multifaceted implications of genomic medicine’s evolving regulatory frameworks on individual autonomy. As genomic technologies increasingly permeate healthcare and society, they fundamentally reshape the boundaries of health and disease, profoundly impacting personal identity and self-understanding. The expansion of genomic surveillance and risk classification introduces new forms of scrutiny and vigilance, as individuals are redefined according to probabilistic genetic markers rather than traditional clinical symptoms. Regulatory developments facilitate compulsory interventions and challenge established notions of informed consent, as genetic risk factors in otherwise healthy individuals prompt preemptive medicalization and intervention. These changes heighten the risk of genetic discrimination and reinforce social stratifications, as access to care, insurance, and employment may become contingent upon genomic profiles. Furthermore, the commodification of genetic information raises significant concerns about privacy, ownership, and the potential misuse of personal data by commercial and governmental entities. The increasingly blurred lines between medical necessity and social control highlight constitutional and ethical dilemmas, particularly regarding the balance of public health priorities and the preservation of individual freedoms. Drawing on theoretical frameworks such as Stehr’s knowledge society and governmentality, the paper critically examines how regulatory responses both reflect and shape broader societal values, often introducing persistent uncertainty and vulnerability into the core of personal and collective identity. Ultimately, the analysis underscores the urgent need for innovative governance models that can effectively balance the promise of scientific and technological advances with the protection of personal autonomy, democratic knowledge control, and social justice in the genomic era. Lay statement: This paper explores how new rules and regulations around genetic medicine can impact people’s personal freedoms and sense of identity. It highlights concerns about privacy, discrimination, and the ways in which our understanding of health and disease is changing, calling for better protections and fairer policies as genetic technologies become more common. Full article

(This article belongs to the Special Issue The Effects of Public Policies on Health)

18 pages, 942 KB

Open AccessArticle

A Heavy Metal and Trace Element Biomonitoring Study in a Young Cohort (Aged 18–24) in Istanbul, Turkey

by Nilay Topal, Meltem Pak Demir, Aydanur Kulaç, Bulut Yurtsever, Demet Dinç and Fehime Aksungar

Int. J. Environ. Res. Public Health 2026, 23(2), 233; https://doi.org/10.3390/ijerph23020233 - 12 Feb 2026

Abstract

This study aimed to determine the exposure levels of young individuals living in Istanbul, a region in Turkey with a high population density and significant environmental pollution, by measuring the levels of heavy metals and trace elements in blood, serum, and urine. A [...] Read more.

This study aimed to determine the exposure levels of young individuals living in Istanbul, a region in Turkey with a high population density and significant environmental pollution, by measuring the levels of heavy metals and trace elements in blood, serum, and urine. A total of 95 young people aged 18–24 participated in the study. Toxic heavy metals (Pb, As, Hg, Cd, and Cr) and physiological trace elements (Cu, Zn, Se, Mo, Mn, and Co) were measured in participants’ whole blood, serum, and urine samples using the ICP-MS technique. Participants were stratified by gender, as differences in body surface area may affect the absorption and metabolism of trace elements, and by smoking status, since smoking is a recognized source of heavy metal exposure. Gender differences revealed that blood lead levels were higher in males (p < 0.05), while manganese levels were higher in females (p < 0.05). When serum samples were analyzed, males had significantly higher zinc (p < 0.05) and selenium (p < 0.05) levels compared to females, whereas females had significantly higher levels of copper (p < 0.05) and cobalt (p < 0.05). Similar differences for copper (p < 0.05) and cobalt (p < 0.05) were observed in urine samples, with higher levels found in females. Blood cadmium levels were found to be significantly higher in smokers (p < 0.05). This biomonitoring study is one of the rare studies conducted in this region to assess heavy metal exposure among young adults. Full article

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32 pages, 1893 KB

Open AccessArticle

Psychological and Mental Health Support for Vietnamese University Students in Economics Majors: Approaches and Needs Assessment

by Ngoc Bich Luu, Hà Thanh Nguyễn, Ngoc Bao Nguyen, Son Hong Dang and Hoa Quynh Nguyen

Int. J. Environ. Res. Public Health 2026, 23(2), 232; https://doi.org/10.3390/ijerph23020232 - 11 Feb 2026

Abstract

The mental health of students in university has become an increasingly pressing concern due to rising academic pressure, career uncertainty, and major life transitions. Identifying students’ psychological support needs requires an understanding of the challenges they face, as well as their expectations regarding [...] Read more.

The mental health of students in university has become an increasingly pressing concern due to rising academic pressure, career uncertainty, and major life transitions. Identifying students’ psychological support needs requires an understanding of the challenges they face, as well as their expectations regarding support forms, intervention methods, and service providers. This study employed a mixed-methods cross-sectional design, combining large-scale questionnaire surveys (701 respondents) with qualitative interviews to assess the mental health status and psychological support needs of students at economics universities in Vietnam. The findings reveal that students commonly experience negative emotional states, particularly anxiety related to academic workload, financial instability, personal health, and future career orientation. A proportion of students reported depressive symptoms such as persistent sadness, prolonged stress, and physiological disturbances including insomnia and disordered eating. While severe behavioral disorders are uncommon, signs of declining academic motivation, social withdrawal, and weakened interactions with lecturers are evident. Students express a strong demand for mental health support, especially in career guidance, learning strategies, emotional regulation, and interpersonal problem-solving. Individual, professional, confidential counseling services are the most preferred forms of support, highlighting the need for a comprehensive mental health and psychological support system tailored to the context of Vietnamese universities. Full article

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9 pages, 934 KB

Open AccessArticle

Socioeconomic and Clinical Risk Factors for Meconium-Stained Amniotic Fluid and Associated Maternal–Neonatal Morbidity in Ethiopia: A Prospective Case–Control Study

by Loris Marin, Guido Ambrosini, Elisabetta Valentini, Jordyn Conley and Alessandra Andrisani

Int. J. Environ. Res. Public Health 2026, 23(2), 231; https://doi.org/10.3390/ijerph23020231 - 11 Feb 2026

Abstract

Meconium-stained amniotic fluid (MSAF) results from premature release of meconium by the fetus under stressful conditions and is associated with increased risk of maternal and neonatal morbidity and mortality. Risk factors for stressful conditions may differ between women living in highly developed countries [...] Read more.

Meconium-stained amniotic fluid (MSAF) results from premature release of meconium by the fetus under stressful conditions and is associated with increased risk of maternal and neonatal morbidity and mortality. Risk factors for stressful conditions may differ between women living in highly developed countries and those in low-income countries. This study aimed to evaluate known and potential risk factors for MSAF and to assess the association between MSAF and maternal and neonatal morbidity. This prospective case–control study was conducted at a tertiary care hospital in Wolisso, Ethiopia. A total of 165 women were enrolled and divided into two groups: group A (65 women with MSAF) and group B (100 women with clear amniotic fluid). Data were collected through medical records (pregnancy, maternal and fetal outcomes) and questionnaires (socioeconomic factors). Women with MSAF had statistically significant differences in distance traveled, means of transportation, travel time to reach the hospital, weekly workload, and family income compared to controls. Higher rates of intrapartum monitoring abnormalities and operative deliveries were also observed among women with MSAF. The socioeconomic situation of pregnant women referred to the hospital in Wolisso appears to be related to the occurrence of MSAF. Recognizing these risk factors is crucial to improving quality of care and maternal–fetal health. Full article

(This article belongs to the Section Global Health)

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9 pages, 587 KB

Open AccessArticle

Global Disparities in Teletherapy Adoption: A Cross-Income Analysis of Mental Health Access

by Gloria Nnadwa Alhassan, Arda Ozturkcan and Seyma Caliskan Cavdar

Int. J. Environ. Res. Public Health 2026, 23(2), 230; https://doi.org/10.3390/ijerph23020230 - 11 Feb 2026

Abstract

Mental health disorders affect nearly one billion people worldwide, yet treatment gaps exceed 75% in low- and middle-income countries. Teletherapy has emerged as a scalable solution, but its adoption differs sharply by economic context. This comparative ecological policy analysis used secondary aggregate data [...] Read more.

Mental health disorders affect nearly one billion people worldwide, yet treatment gaps exceed 75% in low- and middle-income countries. Teletherapy has emerged as a scalable solution, but its adoption differs sharply by economic context. This comparative ecological policy analysis used secondary aggregate data from WHO, World Bank, ITU, and national reports to examine teletherapy adoption in low-income (Nigeria, Kenya), middle-income (South Africa, India), and high-income countries (Norway, Canada). Descriptive statistics and simple linear regression were applied, with findings interpreted through the Consolidated Framework for Implementation Research (CFIR), Technology Acceptance Model (TAM), and Diffusion of Innovations theory. High-income countries achieved widespread adoption (>70%), enabled by universal broadband, comprehensive regulation, and strong reimbursement. Middle-income countries showed moderate uptake (15–30%), constrained by rural–urban digital divides and inconsistent policies. Low-income countries reported minimal integration (<5%), limited by unreliable internet, severe workforce shortages, high data costs, and sociocultural barriers. Digital infrastructure, regulatory maturity, and mental health workforce density explained 78% of the cross-country variance in adoption rates (R² = 0.78). Equitable scale-up of teletherapy directly supports SDGs 3, 9, 10, and 17. Targeted investment and cross-income collaboration are essential to prevent digital mental health solutions from exacerbating existing inequities. Full article

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13 pages, 506 KB

Open AccessArticle

The Cascade of Care for Infectious Diseases in Newly Arrived Refugees

by Mie Fryd Nielsen, Jane Agergaard, Rebecca Vigh Margolinsky, Line Kibsgaard, Mette Holm, Anne Mette Hvass and Christian Wejse

Int. J. Environ. Res. Public Health 2026, 23(2), 229; https://doi.org/10.3390/ijerph23020229 - 11 Feb 2026

Abstract

(1) Background: Post-arrival screening for infectious diseases is routinely offered to newly arrived refugees in Denmark, including tests for hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis. This study aimed to examine the cascade of care following [...] Read more.

(1) Background: Post-arrival screening for infectious diseases is routinely offered to newly arrived refugees in Denmark, including tests for hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis. This study aimed to examine the cascade of care following positive screening results in a local cohort of refugees in Denmark, with a focus on subsequent clinical management, follow-up, and outcomes. (2) Methods: This retrospective cohort study included 1506 newly arrived refugees of all ages and countries of origin. All were offered a post-arrival infectious disease screening in Denmark. Clinical records were reviewed to assess progression through the cascade of care, including referral, evaluation, follow-up, and clinical outcomes among individuals with positive screening results. (3) Results: Of the 1506 screened refugees, 33 (2.2%) had at least one positive screening result. Among the 15 individuals with detectable hepatitis B surface antigen, six (43%) attended regular follow-up, while eight (57%) were lost during the cascade of care. Two participants screened positive for HCV antibodies; both underwent initial clinical evaluation, but their subsequent care trajectories differed due to repeated non-attendance or undocumented reasons. Only one participant with non-specific syphilis antibodies completed follow-up in accordance with national guidelines. One participant was diagnosed with HIV and successfully linked to care. (4) Conclusions: The prevalence of screened infectious diseases in this local Danish refugee cohort was low and consistent with findings from comparable settings. Although post-arrival screening facilitates the identification of infectious diseases, substantial loss to follow-up occurred after initial diagnosis, limiting the effectiveness of follow-up and treatment. These findings highlight the need for targeted, interdisciplinary strategies addressing organisational, social, and individual barriers to improve continuity of care following screening. Full article

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

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